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Objective: The aim of the study was to evaluate the possible effects of calyceal choice for renal puncture under sonographic guidance on the outcomes of percutaneous nephrolithotomy (PNL). Materials and Methods: A total of 70 patients for whom ultrasound-guided PNL was planned for 20–30-mm single renal pelvic stones were prospectively allocated to group 1 (n:35) with middle calyx entry or group 2 (n:35) with lower calyx entry. Procedure-related parameters such as duration of operation, stone-free rates, complication rates, and radiation exposure time were analyzed in detail. Results: The mean age of the patients was 45.67 ± 1.50 years and the mean stone size was 316.4 ± 17.95 mm2. There was no significant difference regarding the age, BMI, stone burden, and the grade of hydronephrosis between the groups. Skin to collecting system distance was significantly shorter in the middle calyx entrance (p = 0.021). Total duration of the procedure was again significantly shorter in group 1 cases (74.69 ± 2.94 min) than in group 2 (84.29 ± 4.25 min) (p = 0.003). Regarding the success rates, the postoperative stone-free rate was higher in group 1 (91.4% in group 1, 80.0% in group 2, p = 0.305). Last, there was no statistically significant difference in hemoglobin reduction rates, blood transfusion requirements, and complication rates between the 2 groups. Conclusion: Getting access to the renal pelvis through the middle calyx during ultrasonic guided PNL procedure is more advantageous to lower the calyceal approach by reducing both the duration of the PNL procedure with significantly higher stone-free and comparable complication rates.

Objective To investigate the effects of flexible ureteroscopy (F-URS) on the operated side of a kidney by assessing the renal damage markers, urine neutrophil gelatinase-related lipocalin (NGAL) and serum cystatin-C (Cys-C), and overall kidney function with the measurements of standard serum creatinine and urine albumin and protein levels. Material and methods A total of 30 patients who underwent F-URS for treatment of upper urinary stone disease were prospectively evaluated. Preoperative serum urea, creatinine, and Cys-C levels were noted. Levels of urine albumin, protein, creatinine, and NGAL in spot urine samples from the operated side of a kidney obtained through the access sheath preoperatively and through the ureteral catheter 1 and 24 hours postoperatively were also measured. Preoperative and postoperative parameter levels were statistically compared. Results The patients' mean age was 46.6±15.9 years. The mean operative and fluoroscopy times were 90.67±32.5 and 3.15±1.43 minutes, respectively. The urine creatinine, albumin, protein, albumin/creatinine, and protein/creatinine levels were similar in preoperative and postoperative periods. Postoperative serum urea, creatinine, and Cys-C levels and urine NGAL and NGAL/creatinine levels were not also found with remarkable changes from the baseline levels. Conclusion F-URS is a safe therapeutic intervention in the treatment of urolithiasis, especially regarding renal damage, and functional outcomes.

BACKGROUND: Radical cystectomy (RC) is one of the most complex surgeries and has a high rate of morbidity. Gastrointestinal complications are the most common type of complications. To reduce these complications some modifications have been described. OBJECTIVE: To evaluate perioperative outcomes of our extraperitoneal antegrade RC technique (EARTC), where the peritoneum is opened at the end of cystectomy just before of ileal reconstruction. METHODS: Group 1 included 120 patients who were operated with a standard RC technique and Group 2 included 80 patients who were operated with the EARC technique in this study. Groups were compared according to preoperative variables including patient characteristics, perioperative parameters, pathologic data, and postoperative overall and gastrointestinal complications. RESULTS: There were no significant differences between the two groups in terms of preoperative characteristics and mean operative time. The group 1 has longer time for the exposure of abdominal cavity to the atmosphere (p

Objective:Since microscopic hematuria and pyuria can be observed in patients with a ureteral double-J (DJ) stent in place, urinalysis findings are not considered significant in terms of predicting stent-related infections. This study evaluates the presence of bacterial colonization and the value/ effectiveness of urine tests in predicting the results of DJ stent cultures.Materials and Methods:In the present prospective study, we analyzed data from patients who were treated with a DJ stent placement following endourological surgery due to ureteral stones. DJ stents were removed only after the urine cultures appeared sterile or after a period of empiric antibiotic use. The relationship between urinalysis results and stent cultures was assessed.Results:A total of 65 patients (mean age, 42.6±13.5 years; 16 females and 43 males) were evaluated. Bacterial colonization was detected in 12 (18%) DJ stent cultures with Enterococcus faecalis (n=4), extended-spectrum beta-lactamase producer (ESBL (+) Escherichia coli (n=4), Corynebacterium urealyticum (n=2), candida (n=1) and methicillin-resistant Staphylococcus aureus (n=1) growth being reported. The antibiogram results of the patients that showed colonization in their cultures demonstrated penicillin (n=4), ampicillin (n=4), tetracycline (n=3), imipenem (n=2), and linezolid (n=1) sensitivity. The rate of leukocyte esterase- and nitrite-positive patients, of those having significant number of leukocytes, and urine culturepositive patients in the groups with and without positive urine culture was 58.5%, 32%, 49%, and 7.5% vs 50%, 16.6%, 50%, and 8.5%, respectively. There were no statistically significant differences between the groups (p=>0.05). None of the study patients applied to our hospital with active infection following DJ stent removal.Conclusion:Urinalysis is insufficient in predicting catheter culture results. Based on the results of this study, we assume that stent culture for removed DJ stents is not a necessity; empirical antibiotic therapy with ampicillin-tetracycline should be started in patients with postoperative infection.

