Search

Purpose: To compare the models developed with a classical statistics method and a Machine Learning model to predict the possibility of orchiectomy using preoperative parameters in patients who were admitted with testicular torsion.Materials Method: Patients who underwent scrotal exploration due to the testicular torsion between the years 2000 and 2020 were retrospectively reviewed. Demographic data, features of admission time, and other preoperative clinical findings were recorded. Cox Regression Analysis as a classical statistics method and Random Forest as a Machine Learning algorithm was used to create a prediction model. Results: Among patients, 215 (71,6%) were performed orchidopexy and 85 (28,3%) were performed orchiectomy. The multivariate analysis revealed that monocyte count, symptom duration, and the number of previous Doppler Ultrasonography were predictive of orchiectomy. Classical Cox Regression analysis had an area under the curve (AUC) 0,937 with a sensitivity and specificity of 88% and 87%. The AUC for the Random Forest model was 0,95 with a sensitivity and specificity of 92% and 89%. Conclusion: The ML model outperformed the conventional statistical regression model in the prediction of orchiectomy.The ML methods are cheap, and their powers increase with increasing data input; we believe that their clinical use will increase over time.

Objectives: Since the introduction of laparoscopic nephrectomies, laparoscopic surgeries in the field of urology have become increasingly popular. Laparoscopic surgery has its advantages but carries the risk of complications like all interventions. In our study, we aimed to discuss our complication rates according to difficulty level by presenting our experiences with urological laparoscopic procedures for the upper urinary system. Methods: This retrospective study includes 942 laparoscopic urological procedures performed by a single surgeon. The procedures divided into three groups according to the European Scoring System (ESS) Classification. The complication rate of each group was calculated separately. Results: A total of 127 (13.4%) complications were observed. Partial nephrectomy, nephroureterectomy and ureterolithotomy had the highest complication rates. Renal cyst excision, simple nephrectomy and radical nephrectomy had the lowest complication rates. According to the Clavien Complication Classification, the distributions of Grade 1, 2 and 3 complications were 29.1% (n =37), 57.4% (n = 73) and 13.3% (n = 17); respectively. The open conversion rate was 0.84%. When procedures were classified as “easy”, “difficult” and “very difficult” according to the ESS classification; complication rates were found 7.3% in the easy group, 13.3% in the difficult group and 16.6% in the very difficult group. There was no significant difference between the three groups in terms of complication rates (p = 0.329). Conclusions: Performing easier operations according to ESS in the first years of the learning curve is beneficial in preventing complications. With increasing experience, more complicated procedures can be performed with similar complication rates.

Objective:We aimed to investigate the predictive value of duration and frequency of macroscopic haematuria for the stage, prognosis and recurrence rates in primary bladder cancer.Materials and Methods:We retrospectively reviewed the data of our patients diagnosed with primary bladder cancers during 2000-2014. Patients with history of macroscopic haematuria were included. Their haematuria duration and frequency and stage and grade of bladder cancer, recurrence rates, time until recurrence, time until progression and pre-operative use of anticoagulants were evaluated.Results:A total of 331 patients comprising 276 males (83%) and 55 females (16%) were included in the study. The mean age of the patients was 64.0±11.8 (28-93) years. The average haematuria duration was 18.5±33.5 (0-260) months. There were 173 (52%), 106 (32%) and 52 (15.7%) patients with cancer stages of Ta, T1 and T2, respectively. The average follow-up time was 54.0±41.8 (1-268) months. The frequency of haematuria was significantly higher in patients with muscle-invasive bladder cancers than in those with superficial bladder cancers (p=0.010). Similarly, patients with tumour diameter >3 cm reported significantly higher frequency of haematuria than in those with tumour diameter

