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Background: The aim of the study is to examine the effect of peritoneal re-approximation or non-approximation on the postoperative course of patients at the end of transperitoneal robot-assisted ra...

We aimed to present our experience of robot-assisted laparoscopic radical prostatectomy (RARP).The study was a retrospective review of 500 patients who underwent RARP between March 2015 and July 2021 in our clinic. A transperitoneal approach was used in all patients. All patients had clinically organ-confined prostate cancer (≤ cT2c).The mean age of the patients was 64.6 ± 5.7 years. The median PSA was 11.4 ng/dL (range 0.3-92.7). The mean operative time was 183.5 min. Positive surgical margin rate was 19.4%. During a mean follow-up of 23.5 months, 96 patients (19.2%) received adjuvant radiotherapy due to the biochemical recurrence and 28 patients (16%) with lymph node positivity received early adjuvant hormone therapy. Considering the continence rates, 69% of the patients were total continence in the 3RARP is a safe and feasible method for experienced centers with patient comfort, surgeon comfort, and successful oncological and functional results.Nuestro objetivo fue presentar nuestra experiencia de prostatectomía radical laparoscópica asistida por robot (RARP).El estudio fue una revisión retrospectiva de 500 pacientes que se sometieron a una (RARP) entre marzo de 2015 y julio de 2021 en nuestra clínica. En todos los pacientes se utilizó un abordaje transperitoneal. Todos los pacientes tenían cáncer de próstata limitado al órgano clínicamente (≤ cT2c).La edad media de los pacientes fue de 64.6 ± 5.7 años. La mediana de PSA fue de 11.4 ng/dL (rango 0.3-92.7). El tiempo operatorio medio fue de 183.5 min. La tasa de márgenes quirúrgicos positivos fue del 19,4%. Durante un seguimiento medio de 23.5 meses, 96 pacientes (19.2%) recibieron radioterapia adyuvante debido a la recurrencia bioquímica y 28 pacientes (16%) con ganglios linfáticos positivos recibieron terapia hormonal adyuvante temprana. Considerando las tasas de continencia, el 69% de los pacientes tenían continencia total en el 3er mes, mientras que esa tasa aumentó a 83 en el 6° mes y 91% en el 12° mes.RARP es un método seguro y factible para centros experimentados con comodidad para el paciente, comodidad para el cirujano y resultados oncológicos y funcionales exitosos.

Background:. To evaluate the changes in penile sensation by electrophysiological tests in patients who underwent radical prostatectomy (RP) and to demonstrate the role of dorsal penile nerve injury in postoperative erectile dysfunction. Materials and methods:. Twenty-six volunteer patients who were eligible for RP were included in the study. Preoperative penile sensory electromyography and the International Index of Erectile Function-5 (IIEF-5) questionnaire were done for each patient. Erectile function assessment and electrophysiological evaluation of penile sensation were repeated at postoperative 3rd and 6th months. Results:. Postoperative IIEF-5 scores and electromyography values were significantly lower than preoperative findings (p 0.05). Conclusions:. Patients who underwent RP have decreased penile sensation due to cavernous nerve damage and a possible dorsal penile nerve injury. The decrease of penile sensation may be associated with postoperative erectile dysfunction.

OBJECTIVE: This study aimed to assess the utility of the radius, exophytic/endophytic, nearness, anterior/posterior, location (RENAL); preoperative aspects and dimensions used for an anatomic evaluation (PADUA), and centrality index (C-index) scores for the outcomes of partial nephrectomy (PN). MATERIAL AND METHODS: The patients who underwent PN with contrast-enhanced preoperative imaging from January 2015 to June 2018 were identified. The RENAL, PADUA, and C-index scores were assigned. The correlation between these scoring systems and perioperative and long-term renal functional outcomes were evaluated. RESULTS: A total of 78 patients were included in the study (58 men and 20 women; age, 58±11.4 years). Median warm ischemia time (WIT), estimated blood loss (EBL), and operation time (OT) were 26 min, 115 mL, and 140 min, respectively. The RENAL score was related to WIT, EBL, and OT (p

