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Background: Evidence-practice gaps exist in urology. We previously surveyed European Association of Urology (EAU) guidelines for strong recommendations underpinned by high-certainty evidence that impact patient experience for which practice variations were suspected. The recommendation “Do not offer neoadjuvant androgen deprivation therapy (ADT) before surgery for patients with prostate cancer” was prioritised for further investigation. ADT before surgery is neither clinically effective nor cost effective and has serious side effects. The first step in improving implementation problems is to understand their extent. A clear picture of practice regarding ADT before surgery across Europe is not available. Objective: To assess current ADT use before prostate cancer surgery in Europe. Design, setting, and participants: This was an observational cross-sectional study. We retrospectively audited recent ADT practices in a multicentre international setting. We used nonprobability purposive sampling, aiming for breadth in terms of low- versus high-volume, academic, versus community and public versus private centres. Outcome measurements and statistical analysis: Our primary outcome was adherence to the ADT recommendation. Descriptive statistics and a multilevel model were used to investigate differences between countries across different factors (volume, centre type, and funding type). Subgroup analyses were performed for patients with low, intermediate, and high risk, and for those with locally advanced prostate cancer. We also collected reasons for nonadherence. Results and limitations: We included 6598 patients with prostate cancer from 187 hospitals in 31 countries from January 1, 2017 to May 1, 2020. Overall, nonadherence was 2%, (range 0–32%). Most of the variability was found in the high-risk subgroup, for which nonadherence was 4% (range 0–43%). Reasons for nonadherence included attempts to improve oncological outcomes or preoperative tumour parameters; attempts to control the cancer because of long waiting lists; and patient preference (changing one's mind from radiotherapy to surgery after neoadjuvant ADT had commenced or feeling that the side effects were intolerable). Although we purposively sampled for variety within countries (public/private, academic/community, high/low-volume), a selection bias toward centres with awareness of guidelines is possible, so adherence rates may be overestimated. Conclusions: EAU guidelines recommend against ADT use before prostate cancer surgery, yet some guideline-discordant ADT use remains at the cost of patient experience and an additional payer and provider burden. Strategies towards discontinuation of inappropriate preoperative ADT use should be pursued. Patient summary: Androgen deprivation therapy (ADT) is sometimes used in men with prostate cancer who will not benefit from it. ADT causes side effects such as weight gain and emotional changes and increases the risk of cardiovascular disease, diabetes, and osteoporosis. Guidelines strongly recommend that men opting for surgery should not receive ADT, but it is unclear how well the guidance is followed. We asked urologists across Europe how patients in their institutions were treated over the past few years. Most do not use ADT before surgery, but this still happens in some places. More research is needed to help doctors to stop using ADT in patients who will not benefit from it.

Objective To compare the clinically significant prostate cancer (csPC)-detecting results of transperineal and transrectal targeted biopsy (TPTB and TRTB, respectively) by performing matching analysis. Patients and Methods This study has used the PC and prostate biopsy database from the Turkish Urooncology Association. A total of 1143 patients with Prostate Imaging-Reporting and Data System (PI-RADS) with >= 3 lesions on multiparametric magnetic resonance imaging (mpMRI) and who had received a software-guided transperineal/transrectal MRI/transrectal ultrasound (TRUS) fusion prostate biopsy with concomitant standard systematic 12-core biopsy were included in this study. csPC detection rates of the TP and TR approaches were compared following Mahalanobis distance matching within propensity score caliper method. The following four variables were selected as covariates for the matching procedure: age, digital rectal examination findings, PSA density, and the index lesion PI-RADS score. Results The matched sample included 508 TR and 276 TP patients. In both the TP and the TR groups, targeted biopsy was superior to systematic biopsy in detecting csPC (27.5% vs. 24.6%, p < 0.001 and 19.5% vs. 16.3%, p < 0.0001, respectively). Both TPTB and TP systematic biopsy was found to be superior to TRTB and TR systematic biopsy in terms of csPC detection (27.5% vs. 19.5%, p = 0.012 and 24.6% vs. 16.3%, p = 0.006). In patients with an anterior index lesion, an apical index lesion, and a larger prostate, the superiority of TPTB to TRTB was found to be more prominent in terms of csPC detection (37.8% vs. 18.3%, p = 0.044; 34.6% vs. 14.7%, p = 0.002; and 25% vs. 5.1%, p = 0.033, respectively). Conclusion Targeted biopsy was found to be superior to systematic biopsy in detecting csPC in both the TP and the TR approaches. The TP approach is preferred because of its clear superiority in detecting csPC in targeted biopsy, especially in patients with anterior and apical lesions and with larger prostates.