To investigate the relationship between failure to insert a ureteral access sheath (UAS) with inflammation and other clinical parameters in patients treated with flexible ureteroscopy for renal stones.This study included patients who underwent flexible ureteroscopy for the treatment of renal stones in our centre between 2015 and 2020. Patients who underwent any surgical procedure on the ipsilateral ureter and had a history of spontaneous stone passage were excluded. Patients were divided into two groups based on UAS insertion success (group 1) or failure (group 2). Both groups were compared with a view to clinical characteristics, preoperative neutrophil, lymphocyte, monocyte and platelet counts and ratios of these counts, all being considered inflammatory markers. A multivariate logistic regression analysis was performed to determine the independent variables affecting UAS insertion success.There were 113 (59.1%) patients in group 1, while group 2 consisted of 78 (40.9%) patients. The rates of male gender, coronary artery disease and preoperative ipsilateral hydronephrosis were significantly higher in group 2, while platelet counts and platelet-lymphocyte ratios were significantly lower. Our analysis revealed four independent predictors for UAS insertion failure: female gender (odds ratio [OR]=2.1) increased the rate of UAS insertion success, while hydronephrosis (OR=1.6), low platelet counts and PLR increased the rate of UAS insertion failure (OR=0.99, OR=0.98, respectively).Our results suggest that male gender and ipsilateral hydronephrosis are associated with increased UAS insertion failure. Although we found a relationship between relatively low platelet levels and UAS insertion failure, we think that further studies are needed to investigate this matter.EINFüHRUNG: Untersuchung des Zusammenhangs zwischen Versagen des Vorschiebens einer Harnleiterschleuse (HLS) und entzündlichen Prozessen sowie anderen klinischen Parametern bei Patienten, die wegen Nierensteinen mit flexibler Ureteroskopie behandelt wurden.Zielgruppe dieser Studie waren Patienten, die zwischen 2015 und 2020 in unserem Zentrum durch flexible Ureterorenoskopie operiert wurden. Patienten, bei denen ein chirurgischer Eingriff in den ipsilateralen Harnleiter durchgeführt wurde und in der Vergangenheit eine spontane Steinpassage aufgetreten war, wurden ausgeschlossen. Die Patienten wurden je nach Erfolg (Gruppe 1) oder Misserfolg (Gruppe 2) des HLS-Vorschiebens in 2 Gruppen eingeteilt. Es erfolgte ein Vergleich beider Gruppen hinsichtlich klinischer Merkmale sowie präoperativer Neutrophilen-, Lymphozyten-, Monozyten- und Thrombozytenzahlen und der Verhältnisse dieser Zahlen, die alle als Entzündungsmarker angesehen wurden. Eine multivariate logistische Regressionsanalyse wurde durchgeführt, um die unabhängigen Variablen zu bestimmen, die den Erfolg des HLS-Vorschiebens beeinflussen.Gruppe 1 bestand aus 113 (59,1 %) Patienten, Gruppe 2 aus 78 (40,9 %) Patienten. Gruppe 2 wies signifikant höhere Raten von Patienten männlichen Geschlechts, koronarer Herzkrankheit und präoperativer ipsilateraler Hydronephrose auf, während die Thrombozytenzahlen und Thrombozyten-Lymphozyten-Verhältnisse in Gruppe 2 signifikant niedriger waren. Unsere Analyse ergab vier unabhängige Prädiktoren für ein Versagen des HLS-Vorschiebens: Das weibliche Geschlecht (Odds Ratio [OR] = 2,1) erhöhte die Erfolgsrate des Einführens der HLS, während Hydronephrose (OR = 1,6), niedrige Thrombozytenzahlen und PLR die Versagensrate beim Einführen der HLS erhöhten (OR = 0,99 bzw. OR = 0,98).Unsere Ergebnisse legen nahe, dass männliches Geschlecht und ipsilaterale Hydronephrose mit einem erhöhten Versagen des Einführens einer HLS verbunden sind. Obwohl wir einen Zusammenhang zwischen relativ niedrigen Thrombozytenwerten und HLS-Insertionsversagen nachweisen konnten, sind wir der Ansicht, dass weitere Studien zu diesem Thema erforderlich sind.

Two patients came to the emergency department with sudden-onset abdominal pain. The first case was a 20-year-old male; a contrast-enhanced computed tomography (CT) scan revealed a 17 cm x 7 cm hematoma in the abdomen and left retroperitoneal space. Furthermore, the left kidney was not visualized by CT. With an emergent diagnostic laparotomy, the etiology of the bleeding was determined to be left atrophic-hydronephrotic kidney rupture. Thus, a left nephrectomy was performed. The second case was a 38-year-old male with a history of chronic hypertension; a CT scan revealed a 7 cm x 6 cm left perirenal hematoma. A left nephrectomy was performed due to hemodynamic instability on the second day of follow-up. A pathology specimen revealed a 1-cm renal cell carcinoma (RCC) in the kidney. In case of hemodynamic instability, spontaneous kidney rupture requires immediate surgical intervention; its causes include atrophic-hydronephrotic kidney and RCC.

Paratesticular neoplasms exhibit different behaviours, depending on the embryological tissue of origin. Treatment modalities can depend on the differential diagnosis. The aim of this study is to present the clinical, morphological and histopathological features of patients with paratesticular masses and their follow-ups and is intended to increase awareness of the issues.We included 31 excisions of paratesticular masses, after radiological diagnosis as paratesticular mass in our hospital between 2007-2020. Information on treatment modalities, tumour recurrence, metastasis, and survival rates were obtained from hospital archives. All patients were evaluated by taking patients' history, physical examination, scrotal ultrasound, chest radiography, and serum tumour markers. Treatment modality was selected according to intraoperative findings. Haematoxylin-eosin sections were examined, and immunohistochemical analyses were performed for smooth muscle actin, desmin, Ki67, CD34, S100, and myogenin. Ten high-power fields were counted to document Ki67 and p53 nuclear positivity rates.A total of 31 operations were performed with recurrence in three patients. Histomorphological and immunohistochemical examination revealed eleven malignant masses; eight rhabdomyosarcomas, a leiomyosarcoma, a liposarcoma and a large B cell lymphoma. Other excised masses were benign and infective lesions.Paratesticular masses are heterogeneous tumours that follow different clinical courses. Clinicians must be aware of this histological diversity in order to plan a treatment pathway. This study is one of the largest published series, with a long follow-up period. It shows that the most critical features in determining prognosis are histopathological subtype and tumour grade.ZIEL: Paratestikuläre Neoplasien zeigen aufgrund der Vielfalt der embryologischen Gewebe, aus denen sie stammen, unterschiedliche Verhaltensmuster. Die Behandlungsmodalitäten können je nach Differentialdiagnose unterschiedlich sein. Ziel dieser Studie ist es, die klinischen, morphologischen und histopathologischen Merkmale von Patienten mit paratestikulären Massen und ihre Follow-ups zur Sensibilisierung darzustellen.Einunddreißig paratestikuläre Massenentfernungen, die an achtundzwanzig Patienten durchgeführt wurden, bei denen zwischen 2007 und 2020 in unserem Krankenhaus radiologisch eine paratestikuläre Masse diagnostiziert wurde, wurden eingeschlossen. Informationen zu Behandlungsmodalitäten, Tumorrezidiven, Metastasen und Überlebensraten wurden aus Krankenhausarchiven erhalten. Alle Patienten wurden anhand der Anamnese, der körperlichen Untersuchung, des Skrotalultraschalls, der Röntgenaufnahme des Brustkorbs und der Serumtumor-Marker bewertet. Die Behandlungsmethode wurde nach intraoperativen Befunden ausgewählt. Hämatoxylin-Eosin-Schnitte wurden untersucht und immunhistochemische Analysen wurden für Aktin, Desmin, Ki67, CD34, S100 und Myogenin der glatten Muskulatur durchgeführt. Zehn Hochleistungsfelder wurden gezählt, um die positiven Positivitätsraten von Ki67 und p53 zu dokumentieren.Bei 31 Patienten wurden insgesamt einunddreißig Operationen mit Rezidiv durchgeführt. Die histomorphologische und immunhistochemische Untersuchung ergab elf bösartige Massen; acht Rhabdomyosarkome, ein Leiomyosarkom, ein Liposarkom und ein großes B-Zell-Lymphom. Andere ausgeschnittene Massen waren gutartige und infektiöse Läsionen.Paratestikuläre Massen sind heterogene Tumoren, die unterschiedlichen klinischen Verläufen folgen. Ärzte müssen sich dieser histologischen Vielfalt bewusst sein, um einen Behandlungsweg planen zu können. Diese Studie ist eine der größten Reihen in der Literatur mit langer Nachbeobachtungszeit, die auch zeigt, dass die wichtigsten Merkmale bei der Bestimmung der Prognose der histopathologische Subtyp und der Tumorgrad sind.

