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Purpose: To evaluate the effects of a single dose of oral 5-mg tadalafil on macular microcirculation as measured using optical coherence tomography (OCT) and angiography (OCTA) in healthy volunteer...

Objectives To develop a model for predicting biochemical recurrence (BCR) in patients with long follow-up periods using clinical parameters and the machine learning (ML) methods. Materials method Patients who underwent robot-assisted radical prostatectomy between January 2014 and December 2019 were retrospectively reviewed. Patients who did not have BCR were assigned to Group 1, while those diagnosed with BCR were assigned to Group 2. The patient's demographic data, preoperative and postoperative parameters were all recorded in the database. Three different ML algorithms were employed: random forest, K-nearest neighbour, and logistic regression. Results Three hundred and sixty-eight patients were included in this study. Among these patients, 295 (80.1%) did not have BCR (Group 1), while 73 (19.8%) had BCR (Group 2). The mean duration of follow-up and duration until the diagnosis of BCR was calculated as 35.2 ± 16.7 and 11.5 ± 11.3 months, respectively. The multivariate analysis revealed that NLR, PSAd, risk classification, PIRADS score, T stage, presence or absence of positive surgical margin, and seminal vesicle invasion were predictive for BCR. Classic Cox regression analysis had an area under the curve (AUC) of 0.915 with a sensitivity and specificity of 90.6% and 79.8%. The AUCs for receiver-operating characteristic curves for random forest, K nearest neighbour, and logistic regression were 0.95, 0.93, and 0.93, respectively. All ML models outperformed the conventional statistical regression model in the prediction of BCR after prostatectomy. Conclusion The construction of more reliable and potent models will provide the clinicians and patients with advantages such as more accurate risk classification, prognosis estimation, early intervention, avoidance of unnecessary treatments, relatively lower morbidity and mortality. The ML methods are cheap, and their powers increase with increasing data input; we believe that their clinical use will increase over time.

Theaim of this study was to determine the effect formedby pelvic diameters preoperatively measured throughmultiparametric magnetic resonance imaging (mp-MRI) and different surgical positions on anesthesiaparameters used during perineal robot-assisted radicalprostatectomy (p-RARP). MATERIALS AND METHODS: Six different pelvimetricdimensions were determined preoperatively.Respiratory and hemodynamic variables of the patientswere measured separately and repeatedly in thesupine position, exaggerated lithotomy position at thebeginning of the 15° Trendelenburg position and the60th minute of insufflation. RESULTS: There was a significant increase in thepartial pressure of oxygen (PaO2) in the exaggeratedlithotomy position compared to the supine position.There was no significant change in the partial pressureof carbon dioxide (PCO2) in the exaggerated lithotomyposition compared to the supine position. In the 60thminute of insufflation, there was a significant increasein the PCO2 compared to the supine and exaggerated lithotomy positions. There was no statistically significantchange in the end-tidal carbon dioxide tension(EtCO2), with surgical position or insufflation time. Asignificant negative correlation was observed betweenthe distance of the ischial spines (ISD) and PCO2 change,and a significant positive correlation was observedbetween the angle of the symphysis pubis-seminalvesicles (ASS) and PCO2 change. A significant positivecorrelation was observed between the ASS value andEtCO2 change between the 60th minute of insufflationand exaggerated lithotomy position. CONCLUSION: In our study, the effect caused by differingpelvimetric diameters, surgical positions, andduration of anesthesia during p-RARP on anesthesiaparameters were shown.INTRODUCCIÓN Y OBJETIVO: Determinarel efecto de los diámetros pélvicos preoperatoriosmedidos a través de la resonancia magnética multiparamétrica(RMNmp) y las diferentes posicionesquirúrgicas en los parámetros anestésicos durante laprostatectomía radical perineal. MATERIAL Y MÉTODOS: Se midieron seis dimensionespélvicas preoperatorias diferentes. Las variablesrespiratorias y hemodinámicas se midieron de formaseparada y repetida en las posiciones de decúbito supino,litotomía forzada al inicio del Trendelemburg a15º y a los 60min de insuflación. RESULTADOS: Se registró un aumento significativo dela presión parcial de oxigeno (PaO2) en litotomía forzada comparada a la posición de decúbito supino. Nohubo cambios significativos en la presión de dióxidode carbono (PCO2) en litotomía forzada comparada condecúbito supino. A los 60min de insuflación, hubo unaumento significativo de la PCO2 comparado con decúbitosupino y litotomía forzada. No hubo cambiossignificativos en la presión máxima de CO2 al final dela espiración (EtCO2) con las posiciones o el tiempo deinsuflación. Se observó una correlación negativa entrela distancia entre las espinas isquiáticas (EEII) y elcambio de PCO2, mientras que se observó correlaciónpositiva entre el ángulo de la sínfisis del pubis-vesículasseminales y el cambio de PCO2. Una correlaciónpositiva se observó entre el valor del ángulo sínfisispubis-vesículas seminales y EtCO2 con respecto a lainsuflación al minuto 60 y la litotomía forzada. CONCLUSIÓN: En nuestro estudio se demuestra lainfluencia de los diámetros pélvicos, las posicionesquirúrgicas y la duración de la anestesia en los parámetrosanestésicos durante la prostatectomía radicalrobótica perineal.