The aim of this study was to evaluate the adjuvant treatment preferences and effects on disease progression in patients with pathologically positive lymph node prostate cancer.Patients who underwent radical prostatectomy from the prostate cancer database of the Turkish Urooncology Association with lymph node involvement were included in the study. Database includes prostate cancer patients from many experience Urooncology centers of Turkey. Adjuvant treatment approaches and the factors that effect the PSA recurrrence was analysed.Postoperative median 2 (1-3) lymph nodes were found to be positive, and the median lymph node density was reported as 0.13 (0.07-0.25). Seventy-four percent of patients received adjuvant treatment postoperatively. Seventy four of the patients (46.54%) received hormonal therapy in combination with radiotherapy; 47 of them (29.55%) received only hormonal treatment and 20(12.57%) only received radiotherapy. The number of lymph nodes removed was less in the group requiring adjuvant treatment, and this group had a higher rate of surgical margin positivity and seminal vesicle invasion. In addition, adjuvant treatment group had a statistically significant higher lymph node density. There was no significant difference in Kaplan-Meier method comparing 5-year PSA recurrence-free survival in patients with and without adjuvant therapy. When the patient clustered as non-adjuvant, only hormonal therapy and hormonal therapy with radiotherapy, a significant survival advantage was found in the hormonal therapy with radiotherapy group compared to the other two groups (p=0.043).No significant difference was found between two groups in terms of time until PSA recurrence during our follow-up. In subgroup analysis survival advantage was found in the hormonal therapy with radiotherapy group compared to non-adjuvant and only hormonal therapy groups.

Objective: To determine whether clinical or radiological parameters can predict clinically significant prostate cancer (csPC) in patients with the Prostate Imaging Reporting and Data System (PI-RADS) 3 lesions. Patients and Methods: Data were obtained from 247 patients with PI-RADS 3 lesions on mpMRI and who had received a soft-ware guided transperineal/transrectal MRI/transrectal ultrasonography (MRI/TRUS) fusion prostate biopsy with concomitant standard systematic 12-core biopsy following mpMRI in the prostate cancer and prostate biopsy database of Turkish Uroon-cology Association, between 2016 and 2020. The cut-off values of clinical parameters were determined using receiver operating characteristic (ROC) curve analysis. Simple and multiple logistic regression analyses were performed to determine the clinical parameters in predicting csPC. Results: A total of 56 patients (22.6%) had prostate cancer, 23 (9.3%) of whom had csPC. In the lesion-based analysis, cancer detection rates (CDRs) of each lesion in targeted biopsy were found to be 6% and 5% for ISUP GG 1 and ISUP GG >= 2, respectively. In the patient-based analysis, clinically insignificant CDRs were significantly higher in systematic biopsy compared with targeted biopsy, whereas no significant difference was found in terms of clinically significant CDRs (p = 0.020 and p=0.422, respectively). The cut-off values were determined as 48.3 mL (AUC [95% CI] = 0.68 [0.53-0.82]) for prostate volume, and 0.213 ng/mL/mL (AUC [95% CI] = 0.64 (0.51-0.77]) for PSAD in predicting csPC. In the multiple logistic regression analysis, only PSAD was found to be an independent risk factor in predicting csPC (OR [95% CI]: 3.56 [1.15-10.91], p = 0.024). Conclusion: Since PSAD > 0.20 ng/mL/mL was found to be positive independent risk factor in predicting csPC, in the absence of advanced radiological parameters, PSAD could be used for the biopsy decision in patients with PI-RADS 3 lesions.