Introduction: Penile metastasis ofrectum cancer is very rare. There are only 40 cases in the literature. In this case report, we aimed to present a caseof penile metastasis of rectum cancer which is very rare in the literature.Case Report: We report a case of a 70years old patient who presented with urinary retention and painful ulceratednodules on the penis. He had undergone low anterior resection for rectum cancerafter neoadjuvant chemotherapy 3 years previously. We performed an 18F-labeledfluoro-2-deoxyglucose Positron Emission Tomography (18F-FDG PET/CT). It revealed that there was recurrence atpelvic area and metastasis on the penis. Biopsy of the nodules showed penilemetastasis of rectum cancer.Conclusion: Despite its rich bloodsupply and closeness to the pelvic organs, penile metastasis is very rare.Metastatic spreading mechanism is not well established. Penile metastasis has avery poor prognosis and there is insufficient data for the treatment of penilemetastasis in the literature. Palliative treatments should be considered withor without survival benefits., Amaç: Rektumkanserinin penise metastazı oldukça az görülen bir olgudur. Biz bu olgusunumunda literatürde sınırlı sayıda bildirilmiş ve çok nadir bir olgu olan rektumkanserinin penise metastazı olgumuzu sunmayı hedefledik.Olgu : 70yaşında erkek hasta tarafımıza akut üriner retansiyon ve penis üzerinde ağrılıülsere lezyonlar ile başvurdu. Hastanın 3 sene önce rektum kanseri nedeniyle neoadjuvankemoterapi ve ardından aşağı anterior rezeksiyon ameliyatı geçirdiği öğrenildi.Çekilen PET BT’ de pelvik bölgede nüks ve penis üzerinde metastastik nodüller görüldü.Penis üzerindeki nodüllerden alınan eksizyonel biyopside rektum kanserininpenise metastazı olduğu histopatolojik olarak anlaşıldı.Sonuç: Zengin kanlanmasına ve pelvik organlara yakınlığınarağmen, penis metastazı çok nadir görülür. Penise metastatik yayılımınmekanizması tam anlaşılamıştır. Çok kötü prognozludur veliteratürde penis metastazı tedavisi için yeterli veri yoktur. Tedavide palyatif tedaviler sağkalım faydalarıolsun veya olmasın düşünülmelidir.

Aim:To analyze the role of De Ritis (aspartate aminotransferase/alanine aminotransferase) ratio in predicting biochemical recurrence (BCR) after radical prostatectomy (RP).Methods:We retrospectively evaluated 425 patients with localised prostate cancer who underwent RP from 2009 to 2018. Patients with neo-adjuvant treatment, elevated liver enzymes, postoperative early hormone therapy, incomplete clinicopathological data and a follow-up of less than 6 months were excluded from the study. Demographic, clinical, pathological and follow-up data of the patients were recorded. Patients with and without BCR were compared. Sensitivity and specificity of De Ritis ratio in predicting BCR were calculated.Results:According to the maximum value of the Youden index, optimal threshold of De Ritis ratio for BCR was 1.1. Sensitivity, specificity, positive predictive value and negative predictive value were 69.7%, 61.1%, 37.6% and 85.7%, respectively. Multivariate analysis showed that the De Ritis ratio (HR=1.968, p=0.014) was a significant predictor factor for BCR. BCR-free survival rate was significantly lower in patients with higher De Ritis ratio.Conclusion:Our study suggests that elevated De Ritis ratio and detailed pathological findings could be an independent predictive factor for BCR after RP.