We aimed to investigate the parameters that have an effect on the length of stay and mortality rates of patients with Fournier's gangrene.A retrospective review was performed on 80 patients who presented to the emergency department and underwent emergency debridement with the diagnosis of Fournier's gangrene between 2008 and 2017. The demographic and clinical characteristics, length of stay, Fournier's Gangrene Severity Index score, cystostomy and colostomy requirement, additional treatment for wound healing and the mortality rates of the patients were evaluated.Of the 80 patients included in the study, 65 (81.2 %) were male and 15 (18.7 %) female. The most common comorbidity was diabetes mellitus. The mean time between onset of complaints and admission to hospital was 4.6 ± 2.5 days. As a result of the statistical analyses, it was found that Fournier's Gangrene Severity Index score, hyperbaric oxygen therapy, negative pressure wound therapy and the presence of sepsis and colostomy were significantly positively correlated with length of stay. Also it was found that the Fournier's Gangrene Severity Index score, administration of negative pressure wound therapy and the presence of sepsis were correlated with mortality.Fournier's gangrene is a mortal disease and an emergency condition. With the improvements in Fournier's gangrene disease management, mortality rates are decreasing, but long-term hospital stay has become a new problem. Knowing the values predicting length of stay and mortality rates can allow for patient-based treatment and may be useful in treatment choice.Wir wollten die Parameter untersuchen, die sich auf die Aufenthaltsdauer und die Sterblichkeitsrate der Patienten mit Fournier-Gangrän auswirken.Eine retrospektive Überprüfung wurde an 80 Patienten durchgeführt, die sich zwischen 2008 und 2017 der Notaufnahme vorstellten und ein Notfalldebridement mit der Diagnose Fournier's Gangrene durchliefen. Die demografischen und klinischen Merkmale, die Verweildauer, der Fournier-Gangrän-Schweregrad-Index, die Anforderungen an Zystostomie und Kolostomie, die zusätzliche Behandlung der Wundheilung und die Sterblichkeitsrate der Patienten wurden bewertet.Von den 80 in die Studie einbezogenen Patienten waren 65 (81,2 %) männlich und 15 (18,7 %) weiblich. Die häufigste Komorbidität war Diabetes Mellitus. Die mittlere Zeit zwischen dem Einsetzen der Beschwerden und der Einlieferung ins Krankenhaus betrug 4,6 ± 2,5 Tage. Als Ergebnis der statistischen Analysen wurde festgestellt, dass der Fournier-Gangrän-Schwereindex-Score, die Hyperbare Sauerstofftherapie, die Unterdruck-Wundtherapie und das Vorhandensein von Sepsis und Kolostomie signifikant positiv mit der Verweildauer korrelierten. Es wurde festgestellt, dass der Fournier-Gangrän-Schwereindex-Score, die Verabreichung einer Unterdruck-Wundtherapie und das Vorhandensein einer Sepsis mit der Mortalität korrelierten.Fournier's Gangrene ist eine tödliche Krankheit und ein Notfall. Mit den Verbesserungen im Gangrän-Krankheitsmanagement von Fournier sinken die Sterblichkeitsraten, aber der langfristige Krankenhausaufenthalt ist zu einem neuen Problem geworden. Die Kenntnis der Werte, die die Aufenthaltsdauer und die Sterblichkeitsrate vorhersagen, kann eine patientenbasierte Behandlung ermöglichen und bei der Wahl der Behandlung hilfreich sein.

OBJECTIVE The objective of this study was to evaluate the functional results of dorsal onlay labia minora graft urethroplasty in the treatment of female urethral strictures. MATERIALS AND METHODS Data were retrospectively examined for 13 patients who underwent augmentation urethroplasty through the dorsal approach using labia minora grafts between September 2017 and January 2019. Demographic, intraoperative, and postoperative data and follow-up conditions were recorded for all patients. RESULTS The mean age of the patients was calculated as 48.2±7 years. The etiology of urethral strictures was found to be trauma in 2 patients, iatrogenic in 4 patients, and idiopathic causes in 7 patients. The mean urethral stricture length of the patients was 1.5±0.4 cm (range, 1-2.5 cm). The mean surgical duration was 95±11.4 minutes (range, 70-110 minutes). The mean postoperative American Urology Association symptom score, maximum urine flow rate, and postmictional residue values were statistically significantly different compared with preoperative data (P < 0.05). No peroperative and postoperative complications were detected in any patients. The mean follow-up duration of the patients was 19±5.3 months, and no recurrence of stricture was observed in any patients based on the cystourethroscopic examinations. All patients are being followed up in our clinic without any stricture recurrence or symptoms. CONCLUSIONS The dorsal onlay labia minora graft urethroplasty technique in female urethral strictures is an efficient and applicable method with postoperative anatomic and functional results. Studies with longer follow-up periods and larger patient populations are required to present the success and reliability of this technique.

Purpose: This study aims to assess the association between CHA2DS2-VASc score and erectile dysfunction in patients who were admitted to cardiology outpatient clinics. Materials and methods: One hundred and two male patients who were admitted to the cardiology outpatient clinic were included to the study. Erectile dysfunction was evaluated in the urology outpatient clinic in the same hospital and scored using Turkish Version of The International Index of Erectile Function. CHA2DS2-VASc score was calculated for every patient using the current associated guidelines. Results: There was a negative correlation between The International Index of Erectile Function score and CHA2DS2-VASc score, age, hypertension, heart failure, diabetes mellitus, stroke respectively. Smoking and dislipidemia were not correlated with The International Index of Erectile Function score (p>0.05). Conclusion: CHA2DS2-VASc score can be used to detect Erectile dysfunction in patients who are admitted to the cardiology outpatient clinics.

In this study, we aimed to measure the change in penile stiffness by evaluating corpus cavernosum (CC) with shear wave elastography (SWE) in patients with chronic obstructive pulmonary disease (COPD).Seventy outpatient patients aged 50-80 years who were diagnosed with COPD were evaluated using SWE. Patients were divided into 2 groups according to the International Index of Erectile Function-5 (IIEF-5) questionnaire (IIEF-517: Group A, IIEF-517: Group B). The measurements were made in both transverse and longitudinal sections.The mean age of the patients was 60 ±7.9 years. The duration of COPD was significantly higher in Group B than in Group A (p = 0.003). The mean SWE values of right transverse mid-portion of corpus penis (RTM) and left transverse mid-portion of corpus penis (LTM) in Group B (21.1 ±5.6 kPa and 20.8 ±4.8 kPa, respectively) were significantly higher than in Group A (15.2 ±2.3 kPa and 15.8 ±2.7 kPa, respectively); (p0.001 and p0.001, respectively). There was a significant negative correlation between IIEF-5 scores and the duration of COPD (p0.05). There was a significant negative correlation between IIEF values and RTM and LTM values of the patients (p0.05 and p0.05, respectively). There was a significant positive correlation between the duration of COPD and both RTM and LTM values (p0.05 and p0.05, respectively).In our study, according to the SWE findings, we showed the effect of systemic changes created by COPD on penile tissue and the negative effect of this on erectile function in patients.

Objective The beta‐coronavirus (COVID‐19) pandemic has changed the clinical approach of 93% of urologists worldwide, and this situation has affected the use of laparoscopic and robot‐assisted laparoscopic methods, which are known as minimally invasive surgery (MIS). This study aimed to determine the effects of the COVID‐19 pandemic on MIS in urology practice at national level. Design, setting and participants A total of 234 urologists in Turkey participated in an online survey between August 22 and September 23, 2020. Outcome measurements and statistical analysis Descriptive statistical analyses were conducted to determine the participants’ demographic characteristics and responses to multiple‐choice questions. Results While 54% of urologists stated that they were concerned about the possibility that the patients planned to undergo MIS were carrying COVID‐19 or false‐negative for the virus, 51% considered that open surgery was safer than MIS in this regard. The pandemic led to a difference in the preferences of 40% of the urologists in relation to open or MIS methods, and during the pandemic, 39% of the urologists always directed their patients to open surgery. It was determined that during the pandemic, there was a statistical decrease in the intensity and weekly application of MIS methods among all surgical procedures compared to the pre‐pandemic (P

Granular cell tumors (GCTs) of the urinary bladder are extremely rare tumors and there are only 26 reported cases in the literature. GCTs are usually benign tumors and it is important to differentiate them from other neoplasms of the bladder such as carcinomas. We herein report a case of a benign GCT of the urinary bladder.