Chronic periaortitis (CP) is a less known but more frequently diagnosed fibro-inflammatory disorder, but we know little about it and data regarding follow-up and outcome are still very limited. This study aims to identify the clinicopathologic, laboratory, and radiologic features, as well as outcomes of CP patients.Patients with CP from HUVAC database were included in the study. CP was diagnosed based on compatible imaging findings and histopathological evaluation (if available), in addition to clinical findings. Demographics, laboratory, clinical, and imaging data were retrospectively reviewed from medical records.A total of 51 (male/female:37/14) patients were included in the study. Median (IQR) age was 63 (53-69) years and follow-up duration was 40 (4-60) months. 32 of the patients were IgG4-related CP. The most common form of CP in our cohort was idiopathic retroperitoneal fibrosis (82%), followed by inflammatory abdominal aortic aneurysms (12%) and peri-aneurysmal retroperitoneal fibrosis (8%). 8 (15.6%) patients had thoracic periaortitis and 16 (31.6%) venous involvement. Cyclophosphamide (CYC) combined with steroids was the most preferred treatment modality (43%), followed by rituximab (RTX) (31.3%). Follow-up imaging was done after a median (IQR) of 7(3-11) months, 30% of the patients were stable and 64.1% showed regression. A total of 18 (35.2%) had been taken off therapy at the last visit.Idiopathic retroperitoneal fibrosis was the most frequent presentation, whereas 15.6% of patients had thoracic involvement. Venous involvement was also not uncommon. Optimal time for follow-up imaging was determined as 6-9 months. Steroids along with CYC/RTX had a favourable outcome in the treatment of these patients.

Purpose To evaluate the effect of risk factors and selected surgical methods on operative and oncological results of patients undergoing radical prostatectomy (RP) with high-risk prostate cancer (HRPC). Methods Retrospective analysis of patients who underwent RP for HRPC from 13 urology centres between 1990 and 2019 was performed. Groups were created according to the risk factors of D'Amico classification. Patients with one risk factor were included in group 1 where group 2 consisted of patients with two or three risk factors. Results A total of 1519 patients were included in this study and 1073 (70.6%) patients were assigned to group 1 and 446 (29.4%) patients to group 2. Overall (biochemical and/or clinical and/or radiological) progression rate was 12.4% in group 1 and 26.5% in group 2 (P = .001). Surgical procedure was open RP in 844 (55.6%) patients and minimally invasive RP in 675 (44.4%) patients (laparoscopic and robot-assisted RP in 230 (15.1%) and 445 (29.3%) patients, respectively). Progression rates were similar in different types of operations (P = .22). Progression rate was not significantly different in patients who either underwent pelvic lymph node dissection (PLND) or not in each respective group. Conclusion RP alone is an effective treatment in the majority of patients with HRPC and PLND did not affect the progression rates after RP. According to the number of pre-operative high-risk features, as the number of risk factors increases, there is a need for additional treatment.

Background/aim: Since the majority of the IgG4-related disease (IgG4-RD) patients in the literature are from the Far East and the United States, there is a lack of large series from other parts of the world. We aimed to identify the clinical characteristics and outcome of Turkish IgG4-RD patients from a tertiary center. Materials and methods: Fifty-two patients classified as having definite IgG4-RD according to comprehensive diagnostic criteria were included in the study. Patients not fulfilling the definite criteria due to lack of pathologic specimen and/or serum IgG4 levels were excluded (n = 47). Clinical, laboratory, and histopathological features and treatment approaches were analyzed. Results: Median age at diagnosis was 51.1 years and sex predominance was not observed (male/female: 26/26). Median follow-up duration was 18 (IQR 25–75: 8–35) months. Retroperitoneal fibrosis was the most frequent presentation. Twenty-four (46.1%) patients had localized involvement. Corticosteroids were the mainstay of treatment (92.5%). Rituximab had been used for cases resistant to previous treatment or with relapses in 19 (47.5%) patients. A complete response was achieved in 52.5% and partial response (

Purpose: We tried to establish the predictive factors influencing the initial response, as well as its duration, and time to castration resistance (CR) for primary advanced prostate cancer (PC) with bone metastasis. Methods: We evaluated all patients initially receiving androgen deprivation therapy (ADT) for primary advanced PC with bone metastasis. A total of 982 patients with complete medical records available for analysis from 18 centers were included in this study. Age, initial PSA, Gleason score (GS) and extent of bone involvement (EBI) were recorded in a database. Results: Among all the patients, 896 (91.2%) responded to ADT initially. Pretreatment PSA and EBI were significant predictors in the multivariate model. Among the 659 patients who progressed into a CR state, the mean duration of response was 22.4 months. There was a significant correlation between the CR state and nadir PSA (nPSA) level and time to nPSA. Pretreatment PSA, EBI, GS, highest tumor volume in biopsy cores (%), number of positive biopsy cores, percent positive biopsy cores and time to nPSA were proven to be significant to predict a nPSA. Pretreatment PSA, GS and EBI were statistically significant predictors of PSA normalization in multivariate analysis. The limitation of the study depends on the retrospective design and a model was developed for low standardization as a result of using multicenter data. The patients enrolled in this study were from a relatively long period of time (1989–2008). Conclusions: The results of this study indicate that it is possible to predict the initial response to ADT by pretreatment PSA levels and EBI, while the duration of response can be reflected by a multitude of clinical factors including nPSA, TTnPSA, percent positive cores, biopsy GS and EBI.