In this study, we aimed to determine the factors predicting the duration and successof semirigid ureteroscopy performed for the treatment of ureteral stones in different localizations. MATERIALS AND METHODS: Medical records of the patients whom under went semirigid ureteroscopy for urolithiasis in our centre between January 2015 and December 2019 were retrospectively reviewed. The study group composed of 170 patients and divided into three subgroups; of which 54 in proximal ureter (31.8%), 51 in the mid (30 %) and 65 (38.2%) in the distal ureter. Predictive factors of semirigid ureteroscopy duration and success were determined by performance of correlation analysis and multivariate analysis.Overall stone-free rate was calculated as 78.8%. Success rates for proximal, mid and distal ureteral stones were 72.2% (39/54 patients), 74.5% (38/51 patients) and 87.7% (57/65 patients), respectively. Complications were present in 19 patients (11.2%). Multivariate analysis indicated that stone diameter and stone burden independently affected the stone-free rate. Statistically significant negative correlation was determined between success of the procedure and stone diameter, stone burden, impaction and more proximal stone localization. While there was a statistically significant positive correlation between duration of procedure and stone burden, diameter, impaction, historyof ipsilateral ureteroscopy and more proximal stone localization, there was negative correlation between duration of procedure and stone-free status. CONCLUSION: We conclude that stone diameter, stone burden, impaction and more proximal stone localization are common factors affecting both duration and success of semirigid ureteroscopy. In addition, stone size and stone burden were determined as independent markers of stone-free status.En este estudio determinamos los factores predictores de la duración y el éxito de la ureteroscopia semirígida realizada como tratamiento de las litiasis ureterales en diferentes localizaciones. MATERIALES Y MÉTODOS: Revisamos retrospectivamente las historias clínicas de los pacientes que han sido sometidos a una ureteroscopia semirígida por litiasis en nuestro centro entre enero 2015 y diciembre 2019. El grupo de estudio está formado por 170 pacientes y dividido en 3 subgrupos: 54 con litiasis en uréter proximal (31,8%) 51 en medio (30%) y 65 (38,2%) en el uréter distal. Los factores predictores de duración y éxito de la ureteroscopia semirígida fueron determinados con análisis de correlación y multivariante. RESULTADOS: La tasa global libre de litiasis fue de 78,8%. La tasa de éxito en uréter proximal, medio y distal fue de 72,2% (39/54 pacientes), 74,5% (38/51pacientes) y 87,7% (57/65 pacientes), respectivamente. Las complicaciones estuvieron presentes en 19 pacientes (11,2%). El análisis multivariante indicó que el diámetro de la litiasis y el volumen afectaron de forma independiente la tasa libre de litiasis. Una significación estadística negativa fue determinada entre el éxito del procedimiento y el diámetro de la litiasis, volumen, impactación y localización proximal. Una significación estadística positiva entre la duración del procedimiento y el volumen de la litiasis, diámetro, impactación, previas ureteroscopias y localización proximal. Se observó una correlación negativa entre la duración del procedimiento y el estado libre de litiasis. CONCLUSIÓN: Concluimos que el diámetro de la litiasis,volumen, impactación y localización proximal son los factores que afectan a la duración y el éxito de la ureteroscopia semirígida. Además, el tamaño de la litiasis y el volumen fueron predictores independientes de la tasa libre de litiasis.

PURPOSE This study aimed to investigate the rate of tunica defect detection by postoperative penile ultrasound (US) and the effect of tunica defect length (TDL) on functional outcomes. METHODS Forty-six patients who underwent early penile fracture surgery in our hospital between July 2010 and December 2018 were included in the study. Each diagnosis was made via history, physical examination and US. Functional outcomes were assessed at 3, 6 and 12 months postoperatively. The International Index of Erectile Function-5 (IIEF-5) score was used to assess erectile function. US detection rates for tunica defects, as well as whether the rates changed according to TDL, were also analysed. The TDL cut-off value for US detection was determined to be 11 mm using the receiver operating characteristic curve. The impact of TDL on functional outcomes was also evaluated using this cut-off value. RESULTS The main cause of fractures in 34 patients (74%) was sexual intercourse. One patient (2.2%) had penile curvature, and 16 (34.8%) had penile nodules in the follow-ups. US had a higher detection rate in the group with TDL >11mm (94% vs 25%). IIEF-5 scores at the postoperative third month were statistically lower in patients with TDL >11mm (n = 34) compared with those with ≤11 mm (n = 12). The rate of penile nodules was found to be statistically higher in the group with TDL >11mm at the end of the 1-year follow-up period (44.1% vs 8.3%). CONCLUSIONS US is a valuable tool for the detection of tunica defects especially with >11mm length. In addition, TDL >11 mm in penile fractures is associated with lower IIEF-5 scores in the early postoperative period and higher rates of penile nodules.