Background To evaluate the outcome of endoscopic treatment for symptomatic vesicoureteral refux (VUR) disease in renal transplantation patients and to determine the factors that were associated with the success rate of the treatment. Methods A total of 121 symptomatic VUR diseases diagnosed between 2014 and 2018 in 3560 renal transplant patients. The results of 49 VUR cases that presented with febrile urinary tract infection (UTI) and were hospitalized for antibiotic treatment were included in the study. Refux was detected by voiding cystourethrogram and treatment was performed by endoscopic Defux® injection. The result of endoscopic treatment was evaluated clinically by 3 months periods. Results The mean time between transplantation and endoscopic treatment was 59.6 (5–132) months, and the mean followup period after the endoscopic treatment was 14 (6–48) months, respectively. The success rate after the frst injection was 59.1% (n=29) and 67.3% (n=33) after the second injection. One patient developed anuria, one patient febrile UTI and four patients developed minimal macroscopic hematuria after the procedure. Conclusions Endoscopic treatment of symptomatic VUR in transplanted kidney is a safe and feasible procedure. The amount of bulking agent or duration between the transplantation and diagnosis of VUR does not have any impact on the success of the treatment. However, the younger age of the patients and the female gender seem to have a positive efect on the outcome of the procedure.

Sevinc, Cuneyd ( isu author) Karadeniz, Tahir ( isu author) The aim of the study was to determine different variables that may be predictive for prolonged lymporrhoea and duration of lymphatic drainage. Two hundred and three patients who underwent radical cystectomy (RC) and pelvic lymph node dissection (PLND) were enrolled in this study. Lymphorrhoea was defined as the total amount of lymph drained by the drains until their removal. Duration of drainage was defined as the days until the removal of the last drains. Parameters that might be related to lymphorrhoea and duration of drainage including age, body mass index (BMI), removed lymph nodes, hemoglobin level (gr/dl), estimated blood loss (ml) (EBL), platelet count (PLN), hospital stay (HS) and lymph node status were reviewed retrospectively. Statistical analyses were performed to determine the association between lymphorrhoea with probable predictors for these variables. The mean number of removed lymph nodes was 28.52 (16-58). The mean amount of lymphorrhoea and the duration of drainage were 1504 ml (300-5850) and 10.10 days (2-27), respectively. Multivariate analyses revealed that the mean amount of lymphorrhoea rises gradually as EBL, patients age, negative lymph nodes and lymphadenectomy extension increases (P

Introduction and objectives: To evaluate the possible effects of two different renal puncture techniques (ultrasound-assisted [US-assisted], fluoroscopic-guided [FG]) on the intraoperative hemorrhage risk during percutaneous nephrolithotomy (PCNL). Material and methods: A total of 130 patients with Guy stone scores of 1-2 were prospectively allocated to US-assisted and FG puncture groups by simple randomization. Patients with intraoperative pelvicalyceal rupture and the ones requiring multiple accesses were excluded from the study. Apart from the puncture steps, all other steps of the PCNL procedure were performed with similar techniques by a single surgeon. Patient characteristics, operative data, and postoperative outcomes were compared. Results: A total of 10 patients were excluded from the study due to intraoperative complications after puncture. Patient demographics and stone characteristics were similar between the two groups (p > 0.05). Mean hemoglobin drop was meaningfully greater in the FG group (1.7 g/dL) when compared with US-assisted group (1.3 g/dL) (p < 0.01). The mean duration of radiation exposure was significantly higher for the FG (p < 0.001). Total operative time, number of attempts for a successful puncture, length of hospital stay, and stone free rates were similar between the groups (p > 0.05). In addition, the remaining complications classified according to the modified Clavien-Dindo grading system were similar between groups (p > 0.05). Conclusion: US-assisted puncture provides significantly decreased level of hemoglobin drop and radiation exposure time when compared with FG. (c) 2021 AEU. Published by Elsevier Espana, S.L.U. All rights reserved.

Introduction: To avoid mesh-related complications, autologous transobturator-tape (a-TOT) technique is a viable option in stress urinary incontinence (SUI) surgery. The method differs from TOT and retropubic tape (RT) in the usage of autologous tissue. We hypothesized that a-TOT improves female sexual dysfunction (FSD) more than TOT and RT. Methods: This is a retrospective cohort study. Patients who underwent a-TOT, TOT, and RT surgeries were surveyed regarding the cure of SUI, complications, and FSD parameters. The groups were compared according to baseline and postoperative data. Results: A-TOT, TOT, and RT groups included 37, 69, and 36 patients, respectively. The median follow-up time was 19 months. The groups were similar in terms of preoperative characteristics. The objective cure, subjective cure, and overall complication rates were comparable among the groups (p > 0.05). A-TOT group had significant improvements in mean female sexual function index (FSFI) scores, TOT group deteriorated, and RT group remained stable (p = 0.001, p = 0.001, and p = 0.226, respectively). The postoperative mean total FSFI scores were 25.73 ± 2.46, 23.17 ± 3.35, and 21.53 ± 2.47 for the a-TOT, TOT, and RT groups, respectively. The a-TOT group had better results than the TOT and RT groups (p < 0.05 and p < 0.05), and besides, the difference between the TOT and RT groups was statistically significant (p < 0.05). According to percentage changes in domain scores following the operations, the a-TOT group had significantly better results in desire, arousal, lubrication, satisfaction, and pain domains than the TOT group (p < 0.05) as well as better desire, arousal, and pain domains (p < 0.05) than the RT group. Discussion/Conclusions: Besides comparable outcomes in SUI treatment, the a-TOT technique provides improvements in female sexual functions while TOT worsens and RT does not change. Favorable outcomes in sexual functions caused by improvements in desire, arousal, satisfaction, and pain domains are observed following the a-TOT technique.