Amaç: Bu çalışmada kliniğimizde üst üriner system taşı nedeniyle perkütan nefrolitotomi (PNL) uygulaması yapılan hastaların sonuçlarının değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Mart 2006 ile Eylül 2008 tarihleri arasında 154 renal üniteye PNL yapıldı. Olguların 126’sına subkostal, 24’üne interkostal giriş uygulandı. Perkütan girişim C kollu floroskopi altında hastalara yüzüstü pozisyon verilerek yapıldı. Amplatz dilatatörler kullanılarak giriş yolu oluşturulduktan sonra 26F rijid nefroskop ile girilerek taşlar alındı. Bir hastaya bilateral eşzamanlı, diğerlerine tek taraflı PNL yapıldı. İki hastaya tüpsüz PNL yapılırken diğerlerine işlem sonrası nefrostomi katateri yerleştirildi. Olgular ilk yapılan 77 (Grup 1) ve son yapılan 77 (Grup 2) renal ünite olarak 2 grupta incelendi. Bulgular: Ortalama taş yüzey alanı 559 (min:156mak:2958) mm2 ve ortalama ameliyat süresi 112±44 (min:40-mak:250) dakika idi. Tüm hastalar için taşsızlık oranı %71.1, 4 mm.den küçük taşalr klinik olarak önemsiz kabul edildiğinde %86.6 idi. Kısmi ve komplet staghorn taşların sırasıyla %28.6 ve %42.8’inde başarısızlık gözlendi. Atnalı böbrek anomalisi olan hastalarda taşsızlık oranı %85.8, çocukluk yaş grubunda ise %100 olarak gerçekleşti. Toplam 19 hastada (%12.3) transfüzyon gerektiren kanama ve 4 hastada uzamış drenaj gözlendi. Ciddi komplikasyon olarak 1 hastada perirenal hematom ve 1 hastada hidrotoraks gelişti. Grup 2 hastalarda interkostal girişin anlamlı ölçüde fazla yapıldığı, hastanede kalış süresinin daha kısa olduğu ve komplikasyon oranının anlamlı ölçüde daha az olduğu gözlendi. Sonuç: PNL böbrek taşlarının tedavisinde güvenli ve etkin bir yöntemdir. Uygun hasta seçimi ile birlikte kazanılan deneyim ile başarı oranı artmaktadır