Percutaneous nephrolithotomy (PNL) for upper urinary tract stones is a minimally invasive, effective treatment modality. Despite its high success rates, its potential complications pose a risk. In this study, we aimed to determine the risk factors associated with bleeding which is one of PNL's most important complications.The data of patients who underwent PNL between January 2017 and December 2018 were retrospectively analyzed. The median reduction in post-operative hemoglobin levels compared to preoperative levels was found to be 1.6 g/dl, which was accepted as the threshold value. The patients with hemoglobin decrease above the threshold were assigned as Group 1, and below the threshold as Group 2. Pre-operative, perioperative data, and stone characteristics of the patients were recorded.169 patients, 85 patients in Group 1 and 84 patients in Group 2 were included in the study. The mean age of Group 1 was significantly higher (47.4±7.9 and 32±9.4 years, respectively, p=0.001) Sixteen in Group 1 (18.8%) and six in Group 2 (7, 1%) had a diagnosis of hypertension (HT) and a significant difference was found (p=0.038). The average stone burden was 2733±1121.3 mm3 in Group 1, and 2326.5±975.6 mmIn this study; advanced age, presence of HT, and high stone burden were found to be predictive of reductions in hemoglobin levels. Furthermore, a correlation of decreased hemoglobin levels was detected with operative times and occurrence of complications.

Objective: To specify the prognostic factors predicting complication rates and postoperative renal function in patients operated with partial nephrectomy. Materials and Methods: Our health center"s archive system was scanned retrospectively for the time interval between January 2006- January 2021 for patients operated with partial nephrectomy for renal mass. History, comorbidities and laboratory results, operational information, tumor morphologies in radiographic images and its specified scores (R.E.N.A.L. score, PADUA score, C-index), peroperative and postoperative complications and pathology results of 148 regularly followed-up patients were analyzed. Results: Mean age of the patients was 55.04±10.91 years, ratio of male to female was 1.27 and mean tumor size was 3.56 cm. Mean follow-up period was 55.53±42.26 months. Postoperative creatinine value in the 6th month showed an increase of 0.18 mg/dl compared to preoperative value. Estimated glomerular filtration rate (eGFR) also decreased by an average of 18.3%. Operation of grade 4 tumors significantly affected the postoperative renal function. PADUA score (p=0.023) had a significant effect on postoperative GFRs and duration of ischemia. Also, difference in pre-and postoperative GFRs and its percentage change were significantly affected by C-index (p=0.035, p=0.042). Pathological size (p=0.038), R.E.N.A.L. score (p=0.001), PADUA score (p

Summary Introduction Giggle incontinence is a type of urinary incontinence (GI) that occurs with laughing due to the urinary bladder's involuntary contraction leading to complete emptying. There are studies in the literature that biofeedback therapy or methylphenidate can be effective in the treatment of this condition. Objective This study aimed to compare the efficacies of biofeedback therapy and methylphenidate treatment in patients with GI. Study Design In this non-randomized observational study, children aged 5–18 years who were diagnosed with GI between January 2014 and December 2019 were included in the study. Patients who were treated by biofeedback were assigned to Group 1, while patients who were given methylphenidate treatment were placed in Group 2. Patients in Group 1 were treated with biofeedback, which was planned once a week for four weeks and once a month for the following two months. They continued their pelvic floor strengthening exercises at home for the following nine months. Patients in Group 2 were prescribed 5 mg oral methylphenidate qid for three months. Patients in both groups were followed up with 3-month intervals within a year. The results were classified as complete response, partial response or no response as per The International Children's Continence Society (ICCS) recommendations. Results The study population consisted of 38 patients with GI. Mean age of the patients was 7.7 (5–11). Among these patients, 31 (81.5%) were female, while 7 (18.4%) were male. Two groups were similar regarding mean patient age and gender distribution. There was no difference between the two groups regarding treatment responses evaluated during the 1st, 3rd, and 6th-month outpatient clinic encounters (p > 0.05). However, treatment responses assessed during the 12th-month outpatient clinic encounter revealed 15 (94.1%) patients with complete response in Group 1, while there were 10 (55.6%) patients who showed complete response in Group 2, with a significant difference (p = 0.03). Discussion Our study showed that treatment responses were reduced after discontinuation of methylphenidate. We achieved high complete response rates in the first, third, sixth, and twelfth-month assessments by biofeedback treatment. Conclusions Significantly more favorable treatment outcomes were achieved with biofeedback therapy than methylphenidate treatment after completion of 1-year. Multi-center, randomized studies are needed to evaluate efficacy and safety. Summery Table . : Comparison of patient numbers according to complete response to treatments. Group 1 (Biofeedback) Group 2 (Methylphenidate) P Total no of patients 17 21 Complete treatment response at; (n; %) 1. month 3. month 6. month 1. year 13 (76.5) 14 (82.4) 15 (88.2) 16 (94.1) 14 (66.7) 13 (72.2) 11 (61.1) 10 (55.6) 0.783 0.604 0.144 0.030