Objective:The aim of this study was to assess the usefulness of neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR) and neutrophil-to-monocyte (NMR) as biomarkers in men who had a prostate-specific antigen (PSA) level of 4 to 10 ng/mL and who subsequently underwent prostate biopsy.Materials and Methods:We retrospectively analyzed the records of 546 patients who underwent multicore (≥12) TRUS-guided biopsy at our institution between April 2010 and November 2017. Age, PSA level, f/t PSA, NLR, PLR, LMR, NMR, Gleason score in patients with prostate cancer (PCa) and biopsy results were collected. Histological results were categorized into three groups as benign prostatic hyperplasia, prostatitis and PCa.Results:The median age of patients was 64 years. The mean total PSA level and f/t PSA ratio were 6.52±1.76 and 0.2±0.09, respectively. The mean NLR, LMR, PLR and NMR were 2.46±1.46, 3.94±2.07, 120.69±60.73 and 8.52±7.97, respectively. The f/t PSA ratio in the PCa group was significantly lower compared to the other two groups (p

Nephrometry scores are designed to characterize tumors and stratify the surgical complexity. It remains unclear as to which nephrometry score can accurately predict the surgical outcomes. We aimed to assess the utility of radius, exophytic/endophytic, nearness, anterior/posterior, location (RENAL), preoperative aspects and dimensions used for anatomic classifications (PADUA), and centrality index (C-index) nephrometry scores for predicting the strict Trifecta achievement from a single institution series robotic-assisted partial nephrectomy (RAPN). We retrospectively identified the prospectively maintained robotic surgery database records of 91 patients who underwent RAPN between June 2015 and September 2020 in Antalya Training and Research Hospital. The main outcome of the study was the achievement of strict Trifecta (negative surgical margin, no major urologic complications, warm ischemia time ≤25 min, and ≥85% preservation of estimated glomerular filtration rate). A multivariable analysis was performed to identify the factors of strict Trifecta success. The mean patient age was 55.82 ± 13.37 years with a median clinical tumor size of 3.5 cm (IQR 2.5–4.9). The median RENAL, PADUA, and C-index score were 7(IQR 6–8), 8(IQR 7–10), and 2.01(IQR 1.64–2.72), respectively. A strict Trifecta could be achieved in 54 patients (59.3%). Clinical tumor size (P = 0.011), RENAL risk groups (low:reference; intermediate; P = 0.040; high; P = 0.009), PADUA risk groups (low:reference; intermediate; P = 0.044; high; P = 0.001) and C-index risk groups (low:reference; high; P = 0.015) were the independent predictors of strict Trifecta attainment in the multivariate analysis. None of the nephrometry scores were a superior predictor compared to other nephrometry scores in comparative analysis. RENAL, PADUA, and C-index scores were all independent predictors of a strict Trifecta achievement. Our comprehensive comparison of the three scores identified that none of the nephrometry scores proved to be inferior to others nephrometry scores.

Port-site metastasis (PSM) have gained importance due to increasing number of robot-assisted radical cystectomy (RARC). To the best of our knowledge, there are 13 cases in the literature, with only one reporting, treatment modality and oncological outcome. There is no consensus about the treatment for PSM developing after RARC. Here, we report a PSM occurring in the early period after RARCand recommend a treatment modality.

Objective:To investigate the validity and reliability of the Fournier’s gangrene severity index (FSGI) and Uludag Fournier’s gangrene severity index (UFGSI) scoring systems and their components in outcome prediction for patients with Fournier’s gangrene.Materials and Methods:Recods of 87 patients, who were diagnosed with Fournier’s gangrene in our clinic between March 2005 and May 2016, were retrospectively analyzed. The patients were divided into 2 groups as survivors and non-survivors. Parameters belonging to the groups were compared.Results:The overall mortality rate was 13.7%. There was no correlation between mortality and dissemination of disease to the rectum, lower abdomen or lower extremity (p>0.05). There was a significant difference in renal failure, heart rate, blood urea nitrogen, creatinine, calcium and serum bicarbonate (HCO₃) values, and FSGI and UFGSI scores between the survivor and non-survivor groups (p

The aim of this study is to assess the erectile function of patients before and after transrectal ultrasound prostate biopsy comparatively in order to determine the appropriate time to evaluate erectile function before radical prostatectomy. A total of 44 patients underwent transrectal ultrasound biopsy. We used the International Index of Erectile Function-5 questionnaire to assess all the patients. In total, 44 volunteered patients were included in this study. All patients were evaluated with the International Index of Erectile Function-5 questionnaire before the biopsy and at 4 weeks after the transrectal ultrasound biopsy. A total of 50% of patients were potent before the biopsy was done. A month after the biopsies, erectile dysfunction was reported by 29 of 44 patients (66%) as mild in 10 (22.7%), as mild-moderate in 14 (31.8%), as moderate in 4 (9.1%), and severe in 1 (2.3%). The differences were statistically significant in the first month of the biopsy ( p