We read the article entitled ''Retrograde Intrarenal Surgery vs. Percutaneous Nephrolithotomy vs. Extracorporeal Shock Wave Lithotripsy for Lower Pole Renal Stones 10-20 mm: A Meta-analysis and Systematic Review'' published in Urology Journal (1). The topic is still hot in urology regarding lower pole kidney stones in 10-20 mm diameters. Although extracorporeal shock wave lithotripsy (ESWL), retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) are the available options for the patients with lower pole renal stones 10-20 mm diameter, the decision making among the methods is still controversy. This manuscript is valuable in this regard. At the present manuscript, the authors prepared a very comprehensive meta-analysis of existing evidence to quantify and compare the safety and efficacy of PCNL, RIRS and ESWL for lower pole renal stones 10-20mm. They emphasized the longer operative time of PCNL and RIRS compared to ESWL. They also reported a higher stone-free rate, the lower retreatment rate and auxiliary procedure following PCNL with the longest hospital stay for PCNL. When it comes to ESWL, the lowest SFR, the higher retreatment rate and auxiliary procedure rate, but a shorter operative time and the shortest hospital stay was reported. The authors indicated stone to skin distance (SSD) as an unfavourable factor for ESWL. This issue is also reported in current literature. SSD was calculated by measuring the distance from the stone to the skin in three angles (0°, 45° and 90°) and the cut-off value for SWL failure was reported in a wide-scale from 100 mm to 119 mm(2,3). At the present study, the authors presented 10 mm as a predictive value for the criteria of SWL failure. This statement seems to be not correct totally also 10 mm is an impossible value for SSD. In our opinion, it was caused by a misspelling, and a correction may be informative for the readers.

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.

Background This study aimed to evaluate the possible effect of anterior calyceal stones on the surgical outcomes of percutaneous nephrolithotomy. Methods Consecutive patients with complex kidney stones from 2012 to 2020 were evaluated retrospectively. In total, 219 patients were divided into 2 groups based on the presence of anterior calyceal stones (group 1; n=89) or not (group 2; n=130). The groups were compared in terms of surgical outcomes (i.e., stonefree rate [SFR], operation time, and hemoglobin drop) and complications. Results The patient demographics and stone characteristics were similar between the groups. Multiple access was more frequently done in group 1 than it was in group 2 (47.2% vs. 30.8%; p = 0.014), and the SFR was lower in group 1 (51.7%) than it was in group 2 (67.7%; p = 0.017). Of the anterior calyceal stones in group 1, 42.6% could not be cleaned. However, when excluding patients who have only anterior residual stones from the statistical analysis, the groups had similar SFRs (68.5% vs. 67.7% for group 1 and group 2, respectively). Conclusions The presence of complex kidney stones with anterior calyceal extension are associated with higher residual stones rates in the anterior calyx. Also, it increases multiple access, the operation time, and level of hemoglobin drop.

This study compared the safety and efficacy of the on-demand (OD) use of sertraline (50 mg), sertraline (100 mg) and dapoxetine (30 mg), and the daily use of sertraline (50 mg) in the treatment of patients with premature ejaculation (PE). This prospective randomised study involved 120 lifelong PE patients (intravaginal ejaculatory latency time [IELT]

Introduction: The aim of this study was to compare the safety of ultrasonography-guided (UG) puncture and fluoroscopy-guided (FG) upper pole access (UPA) in percutaneous nephrolithotomy (PCNL). Methods: Consecutive patients with a solitary UPA were enrolled into the study from 2012 to 2020 and analyzed in a retrospective manner. In total, 177 patients were divided into 2 groups according to the method during the puncture phase of the access: FG (n = 105) and UG (n = 72). The UG and FG groups were compared in terms of complications (i.e., pleural injury and blood transfusion rate) and surgical outcomes. Results: Gender, side, grade of hydronephrosis, type of access (i.e., supracostal vs. subcostal), Guy’s stone score, age, stone diameter, skin-to-stone distance, and stone density were similar in the 2 groups (p > 0.05). Only in 25.9% of cases, UPA was done using a subcostal approach. The overall complication rates were similar between the groups (p > 0.178). For the UG and FG groups, the rate of pleural injury (8.5 vs. 4.1%) and the blood transfusion rate (8.5 vs. 2.8%) were also similar (p > 0.05). The fluoroscopy time and mean hemoglobin drop were significantly lower in the UG group than in the FG group (134.2 vs. 82.2 s, respectively, p = 0.001; 20.8 ± 9.8 vs. 16.8 ± 7.9 g/L, respectively, p = 0.001). Stone-free rate (SFR) was also similar in the FG and UG groups (77.1 vs. 75.0%, respectively, p = 0.742). Conclusion: While it is commonly expected that the complication rates are lower in UG puncture for UPA in PCNL than they are in FG puncture, the present study failed to show this difference. However, the radiation exposure time seemed to be lower in UG puncture than FG puncture and had a similar stone-free rate (SFR) for UPA in PCNL.