Objective : Acute urinary retension (AUR) is one of the most important complications in benign prostate hyperplasia (BPH) patients and its treatment is generally urethral catheterization in acute period. There are studies showing that AUR and urethral catheter placement may cause an increase in serum PSA levels. Our objective in this study was to investigate the relation between increased PSA levels and prostate cancer (PCa) incidence in the patient group after AUR and urethral catheter placement. Materials and Methods : 77 patients who had an indwelling urethral catheter due to AUR, performed prostate biopsy due to high PSA levels and then surgical treatment for clinic BPH were retrospectively examined. Age, prostate volumes, pre-biopsy total serum PSA and PSA densities were noted. Total serum PSA rates, PSA densities and prostate volumes were compared for the groups that PCa was detected (n=6) and not detected (n=71) according to biopsy or surgical specimen results. Results : Mean age of the patients was 65.2±3.9 years. Mean prostate volume was measured as 64.1±12.8 g, mean serum total PSA level as 9.2±4.2 ng/mL and mean serum PSA density as 0.15±0.08 mg/mL/g. In PSA groups with a serum total PSA level of ≤4.0, 4-10, 10-20 and >20, PCa prevalence rates were detected 0%, 4.3%, 13.4% and 20%, respectively. Total PSA levels and PSA densities were found statistically higher in PCa detected group. Conclusion : PCa incidence is low in patients who were placed urethral catheter after AUR. For these patients prostate biopsy should be performed only in chosen cases.

Introduction The question of whether sexual intercourse can harm athletic performance is a long-debated topic since first sport competitions were invented. Therefore, due to the lack of solid evidence, we aimed to evaluate the effects of sexual intercourse on muscle training performance. Materials and methods Physically and sexually active, 50 men (age=29.3±1.14 years) were enrolled in the study. Participants completed three weight training sessions and all sessions were at the same time of the day. The maximum weight was adjusted in the first session. In the second and third sessions, they performed five repetitions of the squat with their maximum weight for each set with a total of five sets after participating in and abstaining from sexual intercourse the night before, respectively. The duration of sexual intercourse was measured with a stopwatch. Results The mean duration of sex was measured to be 13.8±3.61 min. Furthermore, the mean lifted weight before sex was calculated to be 109.4±11.41 kg and the mean lifted weight after sex was calculated to be 107±11.05 kg. According to obtained data, sexual intercourse has a significant detrimental effect on maximum weight in squat training (p=0001). Conclusion Results demonstrate that sexual intercourse within 24 hours before exercise have detrimental effect on lower extremity muscle force, which suggests that restricting sexual activity before a short-term activity may be necessary.

To evaluate the prognostic factors affecting the surgical margin and recurrence in patients who underwent partial nephrectomy (PN) for renal masses.Data of 125 patients who underwent open or laparoscopic PN because of renal mass between January 2006 and January 2019 were analysed retrospectively. Demographic data, habits, additional diseases, clinical and laboratory findings, operational data, the morphology of the tumour in computerised tomography or magnetic-resonance imaging and follow-up data were scanned and acquired via our hospital's system and archive.Average age was 54.4, male-female ratio was 1.55 and average tumour size was 3.31 cm. One hundred and four patients had malignant pathology and 21 were benign. Positive surgical margin (PSM) rate was 5.6% and recurrence rate was 3.2%. Average follow-up was 47.4 months. Pathological size of the tumour was larger (P = .006), warm-ischemia period was lower (P = .003) and PADUA score was higher (P = .015) in open technique. Tumour size and tumour stage were statistically higher in patients with recurrence (P = .009, P .001, respectively). There was a significantly higher PSM ratio in mandatory indication group than elective indication group (P = .025). No statistically significant difference was observed between surgical margin positivity and tumour size, Fuhrman grades, PADUA scores, RENAL scores and C-index. (P .05).Surgical margin positivity after PN is not significantly associated with tumour characteristics and anatomical scoring systems. Surgical indication for PN has a direct influence on PSM rates. Tumour size and stage after PN are valuable parameters in evaluating the recurrence risk.

Kidney anomalies are always a challenge even for the most experienced vascular and urologic surgeons in the reconstruction of the abdominal aortic segment. In the literature, the most common anomalies of the kidney are the horseshoe kidney. The case: A 77-year-old male headed to the emergency department with complaints of acute abdominal pain and sudden onset of fatigue. The enhanced CT-scan performed and the horseshoe kidney with the ruptured aortic aneurysm seen. The cardiovascular and transplantation surgery team decided to perform explorative surgery. Keywords: Renal transplantation, Cardiovascular surgery, Team work, Horseshoe kidney, Abdominal aortic aneurysm

Renal transplantation is the optimal treatment for patients with end-stage renal disease. However, the incidence of malignancies, especially urological malignancies, increases after renal transplantation due to long-term immunosuppressive treatments. We report a case of radical cystectomy and ileal conduit diversion in a 39-year-old female patient who developed invasive bladder carcinoma with extravesical extension three years after renal transplantation. Radical cystectomy and ileal conduit diversion surgery are feasible options for patients who developed invasive bladder cancer after renal transplantation and are effective methods for the protection of renal functions in the short-term follow-up period.

46-year-old wife (donor) and 52-year-old husband (recipient) admitted to our clinic for kidney transplantation. CT angiography of the donor showed us there were bilateral renal double artery and a tortuous aorta that is deviated to the left side. The main artery cannot be reached by laparoscopy because of the upper level of renal artery and deviation of the aorta and an open conversion was performed. Presence of tortuous aorta with multiple renal arteries makes laparoscopic donor nephrectomy a challenging procedure even preformed by an experienced surgeon. The possibility of open conversion should always be kept in mind in these cases. Keywords: Donor nephrectomy, Laparoscopy, Multiple renal arteries