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.

Purpose Purpose of this study is to investigate the quality of life (QoL) in patients with end-stage renal disease who underwent open or robot-assisted kidney transplantation (OKT and RAKT). Materials and methods Patients who underwent OKT and RAKT at Bakirkoy Sadi Konuk Training and Research Hospital between June 2016 and December 2018 constituted the target population of this study. The patient group was divided into two groups as per the surgical technique (ie, open vs. robot-assisted). Demographic data, preoperative and postoperative data of all patients were collected prospectively. The QoL of the patients was assessed preoperatively and on the postoperative 30th day. Results Sixty-seven patients who underwent OKT and 60 patients who underwent RAKT were included. The mean patient age and BMI were calculated as 40.9 ± 11.6 years and 24.4 ± 2.9 kg/m2 , respectively. Patients in the RAKT group were significantly younger than the patients in the OKT group (P = .002). There were no significant differences between the two groups in terms of gender, BMI, ASA and the ratio of premptive patients. The mean preoperative hemoglobin level was significantly higher in the OKT group than the RAKT group (P = .003). While mean total ischemia time was shorter in the "open" group, intraoperative blood loss and incision length were shorter in the RAKT group. Duration of surgical drainage and hospital stay was shorter in the "robot-assisted" group. There was no significant difference between the groups in terms of SF-36 subparameters preoperatively. The physical component scores of the QoL questionnaire revealed that postoperative impairment of quality of life in the early postoperative period was more significant in the OKT than the RAKT. Conclusion Patients who underwent RAKT have a higher QoL than the patients who were treated with OKT as per their self-reported QoL scores in the early postoperative period.

The aim of our study is to compare 2 prostate fusion biopsy models in terms of accurate target sampling. One hundred patients who had Prostate Imaging-Reporting and Data System score 3, 4, or 5 lesions (lesion diameter, >5 mm in long axis) in multiparametric-magnetic resonance imaging and prostate-specific antigen levels between 3 and 10 ng/mL were enrolled in the study. All patients were biopsy naive. Two groups were composed with 50 patients each. Group 1 patients had cognitive fusion (CF) biopsy, and group 2 had magnetic resonance-ultrasound fusion platform biopsy. After fusion biopsy, standard biopsy was also performed. Outcomes of histopathologic and demographic data were evaluated statistically. There were no statistical differences between the 2 groups in terms of age, prostate-specific antigen levels, prostate volume, and lesion length (P > 0.05). There was no statistically significant difference in sampling targeted lesions (P > 0.05). Also, no difference was found between the 2 groups in terms of random biopsy cancer detection rates (P > 0.05). There was no statistically significant difference between CF and magnetic resonance-ultrasound fusion in terms of cancer detection rates. For the experienced operators, we recommend lesions that are longer than 5 mm can be sampled using CF, an inexpensive and faster technique.

Objective Vesicourethral anastomotic stenosis (VUAS) is frequently seen after prostate surgery because of various operative and postoperative factors. In this study, we aimed to present our results of perineoscopic bladder neck reconstruction, which is a new technique of the perineal approach in the treatment of patients with VUAS after prostate cancer surgery. Material and methods Sixteen consecutive patients who underwent perineoscopic bladder neck reconstruction in our clinic between July 2017 and March 2019 were included in the study. Demographic characteristics, surgical history, postoperative continence status, and additional treatment requirements were recorded. Perineoscopic surgery is defined as the visualization of the surgical site with instruments used in laparoscopy and the surgeon performing the entire operative procedure through the screen. Results The mean number of preoperative endoscopic bladder neck resections of the patients was 7±5.1, with a history of suprapubic cystostomy in 7 (43.7%) and radiotherapy in 5 (31.2%) patients before surgery. The mean surgical time was 126.2±13.1 min. The mean follow-up period was 13.2±6.8 months, and the success rate was 81.25%. During follow-up, two (12.5%) patients received perineoscopic re-do reconstruction because of stricture recurrence, and one (6.2%) patient was included in a urethral dilatation program. Conclusion Improving visualization and ergonomics with the perineoscopic approach can increase the success rate of bladder neck reconstruction in comparison with the standard approach. In addition, the lack of need for expanded dissection (corporal separation, inferior pubectomy) reduces postoperative complication rates.

To present our results of first 12 patients on whom we performed gasless robotic perineal radical prostatectomy (r-PRP).We performed gasless r-PRP on 12 patients between August 2018 and October 2018. Multiparametric magnetic resonance imaging was performed forall patients to exclude local advanced disease. Demographic characteristics, technical details, and intra and postoperative data were analyzed.The mean age of the patients was 62.6 ± 6years. The mean body mass index of the patients was 27 ± 4 kg/m2. Four patients had a history of major abdominal surgery. The mean preoperative prostate-specific antigen (PSA) was 7.4 ± 2.5 ng/mL. The mean prostate volume was 40 ± 10.2 cc. The mean perineal dissection time was 45.6 ± 5.8 minutes. The mean console time and total operative time were 117.8 ± 28.1 and 163.3 ± 30.7 minutes, respectively. The mean urethral catheter removal time was 9.2 ± 1.9 days. The immediate continence rate was 25% after the urethral catheter removal and the continence rate was 75% and 91.67% at the 3rd and 6th month follow-up, respectively.Gasless r-PRP is an efficient and safe method in prostate cancer surgery. However, prospective randomized and comparative studies are required with large patient series.Presentar nuestros resultados en los primeros 12 pacientes en los que hemos realizado prostatectomía radical perineal robotica sin gas.MÉTODOS: Se realizó la prostatectomia radical robótica perineal sin gas en 12 casos entre agosto 2018 y octubre 2018. RNM multiparamétrica se realizó en todos los pacientes para excluir enfermedad avanzada local. Las características demográficas, detalles técnicos y datos intra e postoperatorios fueron analizados.La mediana de edad de los pacientes fue de 62,6 ± 6 años. El IMC medio fue de 27 ± 4 kg/m2, cuatro pacientes tenían historia de cirugía abdominal previa. EL PSA preoperatorio fue de 7,4 ± 2,5 ng/mL. El tamaño prostático medio fue de 40 ± 10,2 cc. El tiempo medio de disección perineal fue de 45,6 ± 5,8 minutos. El tiempo medio de consola y el tiempo quirúrgico total fueron de 117,8 ± 28,1 y 163,3 ± 30,7 minutos, respectivamente. El tiempo medio a la retirada de sonda fue de 9,2 ± 1,9 dias. La continencia inmediata fue de 25% después de la retirada de la sonda y la tasa de continencia fue de 75% y 92% al 3r y 6º mes de seguimiento, respectivamente.La prostatectomía radical robótica perineal sin gas es un procedimiento eficiente y seguro en la cirugía del cáncer de próstata. Aunque estudios prospectivos randomizados y estudios comparativos son necesarios con más series de pacientes.