We aimed to investigate the effects of intra-abdominal pressure and steep Trendelenburg position on the intrarenal vascular parameters and estimated glomerular filtration rate (eGFR) in the first 24 hours of robot-assisted radical prostatectomy (RARP) surgery.We prospectively studied 31 men who underwent RARP for prostate cancer in our clinic between September and December 2017. Preoperative color Doppler ultrasonographic (CDUS) measurements of renal intravascular parameters were obtained 24 hours before the operation. Similarly, postoperative CDUS measurements were performed 24 hours after RARP. Preoperative serum creatinine (Cr) level and eGFR were noted. On the postoperative first day, serum Cr levels were checked and eGFR was calculated.The mean age of men was 61.9 years, and the mean operation time was 268.5 minutes. No significant differences between preoperative and postoperative intrarenal vascular parameters were observed (P .05). Serum creatinine was significantly increased (P = .019), but eGFR did not change statistically significant after RARP (P = .144). While the change in the mean resistive index (ΔRI) was affected by intravenous (i.v.) infused fluid volume and renal width; the change in the mean pulsatility index (ΔPI) was only affected by renal width. Also, the change in the mean peak systolic velocity (ΔPSV) was related to age, i.v. infused fluid volume, and renal parenchymal thickness. Finally, the change in the mean end-diastolic velocity (ΔEDV) was related to age and renal width.Renal functions and intrarenal vascular parameters return to baseline levels 24 hours after RARP.

Objective:To present our experience of 267 consecutive patients treated with robotic-assisted laparoscopic prostatectomy (RALP) and assess the perioperative and postoperative outcomes.Materials and Methods:Materials and Methods: We retrospectively analyzed the data of 267 men who underwent RALP in our clinic between March 2015 and April 2018. Preoperative clinical data including age, serum prostate-specific antigen (PSA), biopsy Gleason score, and number of positive cores were noted. Perioperative parameters such as operative time and intraoperative complications were recorded. Postoperative parameters including hematocrit change, length of hospital stay, and catheter removal date were noted. Pathological outcomes included pathological Gleason score; positive surgical margin (PSM) status; extracapsular, lymphovascular, perineural, and seminal vesicle invasion; and lymph node positivity. The Clavien-Dindo system was used to classify surgical complications.Results:The mean age of the patients was 64.2±6.4 years and the median PSA was 8.27 ng/dL. The mean operative time was 196.4±59.4 min and median hematocrit decrease was 3.9%. The overall PSM rate was 21.34% and this rate increased significantly with final pathological stage from 12.97% for pT2 to 35.48% for pT3 (p

Objective To report our initial experience and short-term results in post-chemotherapy robot-assisted retroperitoneal lymph node dissection (RA-RPLND) for advanced testicular cancer. Material and methods We analyzed prospectively collected data of 5 patients who underwent post-chemotherapy RA-RPLND between August 2017 and May 2018. All patients had a diagnosis of non-seminomatous germ cell tumor (NSGCT) of testis and received three or four cycles of BEP chemotherapy for their clinical stage IIC disease before the surgery. Perioperative parameters (operation time, estimated blood loss and intraoperative complications) and postoperative findings (change in hematocrit, duration of hospitalization and postoperative complications) were noted. Pathological outcomes and postoperative radiological imaging in the 3rd month were investigated. Results RA-RPLND was completed successfully in all patients, and none of them required conversion to open surgery or early intervention. The median operation time was 309 minutes (range, 275-360), and median estimated blood loss was 180 mL (range, 150-210). One patient required postoperative transfusion of 1U red blood cells. The histologic examination of the specimens revealed necrosis in 3, and mature teratoma in 2 patients. The median hospitalization time after surgery was 2 days. During a median follow-up of 10 months (range 7-12), there were no retroperitoneal recurrences or distant metastasis in radiological imaging. No major complication (Clavien ≥3) or death occurred. The only minor complication was transfusion of red blood cells in one patient (Clavien 2) and the overall complication rate was 20 percent. Conclusion Post-chemotherapy RA-RPLND appears to be a feasible and oncologically safe procedure with acceptable operative morbidity. However, this technique should be applied in centers highly experienced in robotic surgery, considering that RPLND is a surgery with fatal complications.