Sayin meslektaslarimiz ve okurlarimiz, Uriner sistem tas hastaligi eski caglardan beri bilinen ve tedavisi icin caba harcanan bir hastaliktir. Ozellikle ulkemizde sik gorulmesi nedeniyle onem arz etmektedir. Bir diger onemi ise tedavi edilmediginde bobrek yetmezlikleri ile sonuclanabilmesidir. Her yas grubunda gorulebilen bir hastalik olan tas hastaligi urologlarin gunluk mesaisinin fazlaca bir bolumunu kapsamaktadir. Teknolojideki gelismelerle tas hastaliginin tanisi ve tedavisi zamanla degismistir. Goruntuleme sistemlerine daha rahat ulasilabilmesi ile tani daha kolay konulabilmektedir. Hastalar cogunlukla acil servis ve uroloji polikliniklerine renal kolik ile basvurmaktadir. Bu ciddi agrinin acil servislerde yonetimi ve hastalarin dogru yonlendirilmeleri de onemlidir. Tedavilerde medikal ve cerrahi yontemler kullanilmaktadir. Medikal tedaviler tas olusumunu engelleyici ilaclar olabilecegi gibi olan taslarin dusurulmesi icin de kullanilabilmektedir. Onceleri daha cok acik operasyonlar uygulanirken endoskop caplarinin kuculmesi, bukulebilir endoskoplarin gelistirilmesi ve lazer teknolojilerindeki gelismeler ile minimal invaziv cerrahiler uygulanmaya baslanmistir. Bu guncel ilerlemeler ve bilgiler esliginde bu kitabin yaziminda alaninda uzman yazarlar tarafindan ilgili konular ele alinmistir. Bu kitap hazirlanirken yogun mesailerinden zaman ayirarak emek veren butun yazar arkadaslarima tesekkuru bir borc bilirim. Uriner sistem tas hastaliklari kitabinin tum okuyuculara ve meslektaslarimiza yararli olmasini dilerim.

OBJECTIVE Robotic kidney transplantation, first described by Hoznek and colleagues, and has been improved by investigators like Oberholzer and Menon. We realized the first robotic kidney transplant (RKT) in our clinic in December 2015. In this study, we aimed to present the first 15 cases we performed within 3 months. MATERIAL AND METHODS Starting from January 2016, we performed 15 RKTs in our hospital. Before surgery, the whole robotic procedure was thoroughly explained to the patients and their informed consents were taken. RESULTS We performed RKT in 7 male and 8 female patients. Mean patient age was 37.4±10.8 years. Mean body mass index of the patients was 22.6±3.35 kg/m2. Mean preoperative creatinine and hemoglobin levels were 6.14±2.12 mg/dL and 10.04±1.64 g/dL, respectively. Mean operative time was 300.3±104.2 minutes. Mean warm ischemia and re-warming times were 1.9±0.54 minutes and 73.3±30.7 minutes, respectively. We did not need any necessity to switch to open surgery, and any intraoperative complication did not develop in any patient. Lymphocele which is one of the most frequently encountered complications was not observed in our series. CONCLUSION We think that using a minimally invasive approach greater number of patients will be able to benefit from this treatment modality, and this important health issue may decrease significantly.

Amaç: Akut idrar retansiyonu (AİR) benign prostat hiperplazisi (BPH) hastalarında en önemli komplikasyonlardan biridir ve tedavisi genellikle akut dönemde üretral kateterizasyondur. AİR ve üretral kateter yerleştirilmesinin serum PSA seviyelerinde bir artışa neden olabileceğini gösteren çalışmalar vardır. Bu çalışmada amacımız, AİR sonrası üretral kateter yerleştirilen hasta grubunda artmış PSA düzeyleri ile prostat kanseri (PCa) insidansı arasındaki ilişkiyi araştırmaktır.Gereç ve Yöntemler: AUR nedeniyle kalıcı bir üretral kateteri olan 77 hastada, yüksek PSA seviyeleri nedeniyle yapılan prostat biyopsileri ve daha sonra klinik BPH için yapılan cerrahi tedaviler retrospektif olarak incelendi. Hastaların yaş, prostat hacimleri, biyopsi öncesi total serum PSA ve PSA dansiteleri kaydedildi. Biyopsi veya cerrahi örnek sonuçlarına göre total PSA oranları, PSA dansiteleri ve prostat hacimleri PCa’nın saptandığı (n = 6) ve saptanmadığı (n = 71) gruplar için karşılaştırıldı.Bulgular: Hastaların yaş ortalaması 65.2 ± 3.9 idi. Ortalama prostat hacmi 64.1 ± 12.8 g, ortalama serum total PSA seviyesi 9.2 ± 4.2 ng / mL ve ortalama serum PSA dansitesi 0.15 ± 0.08 mg / mL / g olarak ölçülmüştür. Serum total PSA düzeyi ≤4.0, 4-10, 10-20 ve >20 olan PSA gruplarında PCa prevalansı sırasıyla % 0, % 4,3, % 13,4 ve % 20 olarak tespit edildi. Toplam PSA düzeyleri ve PSA dansiteleri, PCa tespit edilen grupta istatistiksel olarak daha yüksek bulundu.Sonuç: AİR sonrası üretral kateter yerleştirilen hastalarda PCa insidansı düşüktür. Bu hastalar için prostat biyopsisi sadece seçilmiş vakalarda yapılmalıdır., Objective: Acute urinary retension (AUR) is one of the most important complications in benign prostate hyperplasia (BPH) patients and its treatment is generally urethral catheterization in acute period. There are studies showing that AUR and urethral catheter placement may cause an increase in serum PSA levels. Our objective in this study was to investigate the relation between increased PSA levels and prostate cancer (PCa) incidence in the patient group after AUR and urethral catheter placement.Materials and Methods: 77 patients who had an indwelling urethral catheter due to AUR, performed prostate biopsy due to high PSA levels and then surgical treatment for clinic BPH were retrospectively examined. Age, prostate volumes, pre-biopsy total serum PSA and PSA densities were noted. Total serum PSA rates, PSA densities and prostate volumes were compared for the groups that PCa was detected (n=6) and not detected (n=71) according to biopsy or surgical specimen results.Results: Mean age of the patients was 65.2±3.9 years. Mean prostate volume was measured as 64.1±12.8 g, mean serum total PSA level as 9.2±4.2 ng/mL and mean serum PSA density as 0.15±0.08 mg/mL/g. In PSA groups with a serum total PSA level of ≤4.0, 4-10, 10-20 and >20, PCa prevalence rates were detected 0%, 4.3%, 13.4% and 20%, respectively. Total PSA levels and PSA densities were found statistically higher in PCa detected group.Conclusion: PCa incidence is low in patients who were placed urethral catheter after AUR. For these patients prostate biopsy should be performed only in chosen cases.