Ultrasonografî kılavuzluğunda yapılan prostat biyopsisi prostat kanseri tanısı için standart yöntemdir. Bu anketin amacı, Türkiye'deki üroloji uzmanları arasında ultrasonografî kılavuzluğunda yapılan prostat biyopsilerindeki hasta hazırlığı ve biyopsi teknikleriyle ilgili farklılıkların araştırılmasıdır. Temmuz 2004'te prostat biyopsi protokollerini sorgulamak amacıyla, Üroonkoloji Derneği Üyeleri'nin e-posta adresine bir anket formu gönderildi. Anket formundaki sorular çoktan seçmeli olup, prostat biyopsilerindeki hasta hazırlığı ve teknikleri sorguluyordu. Cevaplar yine aynı yolla toplandı ve değerlendirildi. Ankete 24 merkezden 32 üroloji uzmanı katıldı. Bu merkezlerde prostat biyopsileri sadece üroloji uzmanları (%54.16), üroloji ve radyoloji uzmanı beraber (%37.5) ve sadece radyoloji uzmanları (%8.33) tarafından yapılıyordu. Ultrasonografî kılavuzluğunda yapılan prostat biyopsileri büyük çoğunlukla transrektal yolla yapılıyordu. Merkezlerin %50'si biyopsi yapmak için PSA eşik değeri olarak 4 ng/ml'yi kullanıyordu. Biyopsi öncesi hazırlıkta bütün merkezler antibiyotik başlarken; yaklaşık yarısı bağırsak hazırlığı yapmaktaydı. Merkezlerin %37.5'i işlem sırasında analjezik kullanmazken; %29.1'i ağrıyı azaltmak için periprostatik sinir blokajı uyguluyordu. Üroloji uzmanlarının çoğu ilk biyopsilerde 10 veya 12 odaktan biyopsi alırken; %20.8'i rutin olarak transizyonel zon biyopsisi yapıyordu. Bu anket, Türkiye' deki üroloji uzmanları arasında ultrason kılavuzluğunda yapılan prostat biyopsilerinde hasta hazırlığı ve biyopsi teknikleriyle ilgili bir standardizasyon olmadığını ve bunun için bir kılavuz gerektiğini göstermektedir., Introduction: Ultrasound-guided prostate biopsy is the standard method for the diagnosis of prostate cancer. The aim of the present survey is to assess the variability in patient preparation and technique of ultrasound-guided prostate biopsy among Turkish Urologists. Materials and Methods: In July 2004, a questionnaire was sent out to e-mail addresses of the members of Urooncological Association, asking about the details of prostate biopsy protocol of the members. The survey consisted of multiple choice questions about the patient preparation and prostate biopsy technique. Responses were acquired via e-mail and analyzed in detail.Results: Thirty two urologists from 24 centers responded. The biopsy procedure was performed by the urologist only in 54.16% of the centers, both urologist and radiologist in 37.5%, and radiologist only in 8.33%. Transrectal route was the most common method for ultrasound-guided prostate biopsy. A half of the responders performed biopsy when PSA was greater than 4 ng/ml. All of the centers administered antibiotic and a half of them used enema before the procedure. Approximately 37% of responders did not administer any type of analgesia, but 29.1% of all responders administered a periprostatic nerve block for reducing painduring the procedure. Most urologists obtained 10 or 12 biopsy cores and only 20.8% of them obtained routine transitional zone biopsy during the initial biopsy session. Conclusion: This survey demonstrated that patient preparation and technique of ultrasound-guided prostate biopsy is not standardized among Turkish Urologists, and a guideline on prostate biopsy is needed.

Objective: To compare the effects of flexible and rigid cystoscopy on quality of life, pain perception and lower urinary tract symptoms.Material and Methods: A total of 168 patients with bladder tumor history were prospectively randomized to flexible and rigid cystoscopy arms. For the quality of life assessment, a cancer specific module was administered just before and one week after cystoscopy. The expected and experienced pain was recorded by a visual analogue scale before and immediately after the procedure. Lower urinary tract symptoms were assessed using the International Prostate Symptom Score before and 2, 7 and 30 days after the procedure. Results: Of the 168 patients, 140 were eligible for the study and responded to the questionnaires. Of these, 69 and 71 patients were from the flexible and rigid arms, respectively. The mean visual analogue scale scores after the procedure were significantly lower for the flexible arm compared to the rigid arm 2.57±1.83 and 4.48±2.18, respectively, p, Amaç: Fleksible ve rijid sistoskopinin; hayat kalitesi, ağrı skorlaması ve alt üriner sistem semptomları üzerine etkilerini karşılaştırmak. Gereç ve Yöntemler: Mesane tümörü öyküsü olan 168 hasta, prospektif olarak fleksible ve rijid sistoskopi kollarına randomize edildi. Yaşam kalitesi değerlendirmesi için, sistoskopi öncesinde ve bir hafta sonrasında kanser spesifik bir modül kullanıldı. Beklenen ve yaşanan ağrı, işlem öncesinde ve hemen sonrasında görsel bir analog skala ile kaydedildi. Alt üriner sistem semptomları, prosedürden önce ve prosedürden 2,7 ve 30 gün sonra Uluslararası Prostat Semptom Skoru ile değerlendirildi. Bulgular: Çalışmaya katılan 168 hastadan, 140’ı uygun bulunarak değerlendirildi. Sırasıyla, 69 ve 71 hasta fleksible ve rijid kollardandı. İşlem sonrası yaşanan ortalama ağrı skorları, fleksible kol için rijid kola kıyasla anlamlı derecede düşüktü sırasıyla, 2,57 ± 1,83 ve 4,48 ± 2,18, p