Objective:The aim of this study is to analyze the complications of all robot-assisted surgeries performed in our clinic and to investigate the effect of the learning curve on complications occurred.Materials and Methods:Data on a total of 342 robotic surgeries performed in our clinic between March 2015 and February 2018 was retrospectively analyzed. Two surgeons, who performed the surgery, were experienced in urological laparoscopic procedures. Intraoperative and postoperative complications were evaluated. According to the experience of robotic surgery, the complications were divided into two groups as those occurred in the first 18 months (March 2015-August 2016) and in the second 18 months (September 2016-February 2018). The complications were classified according to the Clavien-Dindo classification.Results:A total of 32 complications occurred in 31 of 342 patients undergoing robot-assisted surgery. The overall complication rate was 9.4%. The number of minor complications was 20 (62.5%), and the number of major complications was 12 (37.5%). Among all, 6.2% were intraoperative complications, 62.5% were postoperative complications, and 31.3% were medical complications. It was observed that the number of complications was plateaued after August 2016 and there was a statistically significant difference between the first and the second 18 months (p

Objective:Due to the widespread usage of prostate-specific antigen screening, the number of patients diagnosed with prostate cancer is steadily increasing. Many factors such as high operating room demand, insurance reimbursement, patients’ desire to assess multiple treatment options, and anxiety can cause delays in radical treatment. In this study, we examined the effect of delay from prostate biopsy to surgery on outcomes of men with localized prostate cancer.Materials and Methods:The data of 359 patients who underwent radical prostatectomy (RP) in our clinic between 2008 and 2017 were analyzed retrospectively. Surgical delay was defined as the time from transrectal ultrasound-guided prostate biopsy to surgery. Patients were divided into 3 groups according to the interval between prostate biopsy and RP (≤60, 61-120, ≥120 days) and classified according to the D’Amico risk classification.Results:A total of 248 patients were included in the study. Of these patients, 107 (43.1%) were operated within 60 days of biopsy, 113 (45.6%) 61- 120 days after biopsy, and 28 (11.3%) over 120 days after biopsy. Statistical analysis of patients with follow-up of at least 12 months did not reveal a significant difference between the groups in terms of biochemical recurrence (p=0.06). A delay of over 120 days was not associated with adverse pathological or oncological findings at surgery for the low-risk group. Extraprostatic invasion increased significantly in the intermediate-risk group with longer surgical delay (p=0.044).Conclusion:Our data demonstrated that a delay of more than 120 days was not associated with adverse pathological outcomes in men with low-risk localized prostate cancer. For men with intermediate-risk disease, delays over 60 days were significantly associated with risk of extraprostatic invasion. Our findings indicate that RP should be performed within 60 days of biopsy for intermediate-risk patients.

Objectives: We tried to investigate the effects of lunar phase on Shock Wave Lithotripsy (SWL) related pain. In addition, correlation of various clinical parameters with the pain perception during SWL procedure, were also investigated.Methods: A total of 378 patients who underwent first SWL sessions for renal or ureteral stones were prospectively enrolled in the study. The degree of pain perception during the procedure was evaluated with 10-point visual analog scale (VAS) and pain questionnaires. The date of SWL was allocated to dates and times of lunar phases as: newmoon, waxing crescent, first quarter, waxing gibbus, fullmoon, waning gibbus, last quarter and waning gibbus.Results: Mean VAS scores in first quarter (2,41±1,06) were significantly lower when compared to mean VAS scores in waning crescent (3,58±1,83) and waning gibbus (3,42±1,98) (p=0,005 and 0,041, respectively). No statistically significant differences were observed when other lunar phases were compared between each other. Mean painscores were not affected from gender, age, body mass index (BMI) and stone characteristics (stone laterality, burden and location).Conclusions: SWL procedure performed in first quarter of the lunar phase may become less painful. To the best of our knowledge, this is the first study which evaluated the effect of lunar phase on post-SWL pain outcome. Thus, additional randomized studies with larger series may be more informative.Keywords: lunar phase, lithotripsy, pain, predictive factors, urinary stones