Introduction: The inflatable penile prosthesis (IPP) is the last step in drug-resistant erectile dysfunction treatment. IPP implantation can be challenging, especially following a cystoprostatectomy with an orthotopic neobladder. There is no consensus about surgical techniques for placement of an IPP reservoir in such patients. In this paper, we present a case of an IPP and reservoir placement with a single penoscrotal incision. Case: A 55-year-old patient, who underwent radical cysto-prostatectomy with an orthotopic neobladder seven years ago, presented with severe erectile dysfunction. His oncologic status was stable, and he was in remission. He also had high blood pressure and took medication for it. He previously used different medical treatments, such as oral phosphodiesterase-5 inhibitors (PDE5i), intraurethral prostaglandin E2 (PGE2) installations, and Trimix injections. As far as we know, he had no benefit from these treatments. A three-piece IPP was recom- mended. After a discussion of surgical techniques, we chose the penoscrotal approach, and the ectopic reservoir was placed through the inguinal canal, guided by a forefinger. Results: The total operative time was 60 minutes, and the estimated blood loss was minimal. There were no perioperative complications. The patient was discharged on postoperative day one. He could start to use the IPP in the first month. His sexual and urinary functions were normal, and there was no abdominal bulging from the ectopic reservoir at the three-month follow-up.Conclusions: In conclusion, ectopic placement of the reservoir through a single penoscrotal incision appears to be a safe and acceptable surgical technique for postoperative ED following a radical cystoprostatectomy with an orthotopic neobladder.

Objective: Parameters predictive of biochemical or clinical recurrence after Radical Prostatectomy (RP) were determined as pre-treatment PSA value, pathologic tumor stage, tumor grade and presence of Positive Surgical Margin (PSM), extracapsular extension and seminal vesicle invasion and the status of pelvic lymph nodes. The aim of our study is to evaluate the effect of additional features in patients undergoing RP in our clinic. Materials and Methods: We studied 556 RP operations performed between 2009 and 2016 for prostate cancer at this clinic. Preoperative and postoperative data of the patients were retrospectively reviewed. RP specimens were examined by two pathologists specialized in this subject. Of these patients, 78 (14.02%) patients with PSM were included in the study. The pathology slides of these patients were reassessed. The length of PSM (mm), localization (apex, basis and posterolateral) and Gleason pattern at this margin was determined and statistical correlations with BCR were calculated. Results: The mean follow-up after the RP of 41 patients included in the study was 37.4 ± 13.2 months. During the follow-up period of the patients, BCR was observed in 16 patients (39.02%). No statistically significant difference was observed in age and prostate volume between the groups with and without BCR development (p > 0.05). Preoperative PSA level was found to be statistically significantly higher in the group with BCR development compared to the group without recurrence (p = 0.004). In-group comparisons in each aforementioned Gleason score groups were performed in terms of BCR development and the preoperative Gleason score in the group with development of recurrence was found to be statistically significantly higher compared to the group without recurrence (p = 0.007). The length of the surgical margin was measured as 7.4 ± 4.4 mm in the BCR-developing group and 4.7 ± 3.8 mm in the no-BCR- developing group; it was statistically significantly higher in the group with development of recurrence (p = 0.03). Conclusion: Length and location of the PSM and the Gleason score detected in the PSM region could not predict biochemical recurrence according to the results of this present study. However high preoperative PSA value is an independent prognostic factor for biochemical recurrence.

We evaluated the effect of antegrade and retrograde approaches on functional recovery and surgical outcomes of extraperitoneal laparoscopic radical prostatectomy (LRP). We analyzed 135 patients who underwent extraperitoneal LRP, with the retrograde technique performed on 42 (31%; Group 1) and the antegrade technique on 93 (69%; Group 2). Both groups were statistically similar with respect to age, clinical stage, preoperative prostate-specific antigen (PSA) and American Society of Anesthesiologists (ASA) scores, prostate volume, and previous surgical history. Mean operative time was significantly longer in Group 1 (244±18.3 vs. 203.3±18.4 min, p

Purpose: To compare the safety and efficacy of dapoxetine and acupuncture for the treatment of premature ejaculation (PE) with other treatment methods. Methods: One hundred twenty patients with PE in an outpatient urology clinic were randomized to receive dapoxetine 30 mg and 60 mg, acupuncture or sham acupuncture. The intravaginal ejaculatory latency time (IELT), the PE diagnostic tool (PEDT) score, and adverse events were compared. Results: There were no differences between the groups in terms of age, body mass index, baseline IELT and PEDT scores (p > 0.05). After 4 weeks, IELT was significantly longer compared to baseline values in all groups (p < 0.001 for all comparisons). Comparisons between the groups showed that changes in IELT and PEDT observed after 4 weeks with dapoxetine 60 mg was significantly higher than those achieved in all other groups (p < 0.001 for all comparisons), changes observed with dapoxetine 30 mg was significantly higher than those achieved with acupuncture and sham acupuncture groups (p < 0.001 for both comparisons) and changes observed with acupuncture was significantly higher than those observed with sham acupuncture (p < 0.001). Conclusion: Our results confirm previous reports on the efficacy and safety of dapoxetine. Although less effective than dapoxetine, acupuncture had a significant ejaculation-delaying effect.