Gossypiboma refers to a retained foreign object that was forgotten in the body cavity during an operation. It is a rare surgical complication that most commonly occurs after intraperitoneal abdominal emergency surgical procedures, but may also occur after virtually any type of operation. Gossypiboma can be confused with neoplastic lesions and abscess. Clinical examination and radiological findings may sometimes mislead the physician. We intend to present our cases, which is thought to be a kidney tumour and bladder cancer but resulted gossypiboma which is a condition that is caused by a forgotten sponge during the operation and it can mimic the cancer. During the operation, the team must work in coordination and be careful. Unnecessary operations in such situation can significantly increase the patient’s morbidity.

BACKGROUND By examining patients with testicular torsion (TT) that caused problems in medicolegal terms, the present study aims to define markers causing medical neglect or malpractice in similar conditions and perform a retrospective examination to characterize the medical aspects of patients with TT. METHODS In this study, 53 patients who underwent orchiectomy for TT following interventions made between 2004 and 2019 in different hospitals of Turkey and had satisfactory clinical findings in their files based on medicolegal inspections were included. RESULTS The median age of the patients was nine years. Twenty-three (43.4%) of the patients had TT on the left side, 29 (54.7%) had TT on the right side, and one (1,9%) patient had bilateral TT. It was noticed that 31 (58.5%) patients had epididymo-orchitis (EO), seven patients had (13.2%) urinary infection, five (9.4%) patients had a hydrocele, and four (7.5%) patients had renal colic, and the others had testicle contusion, gastroenteritis, inguinal hernia, and acute appendicitis as misdiagnoses. The mean time that passed between admission and TT diagnosis was detected as 59±11.2 hours. A statistically significant relation was detected between the branch of the physician who first evaluated the patients and the presence of performing scrotal examination and imaging during admission. The ratio of physical scrotal examinations by emergency service physicians was lower than with the urologists. Among the preliminary examiner allowed to be an advanced evaluation for the possibility of missing diagnosis by an independent specialist physicians, 25 (47.2%) were urologists, 22 (41.5%) were emergency service physicians, four (7.5%) were pediatricians, and two (3.8%) were radiologists. CONCLUSION Physicians should perform the required evaluations for a suitable diagnosis and treatment by putting aside their medicolegal concerns and prevent the problems by giving priority to patient health. For the correct diagnosis and proper management of TT, it is necessary to increase the information levels of physicians, and patients should be explored urgently in the event of any clinical suspicion.

Amaç: Paratestiküler kitlelerin testis tümörleri ile pre-op ayrımı net olarak yapılamamaktadır. Genellikle testis tümörü ön tanısıyla radikal orşiektomi yapılıp nihai patoloji sonucuna göre klinik yaklaşım planlanmaktadır. Bu noktadan hareketle, klinisyenler skrotal kitle ile karşılaştıklarında, bu kitlenin testis tümörü dışında; epididimidis, tunika vaginalis, spermatik kord, yağ-kas-bağ dokusu gibi destek dokular ve embriyonel kalıntılardan da orijin alabileceğini akılda tutmalı ve tedavi yönetimini buna göre belirlemelidir..Gereç ve Yöntemler: Merkezimize 2008-2018 yılları arasında skrotal kitle ile başvurmuş, testis tümörü kabul edilerek ingüinal radikal orşiektomi yapılan 140 hastanın patoloji sonucu geriye dönük olarak incelendi. Patoloji sonucu paratestiküler kitle rapor edilen olguların preoperatif ve postoperatif verileri, klinik seyri, tedavi yönetimi literatür eşliğinde tartışıldı.Bulgular: Retrospektif olarak incelenen serimizde 13 olguda paratestiküler kitle(PTK) saptandı. Bunlardan 10 hastada Adenomatoid tümör, 2 tanesinde Rabdomiyosarkom, 1 hastada Anjiomiksoma saptandı. Sonuç: İntraskrotal yerleşimli kitlelerin köken aldığı dokunun testis kaynaklı ya da paratestiküler yapılardan mı kaynaklandığının ayırıcı tanısı sıklıkla yapılamamaktadır. Bu nedenle genelde testis tümörleri ile benzer şekilde radikal orşiektomi yapılıp kesin tanı patolojik inceleme ile konulabilmektedir. Tüm skrotal kitlelerin %2-3 ‘ünü oluşturan paratestiküler kitleler, skrotal kitle ile başvuran ve tedavi planlanması yapılan hastaların ayırıcı tanısında akla gelmesi gereken tanılar arasında kendine yer bulmalıdır. Bu konuda daha fazla sayıda hastayla ileri düzey çalışmalara ihtiyaç vardır., Objective:The pre-op differentiation of testicular tumors from paratesticular masses cannot be made clearly. Generally, radical orchiectomy is performed with pre-diagnosis of testicular tumor and a clinical approach is planned according to the final pathological result.When clinicians diagnose a scrotal mass, they should considered that this mass may be originated from epididymidis, tunica vaginalis, spermatic cord, fat-muscle-connective tissue, and embryonic remnants and should determine the treatment management accordingly.Materials and Methods:The pathology results of 140 patients, who were admitted to our center between 2008 and 2018 presenting scrotal mass and underwent inguinal radical orchiectomy considering as testicular tumor, were retrospectively analyzed. Preoperative and postoperative data, clinical course, and treatment management of the cases reported to be paratesticular mass by pathology were discussed in the light of the literature.Results:Paratesticular mass(PTM)was detected in 13 cases of our retrospectively analyzed series. Of these, 10 patients were found to have adenomatoid tumors(AT) 2 patients have rhabdomyosarcoma(RMS), and 1 patient angiomyxoma(AM). Conclusion:The differential diagnosis of whether intrascrotal masses are originating from testicular tissues or paratesticular structures is usually cannot be made. Therefore, radical orchiectomy is performed in the same way as testicular tumors and a definite diagnosis can be made by pathological examination. The paratesticular masses, 2-3% of the scrotal masses, should be considered in the differential diagnosis. In this regard, there is a need for studies with a higher number of series.