Objectives: T1 bladder cancer has a wide range of tumor behavior and lamina propria invasion depth has a high potential risk of disease progression. To evaluate the patient outcome according to the tumor invasion to the muscularis mucosae-vascular plexus (MM-VP) in pT1 bladder urothelial carcinoma (BUC). Materials and methods: This study is a retrospective analysis of patients consecutively recorded from 2007 to 2013. A total of 93 patients with a history of primary pT1 BUC and complete follow-up were included. We used a pathological substaging system according to the tumor invasion regarding the MM-VP: pT1a (invasion above MM-VP) and pT1b (MM-VP invasion). We evaluated recurrence-free survival (RFS), progression- free survival (PFS), disease-specific-survival (DSS) based on this sub-staging system. Results: Pathological evaluation regarding the MM-VP invasion revealed 53 patients (57%) as pT1a BUC and 40 patients (43%) as pT1b BUC. The mean follow-up was 78.8 months. During the follow-up period; 60 patients (64.5%) had tumor recurrences, 32 patients (34.4%) had progression to invasive disease, 18 patients (19.4 %) died during follow-up related to the BUC. In 29 (54.7%) of pT1a and in 31(77.5%) of pT1b tumors, the recurrent disease was recorded during the followup period (p = 0.023). DSS rates at 5 years for pT1a and pT1b were 80.2% and 60.8%, respectively. PFS, RFS, and DSS rates were similar for pT1a/pT1b and did not reach statistical significance (p > 0.05). Conclusions: Sub-staging of pT1 BUC according to the MM-VP invasion showed a limited impact on the outcome in our patient cohort. However, the presence of pT1b disease caused a significantly higher rate of recurrence.

Introduction: Approximately 2% of the complications occur during initial abdominal entry, and half of them are major complications.1 Although >25 different techniques have been defined, there has b...

To evaluate the possible role of ureteral wall thickness (UWT) assessment in the prediction of the success for stent placement in cases with obstructing ureteric stones. 227 adult patients with a single unilateral obstructing ureteral stone requiring internal ureteral stent placement were included. In addition to stone size, the ureteric wall thickness at the impacted stone site and the degree of hydronephrosis were also assigned on CT images. Patients were divided into two subgroups: Group 1: patients in whom internal ureteral stent could not be passed beyond the stone and Group 2: patients in whom an internal ureteral stent was passed successfully. The possible relationship between the UWT values and the success of stent placement, degree of hydronephrosis were comparatively evaluated. The majority of the stones were located in the proximal ureter in Group 1 and the degree of hydronephrosis was also higher in these cases. Moreover, while the mean value of UWT calculated on CT images was 4.3 ± 0.9 mm in Group 1, this value was noted to be 2.5 ± 0.8 mm in cases of group 2. A cutoff UWT value of 3.35 mm was highly predictive for the stent insertion and cases with higher values required additional procedures or percutaneous nephrostomy tube placement. UWT value calculated at the obstructing stone site was found to be predictive enough for the likelihood of internal ureteral stent passage with high sensitivity and specificity. This evaluation may enable the urologist to make the best decision for urinary diversion in such cases.

Objective: To evaluate the clinical risk factors contributing to the development of extended spectrum beta-lactamase (ESBL)- producing asymptomatic bacteriuria in myelodysplastic children performing clean intermittent catheterization (CIC). Materials and Methods: The clinical risk factors for ESBL-producing bacteriuria were retrospectively investigated in 60 myelodysplastic children who had asymptomatic bacteriuria and were performing CIC. A total of 60 children were included in this study, 30 children (17 females, 13 males) with ESBL-positive bacteriuria in urine culture were identified as the study group and 30 age- and gender-matched ESBL-negative children (16 females, 14 males) served as controls. All children had neurogenic bladder due to myelodysplasia and had been used anticholinergics. The two groups were compared in terms of age, gender, presence of constipation and motor deficit, antibiotic prophylaxis, number of hospital admission, ultrasound findings, and presence of renal scarring in dimercapto succinic acid scintigraphy and urodynamic findings. Results: The mean age of the children was 77 +/- 50 months in study and 78 +/- 69 months in control groups. There was no statistically significant difference in terms of maximum bladder capacity, leak point pressure, constipation status and scarring. In study and control groups, 83\% and 46\% of children were on antimicrobial prophylaxis, respectively (p=0.007). Conclusion: ESBL-producing bacteriuria was found to be associated with long-term antibiotic prophylaxis. Thus, it was concluded that the use of antibiotics for asymptomatic bacteriuria should be kept to a minimum.