The Sweet's syndrome is a rare dermatosis which can be related to underlying malignancies. In this case we presented a case, who applied to our clinic with severe dermatosis and hematuria. We diagnosed high grade non-muscle invasive bladder tumor, which was treated with transurethral resection of bladder-tumor and six cycle of Bacillus Calmette-Guérin therapy. After the treatment the dermatosis was regressed almost completely. However, recurrent bladder tumor was detected at the first control cystoscopy.

INTRODUCTION AND OBJECTIVE:Staging in high risk prostate cancer patients (Gleason score >7, PSA >20 ng/mL, clinical stage T2c – 3a) with 68Ga-PSMA PET/CT is useful for detecting metastatic disease ...

To compare the outcomes of the first 40 patients to undergo robot-assisted kidney transplantation (RAKT) with those of the first 40 patients who underwent open KT (OKT) by a single surgeon at the Dr Sadi Konuk Training Hospital.We prospectively collected the data of the first 40 patients to undergo RAKT between January 2016 and February 2017 (RAKT group), and compared them with the first 40 patients to undergo OKT between November 2010 and April 2015 (OKT group). Comparisons were made using one-way analysis of variance or the Kruskal-Wallis test for continuous variables, and the chi-squared or Fisher's exact test for categorical variables.There were 40 patients in both the RAKT and OKT groups. In the RAKT group, the mean (SD) operative time was 265.375 (46.63) min, total ischaemia time was 96.7 (30.02) min, re-warming time was 54.70 (17.80) min, and estimated blood loss (EBL) was 182.25 (55.26) mL. Whilst in the OKT group the mean (SD) operative time was 250.25 (41) min (P = 0.129), total ischaemia time was 71.79 (8.55) min (P0.01), re-warming time was 37.30 (4.07) min (P0.001), and EBL was 210.75 (28.96) mL (P = 0.005). At 12-24 h postoperatively, linear visual analogue scale pain scores were significantly lower in the RAKT group (P0.001), and the RAKT group had a significantly shorter drain withdrawal time, at a mean (SD) of 3.45 (0.93) vs 7.67 (2.11) days in the OKT group (P0.001).Satisfactory functional outcomes can be achieved by either OKT or RAKT. However, the latter technique seems to have some advantages over the former in that it is less invasive, results in less pain postoperatively, has a shorter drain withdrawal time, and has the potential for fewer complications.

Insertion of foreign bodies into the genitourinary system is a pathological action believed to increase sexual gratification usually for psychiatric patients and mentally retarded cases especially during masturbation. In this report, we represented a male case who is inserted a 195 cm cannula by himself into the bladder through the urethra because of his psychiatric disorder.

Background and objectives Robot-assisted laparoscopic radical prostatectomy (RALRP) is said to provide excellent long-term continence. In this study, we compared the early incontinence outcomes of our patients, who had undergone no reconstruction, posterior reconstruction only, or total anatomic restoration and posterior reconstruction. Methods We retrospectively analyzed the patients who underwent RALRP for localized prostate cancer by a single surgeon in our clinic from January 1, 2009-February 1, 2016. Continence was defined as no leakage or use of a safety pad for minimal leakage. The main outcome measure was continence at postoperative week 1 and months 1, 6, and 12. Results Between 2009 and 2016, 239 patients underwent RALRP for localized prostate disease. Seventy-four patients underwent a standard approach (group 1), 88 had posterior reconstruction (group 2), and 77 had posterior reconstruction with total anatomic restoration (group 3). After 1 week, 24.3% of the patients in group 1 (18/74), 31.8% in group 2 (28/88), and 45.8% in group 3 (33/72) were continent (P = .02). One month after the surgery, continence rates for groups 1, 2, and 3 were 56.7, 67, and 75%, respectively (0.065). After 6 and 12 months, continence rates for groups 1, 2, and 3 were 72.9 and 87.8%, 81.8 and 89.7%, and 84.7 and 91.6%, respectively (P = .178 and .7484). Conclusion Anatomic restoration improves continence rates in the early period after RALRP. Even though other parameters were higher in the total restoration group, immediate continence (at 1 week) was significantly better.

Objective: To evaluate a single surgeon oncological and functional outcomes of laparoscopic partial nephrectomy (LPN) compared to robotic partial nephrectomy (RPN) for pT1a renal tumours. Materials and methods: Between 2006 and 2016, a retrospective review of 42 patients who underwent LPN (n = 20) or RPN (n = 22) by same surgeon was performed. Patients were matched for gender, age, body mass index (BMI), American Society of Anaesthesiologists (ASA) score, tumour side, RENAL and PADUA scores, peri-operative and post-operative outcomes. Results: There was no significant differences between the two groups with respect to patient gender, age, BMI, ASA score, tumours side, RENAL and PADUA scores. Mean operative time for RPN was 176 vs. 227 minutes for LPN (p = 0.001). Warm ischemia time was similar in both groups (p = 0.58). Estimated blood loss (EBL) was higher in the LPN. There was no significant difference with preoperative and postoperative creatinine and percent change in eGFR levels. Only one case in LPN had positive surgical margin. Conclusions: RPN is a developing procedure, and technically feasible and safe for small-size renal tumours. Moreover RPN is a comparable and alternative operation to LPN, providing equivalent oncological and functional outcomes, as well as saving more healthy marginal tissue and easier and faster suturing.