Background Conventional imaging modalities are inadequate to evaluate locoregional extension of prostate cancer (PCa). The aim of the current retrospective study was to investigate the diagnostic efficacy of Gallium-68 prostate-specific membrane antigen-11 (Ga-68 PSMA-11) positron emission tomography/computed tomography (PET/CT) and multiparametric magnetic resonance imaging (mp-MRI) for staging preoperative PCa patients with correlating histopathology. Materials and methods Twenty-four patients with histologically proven PCa underwent both Ga-68 PSMA-11 PET/CT and mp-MRI before robot-assisted laparoscopic radical prostatectomy. For each tumor area, correlations with histopathological results were defined for tumor localization, extraprostatic extension (EPE) of the tumor, invasion of seminal vesicle (SVI) and bladder neck invasion (BNI). In patients with regional lymph node (LN) dissection, histopathological results were also correlated with imaging modalities. Results Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for detection of EPE and SVI were higher for mp-MRI than Ga-68 PSMA-11 PET/CT. On the other hand Ga-68 PSMA-11 PET/CT had significant successful results for detection of LN metastases when compared with mp-MRI. But for BNI detection both modalities had same insufficient results. Ga-68 PSMA-11 PET/CT had strong results for appropriate tumor localization in the gland. Conclusion Ga-68 PSMA PET/CT has superior results for assessing local LN metastases and for intraprostatic tumor localization. Whereas, mp-MRI must be the preferred modality for determining SVI and EPE. But both imaging modalities failed for determining BNI accurately. Both modalities should be used in conjunction with each other for better treatment planning.

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

Paraoxonase-1 (PON1) is a high-density lipoprotein-associated enzyme implicated in the pathogenesis of atherosclerosis by protecting lipoproteins against peroxidation. PON1 has two genetic polymorphisms both due to amino acid substitution, one involving glutamine and arginine at position 192 and the other leucine and methionine at position 55. Recent reports suggest that nephrolithiasis and atherosclerosis share a number of risk factors. Our study aimed to compare the effects of PON1 192, PON1 55 polymorphisms, and PON1 activity in patients with urolithiasis and controls.PON1's arylesterase/paraoxonase activities and phenotype were determined in 158 stone forming cases (Group 1) and 138 non-stone forming controls (Group 2). The PON1 192 and PON1 55 polymorphisms were studied by polymerase chain reaction/restriction fragment length polymorphism.Paraoxonase activity was significantly lower in Group 1 than Group 2 (112 ± 31.8 vs. 208 ± 53.1 IU/L) (p 0.001). The PON1 L55M polymorphism was significantly higher in Group 1. The "M" allele coding for PON1 was higher in Group 1 (p 0.001). PON1 192 RR homozygotes had significantly higher PON1 activity than QR and QQ genotypes among all the patients (p 0.001).The results of our study demonstrate that the PON1 55 gene "M" allele is associated with renal stone disease. Individuals possessing the "M" allele have a higher incidence of urolithiasis. The results of this study provide genetic evidence that the PON1 gene may play a role in stone formation. PON1 genotype determination may provide a tool to identify individuals who are at risk of urolithiasis.

Objective We compared the outcomes of robotic-assisted radical perineal prostatectomy (r-PRP) versus robotic-assisted transperitoneal laparoscopic radical prostatectomy (RARP). Material and methods Between November 2016 and September 2017 in our center, 40 patients underwent r-PRP, and 40 patients underwent RARP. All patients also underwent multiparametric magnetic resonance imaging (mpMRI) to exclude the cases with locally advanced disease. Patients with localized prostate cancer (C-T2N0M0) were included in the study. The exclusion criteria were contraindications for undergoing robotic radical prostatectomy; the Gleason score ≥4+3; extracapsular extension proven on biopsy or suspected on mpMRI; clinical stage ≥T2c; required pelvic lymph dissection according to Partin's normogram; previous radiation therapy; hormonal therapy; any previous prostatic, urethral, or bladder neck surgery; and preoperative urinary incontinence or erectile dysfunction. Patients were placed in the exaggerated lithotomy position with 15° Trendelenburg for r-PRP and 40° Trendelenburg for RARP. Results The mean age for the r-PRP and RARP groups were 61.2 (46-73) and 62.2 (50-75) years, respectively. The mean body mass index was significantly higher in the r-PRP group (p=0.02). The mean procedure duration time was 169.4 (100-255) minutes for the r-PRP group and 173.1 (130-210) minutes for the RARP group. The mean console time and anastomosis time were significantly lower for the r-PRP group. The mean estimated blood loss was significantly lower for the r-PRP group (p=0.002). Immediate continence rates in the r-PRP and RARP groups following the urethral catheter removal were 42% and 35% (p=0.30), respectively. Continence rates increased to 94.2% in the r-PRP and 72% in RARP (p=0.001) group at the 6th month, and to 95% in the r-PRP and 85.2% in RARP (p=0.02) group at the 9th month follow-up period. According to the International Index of Erectile Function-5 (IIEF-5), the erectile function rates at the 3-, 6-, and 9-month follow-up in the r-PRP group were 44%, 66%, and 75%, respectively. The rates in the RARP group at the 3-, 6-, and 9-month follow-up were 25%, 42%, and 66% (p=0.001), respectively. Conclusion In our experience, r-PRP has acceptable morbidity, excellent surgical and pathological outcomes, and satisfactory oncologic and functional results compared to RARP.

Objective: To compare safety and effectiveness of flexible ureteroscopy (F-URS) and laparoscopic retroperitoneal ureterolithotomy (L-RU) in treatment of proximal ureteral stones larger than 15 mm. Materials and Methods: This study included 103 patients treated with L-RU (Group I), and 80 patients treated with F-URS (Group II) due to proximal ureteral stones larger than 1.5 cm, in a single center. Patients' characteristics and procedure-related parameters including success rate, operation time, hospital stay, postoperative visual analogue scale (VAS) scores, auxiliary procedures, and complications were compared between Groups I and II. Results: It was seen that both methods were effective in the treatment of large ureteral stones; however, R-LU provided a higher stone-free rate (100 vs. 87.5%), a lower complication rate (10.6 vs. 23.7%), and a shorter operation time (65.4 vs. 75.1 min). On the other hand, patients treated with F-URS had less postoperative pain, a shorter hospital stay, a faster return to daily activities. Conclusions: For treatment of large proximal ureteral stones, L-RU provides significantly higher success and lower retreatment rate compared with F-URS. Our results also indicate that R-LU, which has been regarded as an invasive procedure is not as invasive as it is thought to be, and it must be kept in mind that F-URS may cause complications despite its noninvasive nature.