Objectives: The aim of this study is to evaluate prediction of postoperative ureteral obstruction needing ureteral stent insertion by evaluating the resistive index (RI) values and the grade of hydronephrosis. Material and Methods: A total of 66 adult patients undergoing stentless endoscopic ureteral stone treatment (URS) between January 2018 and January 2019 were included in this prospective study. Preoperative patient and stone characteristics were noted. All patients were evaluated with renal Doppler ultrasonography study to assess degree of hydronephrosis and RI values. A renal Doppler ultrasonography was repeated at postoperative 1st, 3rd and 7th days. Changes in both RI and hydronephrosis levels before and after the procedures were noted. On the postoperative 7th day, patients were divided into two groups including obstructive and non-obstructive cases according to RI values assessed where a RI value of 0.7 was accepted as the cut-off for obstruction. The preoperative and perioperative characteristics of both groups were evaluated in a comparative manner. Results: The mean patient age was 43.6 ± 1.72 years. Significant improvements were noted in RI and grade of hydronephrosis after the operation. The grade of hydronephrosis and RI values were found to improve more significantly on postoperative 3rd day when compared to the postoperative 7th day (p < 0.01 and p < 0.01). A significant correlation was detected between the grade of hydronephrosis (>grade 2) and obstructive RI values (> 0.7) in each postoperative visits (p: 0.001). RI values (> 0.7) at postoperative seventh days were correlated with larger mean stone size, increased ureteral wall thickness, increased diameter of the ureter proximal to the stone, and longer duration of the operation. Preoperative high-grade hydronephrosis indicated obstructive RI values at postoperative seventh day (p = 0.001) Conclusion: Changes in RI values on Doppler sonography and the grade of hydronephrosis may be a guiding parameter in assessing postoperative ureteral obstruction.

Benign prostatic enlargement (BPE) is a disease that testosterone plays a role in its aetiology. Second to fourth finger ratio is a marker of prenatal androgenic exposure and may be a risk factor for several androgen-related diseases such as BPE. In this study, we investigated the relationship between the second to fourth finger ratio and BPE. A total of 63 patients with BPE were included for study group, and age-matched 63 healthy patients were included as a control group. Finger was measured by the distance from the proximal crease to the tip by using a digital caliper. The mean age of patients with BPE and non-BPE was 62 ± 8.9 and 61.5 ± 7.1 years respectively. There was statistically significant difference between groups in terms of prostate-specific antigen levels, prostate volumes and international prostate symptom scores. The mean finger ratios for right and left hand were 0.97 ± 0.03, 0.99 ± 0.03(p = .001) and 0.93 ± 0.15, 0.98 ± 0.03(p

Objective To compare modified autologous transobturator-tape (a-TOT) and transobtrator-tape (TOT) surgeries in terms of effectivity and complications. Materials and Methods Prospectively 117 patients (a-TOT:36,TOT:81) were enrolled in this study. A-TOT was performed with autologous fascia elongated with nonabsorbable sutures and TOT was performed with standard technique. Preoperative data regarding operative time, complications and postoperative visual analog scores (VAS) were noted. Patients were assessed 12 months after surgery. Objective cure was evaluated with cough stress test (CST) and necessity of reoperation due to failure while subjective cure was evaluated with Patient Global Impression of Improvements scale(PGI-I) and the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms(ICIQ-FLUTS) questionnaire. Results The mean follow-up time was 21.5 ± 1.1 months. Preoperative demographic characteristics were similar. The mean operation time was longer in a-TOT group(P = .001).VAS at postoperative 8. and 24. hours and overall complication rates were similar for the groups. Clavien grade-3 complications occurred only in TOT group (3.7%). Objective cure rates according to CST were 97.3% and 97.6% (P = .998) and the subjective cure rates according to PGI-I were 97.3% and 92.5% (P = .664) for a-TOT and TOT groups, respectively. One patient in TOT group needed reoperation. The a-TOT group gained better improvements in total score and total QoL score of ICIQ-FLUTS (P = .028 and P = .032, respectively) as well as subscore and QoL subscore of filling and voiding sections of ICIQ-FLUTS (P = .043, P = .048,P = .034, and P = .039, respectively). Conclusion The a-TOT technique has similar objective and subjective cure rates and overall complication rates furthermore better results in postoperative voiding dysfunction and de-novo filling phase symptoms when compared to TOT.

The microsurgical varicocelectomy is the gold standard treatment with a low recurrence rate and less postoperative complications. We compared the surgical outcomes and difficulty in intra-operative vascular Doppler ultrasound-assisted microscopic varicocelectomy (IVDU-MV) with MV in primary and recurrent varicocele. A total of 228 infertile patients with clinically palpable varicocele were included in the study. One hundred fifteen patients were operated on with the standard MV approach, whereas the other 113 patients were operated on with IVDU-MV. Perioperative outcomes, sperm parameters and operative difficulty of the procedure were evaluated. The operative times were significantly shorter for the IVDU-MV group for primary and recurrent varicocele (p = .001). Mean number of veins ligated for primary and recurrent varicocele was significantly higher in the IVDU-MV group than in the MV group (6 +/- 1.4 vs. 4.8 +/- 1.8 and 3.7 +/- 0.9 vs. 2.9 +/- 1.2; p < .01). The increase in mean sperm motility was significantly higher in the IVDU-MV group for both primary and recurrent varicocelectomy patients (p < .05). A significant number of IVDU-MV procedures were described as easy in both primary and recurrent varicocelectomy procedures (p = .006). The use of Doppler ultrasound(US) revealed advantages in ligating veins, preserving arteries and improving sperm motility and facilitates the operation for the surgeon, especially during recurrent varicocele repair. WOS:000530729800001 32379354 Q3