Objectives: After radical prostatectomy, surgical margin positivity is an important indicator of biochemical recurrence and progression. In our study we want to compare the surgical margin positivity rates for retropubic radical prostatectomy (RRP) and robotic assisted radical prostatectomy (RALP) and investigate the factors affecting surgical margin positivity in RALP. Materials and methods: Data from 78 RRP and 62 RALP patients operated from 2011 May to 2016 March were retrospectively screened. Patients in both groups were compared in terms of age, postop hematocrit reduction, hospital stay, duration of follow-up, surgical margin positivity, biochemical recurrence and oncologic parameters. In RALP group it was searched the relationship between the surgical margin positivity and prostate specific antigen (PSA), positive biopsy core, biopsy Gleason scoring, pathologic stage and Gleason scoring, lymph node positivity, lymphovascular and perineural invasion, extracapsular extension, seminal vesicle invasion, prostate weight. Results: Patients in the RALP group had lower postop hematocrit reduction and shorter hospital stay (p < 0.001). There was no difference in surgical margin positivity between RALP and RRP groups (37.1% vs. 29.5%, p = 0.341). In RALP group there was a correlation between surgical margin positivity and positive biopsy core number (p = 0.011), pathologic stage (p < 0.001) and Gleason score (p < 0.001), EAU risk classification (p = 0.001), seminal vesicle invasion (p = 0.045), extraprostatic extension (p < 0.001). There was no correlation between prostate weight (p = 0.896), PSA (p = 0.220), biopsy Gleason score (p = 0.266), lymph node positivity (p = 0.140), perineural (p = 0.103) and lymphovascular invasion (p = 0.92) with surgical margin positivity. Conclusions: Positive biopsy core number, pathological stage and Gleason score, EAU risk classification, seminal vesicle invasion and extraprostatic extension are correlated with surgical margin positivity in RALP.

Purpose: The aim of this study was to evaluate the outcomes of laparoscopic pyeloplasty in children less than 12 months of age. Materials and methods: The records of 20 infants, who had pelviureteric junction obstruction and subsequently underwent LP from January 2013 to November 2016 with at least 1 year of follow-up, were retrospectively reviewed. Patients demographics, the results of preoperative and postoperative imaging studies, perioperative details, complications, and results were noted. Results: The mean age of 20 infants was 4.75 months. The gender of cases was 5 females (25%) and 15 males (75%). Of that, 13 (65%) laparoscopic pyeloplasties were in left side and 7 (35%) were in right side. No cases needed open conversation. Aberrant crossing vessel was observed in three patients (15%). The mean operation time was 79.35 min (45–128 min). The mean hospital stay was 2.9 ± 0.308 days (2–3 days). There were complications in three children (15%); two patients developed stent migration and one child had fever over 38°. Three children with complications did not require a second intervention. In one child, the kidney was non-functioning in follow-up and nephrectomy was performed. The anteroposterior diameter significantly reduced. Preoperative mean value was 24.305 ± 5.6157 and postoperative mean value was 15.40 ± 6.030 (p = 0.000, p Conclusion: Although there are doubts about the reliability and efficacy of results for pyeloplasty in children less 12 months, many studies including this study show that laparoscopic pyeloplasty is an effective and reliable method for infants.