PDE5 inhibitors are widely used for the treatment of erectile dysfunction. However, these drugs have recently become popular among men without erectile dysfunction as a means of enhancing sexual performance and improving sexual desire. The aim of this study was to investigate the histopathological and ultrastructural effects of PDE5 inhibitors on the corpus cavernosum in young, healthy male rats. Twenty-four 4-month-old male rats were divided into four groups: group 1 was the control group, group 2 rats received sildenafil citrate, group 3 rats received vardenafil hydrochloride, and group 4 rats received tadalafil. All drugs were administered for 4 weeks. Penile tissue was collected for electron microscopy and tissue collagen measurements. Electron microscopic analysis indicated that the number of active fibroblasts and macrophages and the synthesis of new collagen fibers increased in treated rats. Cavernous tissue collagen levels were significantly higher in the sildenafil-, vardenafil-, and tadalafil-treated groups than in controls (46.16 ± 4.9, 42.06 ± 2.4, 41.07 ± 2.4, and 29.20 ± 3.3, respectively) (p

Objective Robotic-assisted radical prostatectomy (RARP) is the minimally invasive surgical treatment for patients with localized prostate cancer. Perioperative or postoperative complications following RARP have been reported in some studies and severe postoperative bleeding after RARP is rare, but haemodynamic instability may necessitate open surgical exploration and be associated with considerable morbidity. We reported postoperative bleeding cases, which is a kind of complication associated with robotic surgery and requiring massive transfusion after RARP. Patients and methods From August 2009 to May 2012, 317 consecutive patients who underwent RARP performed at our institution were analyzed. Patients with serious postoperative bleeding that caused haemodynamic instability after surgery were enrolled. Results A total of 5 among 317 (1.6%) patients had bleeding requiring postoperative transfusion. In these cases, mean operative time was 114 min. The mean estimated blood loss was 110 ml during operation. In these patients, hematocrit (Hct) levels gradually fell after surgery and ecchymosis was detected on the side and posterior walls of the abdomen on the second day. The mean preoperative Hct was 44.3% and mean lowest Hct was 23.1%. All patients were successfully treated without surgical exploration. Conclusions Robotic radical prostatectomy has proven to be a safe surgical treatment with low morbidity. However, postoperative bleeding can reach serious problems. This is the first study to explain haemorrhage, associated with possible risk of robotic surgery.

Resumen Objetivo La prostatectomia radical asistida por robot (PRAR) es el tratamiento quirurgico minimamente invasivo para los pacientes con cancer de prostata localizado. Se han notificado complicaciones perioperatorias o postoperatorias despues de PRAR en algunos estudios, y el sangrado postoperatorio severo despues de PRAR es poco comun, pero puede ser que la inestabilidad hemodinamica requiera exploracion quirurgica abierta y se asocie con una morbilidad considerable. Informamos de casos de sangrado postoperatorio, que es una especie de complicacion asociada con la cirugia robotica, y la necesidad de transfusion masiva despues de PRAR. Pacientes y metodos Desde agosto de 2009 hasta mayo de 2012 317 pacientes consecutivos sometidos a PRAR en nuestra institucion fueron analizados. Los pacientes con hemorragia postoperatoria grave, que causo inestabilidad hemodinamica despues de la cirugia, fueron estudiados. Resultados Un total de 5 de entre 317 (1,6%) pacientes tuvieron hemorragia que requeria transfusion postoperatoria. En estos casos la media de tiempo operatorio fue de 114 min. La media de perdida estimada de sangre fue de 110 ml durante la operacion. En estos pacientes los niveles de hematocrito (Hct) gradualmente disminuyeron despues de la cirugia, y se detecto equimosis en las paredes laterales y posteriores del abdomen en el segundo dia. El Hct preoperatorio medio fue de 44,3% y el Hct medio mas bajo fue de 23,1%. Todos los pacientes fueron tratados exitosamente sin exploracion quirurgica. Conclusiones La prostatectomia radical robotica ha demostrado ser un tratamiento quirurgico seguro con baja morbilidad. Sin embargo, el sangrado postoperatorio puede llegar a problemas serios. Este es el primer estudio para explicar la hemorragia asociada con el posible riesgo de la cirugia robotica.

Osteopontin (OPN) is one of the urinary proteins with an important role in stone formation. Recently, OPN Ala250 (rs1126616) polymorphism and other single nucleotide polymorphisms (SNPs) have been studied to define their role in urolithiasis. This study was conducted to examine the impact of OPN Ala250 polymorphism on the risk of stone formation and their association with serum OPN levels. OPN Ala250 polymorphism was investigated in 127 urolithiasis patients and 92 healthy controls. Stones were analyzed for their chemical composition by using X-Ray diffraction method. Genomic DNA was isolated from peripheral blood leucocytes. The study groups were genotyped by PCR-RFLP and serum OPN levels were measured by ELISA. There was a significant difference between urolithiasis patients and controls concerning genotype and allele frequencies of OPN Ala250 (p 0.05). Separate analysis by BMI greater or less than 25 kg/m(2) showed that the presence of one mutant T-allele was more frequent in patients with higher BMI than patients with BMI less than 25 kg/m(2) (p 0.05). Serum OPN concentrations were two-fold higher in the control group compared to urolithiasis patients (p 0.05). But the mean serum levels did not show any significant difference between OPN Ala250 genotypes in both groups. Moreover, we found an association between higher BMI and stone formation. Our findings suggest that OPN Ala250 polymorphism is associated with the correlation between weight gain and urolithiasis. However, the correlation between urolithiasis and obesity needs to be further studied in larger cohorts.

Objectives To evaluate the potential benefits of laparoendoscopic single-site pyeloplasty over conventional laparoscopic pyeloplasty. Methods Between October 2009 and January 2012, 39 patients were enrolled in a prospective study and randomized to undergo a laparoendoscopic single-site pyeloplasty (n = 19) or conventional laparoscopic pyeloplasty (n = 20). The outcomes in the two groups were compared by using Mann-Whitney U-test and χ2-test, and considering a P-value less than 0.05 as statistically significant. Results There was no difference in blood loss (55.67 ± 6.71 vs 45.84 ± 5.22 mL, P = 0.60), transfusion rates (0% for both) and hospitalization time (2.12 ± 0.23 vs 2.06 ± 0.34 days, P = 0.72) between the laparoendoscopic single-site pyeloplasty and conventional laparoscopic pyeloplasty groups. The time to return to normal activities was shorter (8.65 ± 1.25 vs 11.53 ± 1.28 days, P = 0.01), and median operative time (195.21 ± 12.15 vs 145.62 ± 15.34 min, P = 0.001) was longer in the laparoendoscopic single-site pyeloplasty group compared with the conventional laparoscopic pyeloplasty group. No significant intraoperative or postoperative complications occurred in either group. Compared with conventional laparoscopic pyeloplasty, laparoendoscopic single-site pyeloplasty yielded better cosmetic results and patient satisfaction. The mean follow-up period was 19.7 months (4–28 months). The success rate was 95% in both the groups. Both the visual analog scale and the postoperative use of analgesics were significantly lower in patients who underwent laparoendoscopic single-site pyeloplasty. Conclusions Our findings suggest that laparoendoscopic single-site pyeloplasty can offer faster recovery and higher patient satisfaction than conventional laparoscopic pyeloplasty. Thus, this novel technique promises to become the treatment of choice in minimally-invasive management of ureteropelvic junction obstruction.