A review of the literature indicated that sirtuin-1 expression, a regulator of nitric oxide bioavailability in erectile dysfunction (ED) after melatonin therapy, has not yet been investigated. The objective of this study was to evaluate the protective effects of melatonin for erectile function with sirtuin-1 protein expression in type 1 diabetic rat models. Fifty male Sprague Dawley rats were placed into five groups. Except for those in the control group (C), each animal received a single dose (60 mg/kg) of streptozotocin to induce diabetes. The animals were placed into the diabetes (D) group, insulin (I) group (6 U/kg/day), melatonin (Mel) group (10 mg kg(-1) day(-1)) and combined treatment (I + Mel) group. Ten weeks later, the serum testosterone levels, intracavernosal pressure (ICP), mean arterial pressure (MAP), malondialdehyde (MDA), cyclic guanosine monophosphate (c-GMP), 8-hydroxydeoxyguanosine (8-OHdG), nitric oxide synthase (NOS), caspase-3 activity, sirtuin-1 and endothelial nitric oxide synthase (eNOS) protein expression and histological findings were assessed. The mean ICP/MAP ratio for the D group was lower than the mean ratios for the other groups. The treatment groups, particularly the I + Mel group, exhibited lower 8-OHdG and MDA levels and caspase-3 activity than the D group. The sirtuin-1 and eNOS expression and cavernosal tissue (CT) histology seemed to have been preserved by the melatonin and/or insulin therapy. These results were indicative of a profound protective effect of melatonin by the activation of sirtuin-1 protein expression against hyperglycemia-induced oxidative CT injury.

Although the standard treatment for testicular tumors is radical orchiectomy in children, testis-sparing surgery (TSS) is an alternative method in selected cases according to tumor size, tumor markers and histopathological findings. In this paper, we present two patients aged 11 and 12 years who underwent TSS in our clinic. Frozen section examination was performed in both patients. Intraoperative ultrasound-guided mass excision was performed in one patient. Histopathological examination revealed an epidermoid cyst in one patient and Leydig cell hyperplasia in the other. TSS may be performed in children with a small testicular mass and negative tumor markers.

Objective: The aim of this study was to determine the significance of contralateral testis size in predicting monorchism in pediatric patients with unilateral undescended testis. Materials and Methods: The data of patients who underwent surgical operation by a single pediatric urologist for undescended testis between 2013 and 2016 was evaluated retrospectively. The patients were grouped as having monorchism (M), nonpalpable intra-abdominal testis (NPIAT), and palpable undescended testis (PUDT). The dimensions of the testes were measured ultrasonographically and recorded before operation. Patients with nonpalpable testis underwent diagnostic laparoscopy and patients with PUDT underwent inguinal orchiopexy. Results: A total of 57 children with a mean age of 31 (11-60) months were evaluated. Of the children, 12 had M, 9 had NPIAT and 36 had PUDT with a similar mean age (p>0.05). The size of the descended testis was found to be significantly small in NPIAT* and PUDT** groups compared to the M group (*p0.05). Conclusion: The size of the testis in the scrotum might help to localize the position of the undescended testis.

Objective: The aim of this study was to determine the effectiveness of the voiding dysfunction symptom score (VDSS) in evaluation of children with nocturnal enuresis. Materials and Methods: Four hundred children with nocturnal enuresis were included in the study. They were evaluated with VDSS, physical examination, urinalysis and 2-day voiding diary. All children with nocturnal enuresis symptoms were treated with desmopressin and/or urotherapy. However, children with overactive bladder symptoms were also treated with anticholinergics. Treatment success and change in VDSS were compared and assessed between different treatment methods. Results: Two hundred forty-five children (61.25%) were male and 155 (38.75%) were female. The mean age was 7.6 +/- 3.0 years (range: 5-18). The mean VDSS was 9.2 +/- 6.3. 35% of children with nocturnal enuresis had concomitant daytime symptoms. 126 children (31.5%) had a VDSS of nine or above and majority of these children were treated with anticholinergic therapy. VDSS questionnaire could not help determine treatment success in children with non-monosymptomatic nocturnal enuresis. However, children treated with urotherapy and desmopressine showed significant difference in VDSSs according to their treatment response. Conclusion: VDSS has shown to decrease after treatment in children with mono-symptomatic nocturnal enuresis. The treatment strategies should be checked and modified if VDSS does not decrease after proper therapy as this would increase the success of treatment.

Objective: This study aims to validate the “Marmara post-prostatectomy incontinence symptom score (M-PPISS)” designed for the assessment of post-prostatectomy incontinence (PPI). Materials and Methods: The questionnaire consists of 3 sections including 8 questions (4 questions examining the type and degree of PPI, 3 questions examining the effect of PPI on quality of life (QoL) and 1 question examining bladder emptying) and an analogue scale to assess the impact of PPI on the QoL. The questionnaire was completed by 106 patients, who underwent radical prostatectomy (RP) in our clinic between 2007 and 2015, at the end of the first week, first month and at 3-month intervals up to one year after RP. Results: The mean score of 106 patients at the end of the first week after the operation was 6.57 (minimum: 0, maximum: 24). The internal consistency coefficient measured for our questionnaire was found to be higher (Cronbach’s alpha: 0.887). When an item was deleted, Cronbach’s alpha was not lower than 0.85 for any value. According to the 27% rule, p value was calculated as 0.0001. In the numerical evaluation of total score and the analogue scale considering QoL (satisfaction and dissatisfaction); patients with a total score of 0-4 were accepted as “satisfied with QoL”, while patients with a total score of ≥5 were included in the dissatisfied group (cut-off value: 5). Conclusion: The M-PPISS was found to be a reliable and valid instrument in the evaluation of urinary incontinence after RP.