OBJECTIVE To present the surgical and pathological results of robotic radical cystectomy (RRC) operations performed in our clinic. MATERIAL AND METHODS A total of 18 patients, who underwent RRC and intracorporeal urinary diversion between October 2016 and September 2017 for clinically localized bladder cancer in our clinic, were included in the study. The results were evaluated under three headings. 1. operative outcomes (total operation time, perioperative blood loss, postoperative hematocrit decrease) 2. recovery period (pull-off drain day, hospitalization time) 3. oncological results (pathologic stage, surgical margin, number, and characteristics of lymph nodes removed). Complications within the postoperative 30-day period, were evaluated and the Clavien classification system was used to classify the complications. RESULTS The mean age of the patients was 64.4 (52-80) years. Seventeen male patients and one female patient underwent robotic cystectomy. At the operative outcomes, the mean blood loss was 325 mL, and the mean hematocrit decrease was 3.15%. The mean duration of the surgery was 471 minutes (330-630), while the median operative time was 450 minutes. Complications occured in 6 patients during the early postoperative period. Six of them (75%) had minor complications (Clavien grade 1), two patients (25%) had major complications (Clavien grade 4). CONCLUSION Our initial experience with RRC is that, this surgical technique has acceptable operative, oncological and short-term clinical outcomes. However, prospective randomized studies are needed to assess whether there is a clear advantage compared to open surgery.

To investigate whether core length is a significant biopsy parameter in the detection of prostate cancer.We retrospectively analyzed pathology reports of the specimens of 188 patients diagnosed with prostate cancer who had undergone initial transrectal ultrasound (TRUS) guided prostate biopsy, and compared biopsy core lengths of the patients with, and without prostate cancer. The biopsy specimens of prostate cancer patients were divided into 3 groups according to core length, and the data obtained were compared (Group 1; total core length10 mm, Group 2; total core length 10 mm-19 mm, and Group 3; total core length20 mm). Biopsy core lengths of the patients diagnosed as prostate cancer, and benign prostatic hyperplasia were compared, and a certain cut-off value for core length with optimal diagnostic sensitivity and specificity for prostate cancer was calculated.Mean age, PSA and total length of cores were 65.08±7.41 years, 9.82±6.34 ng/mL and 11.2±0.2 mm, respectively. Assessment of biopsy core lengths showed that cores with cancer (n=993, median length 12.5 mm) were significantly longer than benign cores (n=1185, median length=11.3 mm) (p0.001). Core length analysis yielded 12 mm cores have an optimal sensitivity (41.9%) and specificity (62%) for detection of cancer (odds ratio: 1.08).Biopsy core length is one of the most important parameter that determines the quality of biopsy and detection of prostate cancer. A median sample length of 12 mm is ideal lower limit for cancer detection, and biopsy procedures which yield shorter biopsy cores should be repeated.

Dear Editor, We read the article by Drs Westesson and Goldman with interest [1]. They reported a case of pelvic pain and a bulge from the urethra. After physical examination and radiological evaluation, the diagnosis of prolapse of a single system ureterocele was made. No stone was documented in the ureterocele sac. The ureterocele was successfully incised and excised with the aid of cystoscopy. We saw a 34-year-old woman who presented with dysuria and right-sided flank pain for 6 months. Urinalysis and urine culture revealed bacteriuria and microscopic hematuria. On plain X-ray, radio-opacity suggestive of right distal ureter was observed (Fig. 1). Blood biochemical analysis was normal. Abdominopelvic ultrasound examination confirmed 1x1-cm calculus in a single-system ureterocele. In addition, mild right hydroureteronephrosis was noticed. Cystoscopy was performed and demonstrated a right-sided ureterocele. The patient underwent a ureterocele incision along its inferolateral border (Fig. 2). The incision was performed using a Collings knife. The cutting current level was set low in order to provide a clear incision. Moderate bladder distention was maintained to better make a low and short incision. This low and short smiling incision technique preserves the flap valve ureteral antireflux mechanism. because when the roof of the ureterocele collapsed, it formed a valve to prevent reflux. Since the stone was not very big, it was extracted and removed easily. We think that the low and short smiling incision technique with use of a Collings knife provides adequate drainage in the upper urinary tract, decompresses the ureterocele, and prevents reflux. For bigger stones, the stone may be fragmented in the ureterocele sac, and small

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