Objective:We aimed to present the outcomes of patients with symptomatic kidney stones treated with percutaneous nephrolithotomy (PNL) or retrograde intrarenal surgery (RIRS).Methods:The medical records of patients with symptomatic renal calculi treated with PNL or RIRS between November 2010 and May 2015 were obtained. Demographic characteristics such as age; sex; BMI; stone size and location; and perioperative data including operation, fluoroscopy, and hospitalization time; and success and complication rates were assessed.Results:Standard (n:336), mini-PNL (n:51), ultramini-PNL (n:37) and microperc (n:47) were performed for 471 renal units. RIRS was the treatment method for 290 renal unites. In the PNL group, the mean patient age was 44.5 (1–83) years and BMI was 26.9 kg/m2. The mean stone size was 27.6 mm. In the RIRS group, the mean age and BMI were 47.1 (1–86) years and 25.1 kg/m2, respectively. The mean operation, fluoroscopy, and hospitalization times were 70.0 (20–240) min, 45.1 (17–610) s, and 2.4 (1–20) days, respectively, in the PNL group. On the other hand, the mean operation, fluoroscopy, and hospitalization times were 62.5 (40–180) min, 29.8 (0–96) s, and 26.4 (12–120) h, respectively, in the RIRS group. Whine stone free status was achieved in 88% in the PNL group; this rate was lower (80%) in the RIRS group.Conclusion:Both PNL and RIRS are efficient minimally invasive methods with low morbidity and high success rates for the treatment of symptomatic kidney stone disease.

Background Penile fracture is a surgical emergency defined as rupture of the tunica albuginea. Although most cases can be diagnosed with clinical evaluation, it has been stated in the literature that diagnosis in as many as 15% of cases can be challenging. In uncertain cases, imaging can help determine diagnosis. Methods Present study included 20 cases where diagnosis could not be made with certainty and magnetic resonance imaging (MRI) was performed. MR images were examined for tunical rupture and accompanying pathologies. When rupture was observed, localization and length of rupture were noted. All patients underwent degloving surgery. All imaging findings were compared to surgical findings. Results MRI revealed 19 tunical ruptures. In 1 case, hematoma was seen with no sign of penile fracture. No urethral injuries were found. All MRI findings were confirmed during surgery. Conclusion Performing MRI in clinically equivocal cases can provide crucial data to make precise diagnosis and improve patient management.

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: There are 2 critical steps of stent placement during laparoscopic pyeloplasty (LP) in children. Introduction to the ureteropelvic junction and passing through the ureterovesical junction. We aimed at overcoming those 2 steps by creating a modified technique. Methods: Consecutive 27 children undergoing transperitoneal laparoscopic dismembered pyeloplasty by a single surgeon were prospectively enrolled into this study. The modifications of our technique are using an Amplatz dilator and a closed tip stent. Results: The mean age of the children was 6.7 (range 4 months-17 years). The mean time of stent insertion was 2.7 ± 2.0 (2-6) min and the operative time was 128.3 ± 17.6 (90-180) min. The mean number of days of hospital stay was 2.0 ± 0.4 (1-3). After a mean follow-up period of 20.3 ± 4.2 (14-30) months, no operative failure was detected. Conclusion: Our modified technique is a completion of the current armamentarium for stent placement during LP in infants and children.

The purpose of this study was to present our initial clinical experience with laparoendoscopic single-site surgery (LESS) for ureteropelvic junction (UPJ) obstruction.Between May and October 2009, 14 consecutive patients underwent LESS-pyeloplasty (LESS-P) by the same surgeon at our institution. All patients underwent single port transperitoneal Anderson-Hynes laparoscopic dismembered pyeloplasty using the single incision laparoendoscopic surgery port, inserted through a transumbilical incision. Ultrasonography, intravenous urography (IVU) or diuretic renal scan was performed at the third month and semiannually thereafter. Patients were examined clinically every 3 to 6 months, depending on the symptoms. Radiographic success was defined as improvement of hydronephrosis with a patent UPJ on IVU, or improved drainage on diuretic renal scan.Anterior crossing vessels, high insertion, and severe adhesion were found in seven (50%), five (35.7%), and two (14.3%) cases, respectively. The mean operating-room time, which includes cystoscopy with retrograde ureteral catheterization and open-end stent placement, was 204.5 minutes (range 160-300 min), and the mean estimated blood loss, including urine, was 102 mL (range 80-170 mL). Mean hospital stay was 2 days (range 1-3 d). Wound infection occurred in one patient. The mean follow-up period was 6.2 months (range, 3-8 mos). The success rate was 100%.With the advent of the single port and laparoscopic instrument technology, the LESS-P, as minimally invasive surgery, would take the place of the standard laparoscopic pyeloplasty, and it may be a new choice for the management of UPJ obstruction.

Laparoendoscopic single-site surgery (LESS), an attempt to further enhance the cosmetic benefits of minimally invasive surgery while minimizing the potential morbidity associated with multiple incisions, has been developed recently. Our aim was to compare LESS simple nephrectomy (LESS-SN) and conventional transperitoneal laparoscopic simple nephrectomy (CTL-SN).In this randomized study that was conducted between December 2008 and September 2009, 27 patients who needed simple nephrectomy were randomized to either LESS-SN or CTL-SN. All procedures in both groups were performed by the first author, who is experienced in laparoscopic surgery. Patient characteristics, perioperative details, and time to return to work were recorded. Postoperative evaluation of pain and use of analgesic medication were recorded.There was no difference in median operative time (117.5 vs 114 min, P = 0.52), blood loss (50.71 vs 47.15 mL, P = 0.60), transfusion rates (0% for both), and hospitalization time (2.07 vs 2.11 days, P = 0.74) between the LESS-SN and CTL-SN groups. Time to return to normal activities was shorter in the LESS-SN group compared with the CTL-SN group (10.7 vs 13.5 days, P = 0.001). Both the visual analogue scale and the postoperative use of analgesics were significantly lower during postoperative days 1, 2, and 3 in patients who underwent LESS-SN, compared with patients who underwent CTL-SN. There were no intraoperative or postoperative complications in both groups. Compared with CTL-SN, LESS-SN was more expensive, but all patients undergoing LESS-SN were very pleased with the cosmetic outcome (no visible scars).The early experience described in this study suggests that LESS-SN is a safe and effective alternative to CTL-SN that provides surgeons with a minimally invasive surgical option and the ability to hide the surgical incision within the umbilicus; however, a larger series is necessary to confirm these findings and to determine if there are any benefits in pain, recovery, or cosmesis.