A number of factors that can impact the outcomes of percutaneous nephrolithotomy (PCNL) procedures have previously been investigated. Complex stones that extend to the anterior calyx could affect the success and complication rates of PCNL.We analyzed the effect of anterior calyx involvement on the outcomes of patients with complex stones treated with PCNL.A total of 132 consecutive patients who underwent PCNL due to complex stones (multiple, partial staghorn, or staghorn stones) between 2015 and 2017 were enrolled in this study. They were stratified into two groups based on whether the stone extended to the anterior calyx (group 1, n = 45) or not (group 2, n = 87). The stratification was achieved through contrast-enhanced computerized tomography (CT). Demographics, laboratory tests, and peri- and postoperative findings (operation and fluoroscopy duration, hospital stay, utilization of flexible instruments, access numbers, total blood count change, stone-free rate [SFR], and complications) were compared between the groups. The SFR was evaluated by plain kidney-ureter-bladder radiography or CT.The demographics, operation and fluoroscopy duration, access number, and hospital stay were similar between the groups (p0.05). A higher drop in the hemoglobin level in group 1 was identified (group 1 [2.14 ± 1.49 g/dL] vs. group 2 [1.43 ± 1.31 g/dL]) (p = 0.006). The SFR among the patients with extension to the anterior calyx was 60%, compared to 77% among the patients with no extension to the anterior calyx (p = 0.041). Flexible instruments were utilized in 60% of the patients of group 1, which was a higher rate than for group 2 (36%) (p = 0.007). Complication rates were similar in the two groups according to the Clavien-Dindo classification (p0.05).Our study demonstrated that complicated stones with extension to the anterior calyx are more challenging than cases without extension to the anterior calyx. This was noted by a lower SFR, a more prominent drop in total blood count, and more frequent utilization of flexible scopes.

Background Many diseases have been associated with anogenital distance, as an indicator of intrauterine androgen exposure. Objectives The aim of this study was to investigate the association between lifelong premature ejaculation and anogenital distance. Materials and methods The study included 140 participants: 70 with lifelong premature ejaculation (group 1) and 70 without any ejaculatory complaints (group 2). Premature Ejaculation Diagnostic Tool and stopwatch intravaginal ejaculatory latency time were recorded from all participants in order to evaluate ejaculatory function. Two variants of anogenital distance were measured: anogenital distance (from anus to the posterior base of the scrotum) from anus to the posterior base of the scrotum and anogenital distance (from anus to the cephalad insertion of the penis) to the cephalad insertion of the penis. We compared differences between groups and correlations between anogenital distance variants and patients' characteristics. Results The groups were similar in terms of age, BMI, and total testosterone levels. The mean anogenital distance (from anus to the posterior base of the scrotum) scores were 59.45 ± 10.76 vs. 55.02 ± 10.13 (p = 0.01), and anogenital distance (from anus to the cephalad insertion of the penis) scores were 128.37 ± 22.2 vs. 126.78 ± 16.21 (p = 0.63) in groups 1 and 2, respectively. Significant correlation was observed between anogenital distance (from anus to the posterior base of the scrotum) and Premature Ejaculation Diagnostic Tool scores (r = 0.199, p = 0.019) and intravaginal ejaculatory latency time (r = -0.185, p = 0.028). There were no statistically significant differences between anogenital distance (from anus to the posterior base of the scrotum) scores and total testosterone levels and between anogenital distance (from anus to the cephalad insertion of the penis) and Premature Ejaculation Diagnostic Tool scores or intravaginal ejaculatory latency time. Conclusions These results suggest that longer anogenital distance is associated with higher possibility of lifelong premature ejaculation. However, further studies are needed to confirm our results.

INTRODUCTION AND OBJECTIVES:Upper calyx access in percutaneous nephrolithotomy (PCNL) is an effective route to achieve access to the whole collecting system in complex kidney stone case or in high ...

Ureteric stents are frequently used in urology practice and can cause significant impairment in quality of life (QoL). The aim of this study was to validate the Ureteral Stent Symptoms Questionnaire (USSQ) to be used in the evaluation of stent-related symptoms and impairment in QoL in Turkish-speaking patients. After linguistic validation of the original USSQ into Turkish language, the Turkish version of the USSQ (T-USSQ) was self-administered to all participants at week 1 and 4 after stent placement for test–retest reliability and internal consistency and at week 8 (4 weeks after stent removal) for sensitivity to change analysis. Control patients completed the form only once. Additionally male and female patients completed the validated Turkish versions of International Prostate Symptom Score (IPSS) and Marmara Overactive Bladder (mOAB) Symptom Scores, respectively. A total of 68 patients with ureteral stents and 37 controls were available for the final analysis. The Cronbach’s alpha value was higher than 0.7 at week 1 for all sub-domains except additional problems domain. The test–retest reliability of the T-USSQ was high for all sub-domains except the additional problems domain. Relatively high correlation coefficients were found for the visual analog scale for pain, IPSS (for males), mOAB score (for females) with the corresponding USSQ domains, suggesting good convergent validity. Also the T-USSQ could effectively differentiate between patients and controls. The T-USSQ is a reliable and robust instrument that can be self-administered to patients of Turkish population with ureteral stent in the clinical applications.