Objective. Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is of significant interest in urology and unfortunately, the therapy modalities recommended are not fully effective. Therefore, we undertook a pilot study to determine whether acupuncture improves the pain, voiding symptoms, and quality of life in men with category IIIB CP/CPPS. Design. Prospective, one-group trial, cohort study. Setting. Outpatient urology clinic. Patients and Interventions. Ninety-seven CP/CPPS patients received six sessions of acupuncture to the BL-33 acupoints once a week. The National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI) was completed by each patient before and after the treatment and on 12th and 24th weeks following the treatment. Outcome Measures. Mean values of total CPSI score, pain subscore, urinary subscore, and quality of life subscore after the treatment and on follow-up after the treatment were compared with the baseline values. Results. There was a statistically significant decrease in all of the subscores evaluated at all periods compared with the baseline. Eighty-six patients out of 93 (92.47%) were NIH-CPSI responders (more than 50% decrease in total NIH-CPSI score from baseline) at the end of the treatment. Conclusions. The results of this study suggest that acupuncture appears to be a safe and potentially effective treatment in improving the symptoms and quality of life of men clinically diagnosed with CP/CPPS.

Shock wave lithotripsy (SWL) is commonly used for treatment of renal stones. Free oxygen radicals are involved in the pathophysiology of renal injury due to SWL. We investigated the protective effects of curcumin, which is an antioxidant and nuclear factor kappa-B (NF-kappaB) inhibitor, against renal injury. Forty-eight rats were included and divided into four groups: group 1, control; group 2, SWL (15 kW-1,500 shocks); group 3, SWL + curcumin (curcumin orally 75 mg/kg/day dissolved in 10% ethyl alcohol, 1 day before and 5 days after SWL); and group 4, SWL + vehicle (10% ethyl alcohol). The kidneys were removed on days 7 and 35 after SWL. A sample was fixed in formaldehyde solution. Renal tissues were examined for proximal tubular injury under light microscope. iNOS activity and active subunit of NF-kappaB, p65, were evaluated immunohistochemically using rat monoclonal antibodies interpreting results semiquantitatively. There were significant differences between SWL and control groups on days 7 and 35, considering histological changes under light microscope (P0.02). There was a significant decrease in necrosis and fibrosis in the curcumin group as compared to the SWL group. Expressions of iNOS and p65 on days 7 and 35 were at basal levels with immunohistochemical staining. These parameters had high levels in the SWL group (P0.02). No significant difference was present between the control and the curcumin groups (P0.02). Curcumin, decreasing expressions of iNOS and p65 and serum nitric oxide levels prevented interstitial, glomerular, tubular epithelial and endothelial cellular injuries. We suggest that curcumin, could be used, especially in high-risk patients, as a protective agent to prevent renal injury due to SWL.

To compare transurethral cystolithotripsy (TUCL) and percutaneous cystolithotripsy (PCCL) modalities performed during simultaneous transurethral resection of the prostate (TURP) in patients with prostate hyperplasia and large bladder stones.Sixty-three patients with prostate volume40 cc and aggregate stone size2.5 cm were enrolled in the study between August 2003 and February 2007. TUCL (n = 38) or PCCL (n = 25) procedures were performed during simultaneous TURP. In the TUCL group, the stones were removed after fragmentation through a 23F cystolithotripter with pneumatic lithotripsy. This was followed by TURP, performed with a 26F continuous-flow resectoscope. In the PCCL group, the stones were removed through a suprapubic 30F Amplatz sheath after fragmentation. TURP was then performed with the suprapubic sheath providing continuous drainage.Mean age and prostate volumes of the groups were similar. Mean aggregate stone sizes were significantly larger in the PCCL group. The operative time for stone removal was significantly less in the PCCL group while time needed for TURP was statistically similar in the two groups. In the TUCL group, three patients had residual stones necessitating repeated TUCL and urethral stricture developed in three patients.The smaller caliber of the working channel during TUCL, compared with PCCL, necessitates disintegration of the stones into smaller fragments. This elongates the duration of the intervention and results in increased urethral and bladder trauma. Combined TURP and PCCL is a safer, more effective, and much faster alternative to combined TURP and TUCL in patients with large bladder stones and prostate hyperplasia.

To evaluate the role of the inducible nitric oxide synthase (iNOS), selective nuclear factor-kB (NF-kB), and p38-mitogene-activated protein kinase (p38-MAPK) on hyperoxaluria-induced oxidative stress and stone formation in rat kidneys. The rats were divided into five groups: group 1, control group; group 2: ethylene glycol (EG) group; group 3: EG + pomegranate juice (PJ)-low group; group 4: EG + PJ-middle group; group 5: EG + PJ-high group. Rats were sacrificed on 7, 15, and 45 days. The iNOS expression, p65-NF-kB and p38-MAPK activity, and oxidative stress markers were evaluated in the kidney. Crystal depositions were evident on day 7, and mild and severe crystallization were observed on day 15 and 45 in EG group, respectively. There was limited or no crystal formation in rats in both middle- and high-dose PJ groups when compared to low-dose PJ group. Crystal depositions, iNOS, p38-MAPK and p65-NF-kB activity, and oxidative stress markers were found to be decreased by middle- and high-dose PJ treatment. PJ was found to have inhibitory effects on renal tubular cell injury and oxidative stress caused by oxalate crystals by reducing ROS, iNOS, p38-MAPK, and NF-kB expression.

We aimed to study the protective effects of pomegranate juice (PJ) on ethylene glycol (EG)-induced crystal deposition in renal tubules, renal toxicity, and inducible nitric oxide synthase (iNOS) and nuclear factor-kappaB activities in rat kidneys.Fifty-six rats were divided into four equal groups: Control, EG, EG + 50 microL PJ/d (PJ50), and EG + 100 microL PJ/d (PJ100). Rats were sacrified on days 10 and 45. Tissue sections were evaluated under light and polarized microscopy for the presence and degree of crystal deposition and toxicity in the kidneys. Crude extracts of the cortex were used to determine reduced gluthatione (GSH), nitric oxide (NO), and malondialdehyde (MDA) levels.In the EG group, crystal depositions were more evident and mild crystalization was observed in proximal tubules on day 10; severe crystalization and granulovacuolar epithelial cell degeneration were observed on day 45. There was limited or no crystal formation in the EG + PJ-given groups. There were completely normal renal and tubular structures in the control group. There was no significant difference between the four groups in serum levels of sodium, potassium, blood urea nitrogen, and creatinine in any sampling time. Hyperoxaluria, a marked increase in MDA and NO levels, and decrease of GSH were observed in the EG-given groups compared with the others. There were marked iNOS and p65 expressions in only the EG-given rats compared with control and PJ groups, immunohistochemically.This experiment shows the protective effect of PJ in the EG-induced crystal depositions in renal tubules.