To differentiate ureteral stones and phleboliths by measuring density [as Hounsfield unit (HU)] and volume (as mm3) of the opacities in the bony pelvis on unenhanced computerized tomography (U-CT). A total of 52 patients, who underwent semirigid ureteroscopy and laser lithotripsy for distal ureteral stone and had isochoronous phleboliths in U-CT, were included. Images were reviewed for density and volume of the opacities. Data were compared, and a cut-off value was defined with receiver operating characteristics curve analysis to differentiate the nature of the opacity. Using the cut-off values of 171 mm³ for volume (sensitivity 75 %, specificity 100 %) and 643 HU for density (sensitivity 75 %, specificity 93 %), differentiation between stone and phlebolith was achieved. Differentiation of pelvic opacities needs meticulous observation with certain signs on U-CT. On the other hand, our study offers a new method, with certain cut-off values, such as 643 HU and 171 mm3, which can be used to precisely predict the actual nature of opacities of interest.

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.

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

WOS: 000406687000043, PubMed ID: 28215833, Background Testicular torsion is a common problem and, to date, there is no agent to preserve testicular function following detorsion. Platelet-rich plasma (PRP), with its rich growth factor composition, has proven beneficial in regenerative therapy. It is believed that PRP has not been studied in testis for ischemia/ reperfusion (I/R) injury. Objective This study investigated the effect of PRP in an I/R rat model 1 month after detorsion. Study design Of 24 adult male Spraguee-Dawley rats, 18 were randomly assigned into three groups, with six in each: control, I/R and I/R + PRP. The PRP was prepared from the remaining six. Each group underwent right orchiectomy. Ischemia was performed by rotating the left testis 720 degrees and fixing with a nylon suture for 4 h. Reperfusion occurred 4 h later by removing the suture, and PRP was administered at a dose of 10 ml (2000 x 10(9)/l) into the left testis via the intra-parenchymal route. Animals were sacrificed at the fourth week, and testes were taken for malondialdehyde (MDA), glutathione (GSH), superoxide dismutase (SOD), myeloperoxidase (MPO), transforming growth factor beta (TGF-beta), and caspase-3 measurements. Results Ischemia/reperfusion caused a significant increase in MDA, MPO and caspase-3 activity, and significant decrease in GSH levels and SOD activity. The PRP treatment helped correct the alterations in SOD, caspase-3, and MPO activities and MDA levels. However, the mean MDA level and MPO activity were not totally restored compared with the controls. Serum testosterone levels of the I/R group were significantly lower compared with the control and I/R + PRP groups. TGF-b and caspase-3 protein expressions were significantly higher in the I/R group compared with the control group and were low with PRP administration compared with I/R groups (summary Table). Discussion The findings of the present study suggest that PRP, by inhibiting neutrophil infiltration and oxidative stress and increasing antioxidant defense, exerts protective effects on testicular tissues against I/R. This study had some limitations: a scoring system was not used in the assessment of spermatogenesis in the histopathological findings and specific testis cell types were not histologically assessed. Conclusions In light of the biochemical, histological and, especially, hormonal findings, intraparenchymal PRP injection may have a protective effect in testicular tissue against I/R injury.

INTRODUCTION AND OBJECTIVES: Previous reports have suggested an association between cold temperatures and the prevalence of testicular torsion. We hypothesized there is no association, and we used large-scale national data to evaluate this hypothesis. METHODS: For testicular torsion cases, we used the Pediatric Health Information System (PHIS) database to determine the date and city of a case of testicular torsion from 9/2006 to 7/2015. Cases were identified using ICD-9 diagnosis codes for testicular torsion (608.2) occurring concomitantly with procedure codes for reduction of torsion (63.52). For weather data, we used data from the National Climatic Data Center at the National Oceanic and Atmospheric Administration. For all cities with hospitals in the PHIS database, we determined the maximum and minimum daily atmospheric temperature at the weather station closest to each hospital. We then built cumulative distribution functions and density graphs for the distribution of (a) median daily temperature (calculated from measured temperature maximum and minimum) for cases of testicular torsion, and (b) median daily temperature for all days. Cumulative distribution curves and density graphs were compared using the KolmogorovSmirnov (K-S) test. All analyses were completed using the R software package. RESULTS: 9,126 cases of testicular torsions were identified and 154,542 days of temperature data across all hospital cities over the time period of interest. Days at each temperature across all hospitals and time from 9/2006 to 7/2015 were calculated, as were number of torsions at each temperature. The relative distribution of each temperature is compared in Figure 1, with all days portrayed in red and torsions portrayed in blue. The K-S test for similarity of distribution showed a D statistic of 0.019 (p-value 0.005), indicating the maximum deviation between these two distributions was 1.9%, a nearly imperceptible change. CONCLUSIONS: We therefore concluded that there is no clinically significant difference between the distribution of temperature in the United States and the distribution of temperature related to testicular torsion. We have shown using more than 150,000 individual days in individual cities and more than 9,000 cases of testicular torsion that there is no association between temperature and the prevalence of this disorder. We suggest abandoning this premise. Source of Funding: none