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Purpose: To investigate the clinical and pathological predictive factors affecting biochemical recurrence (BCR) after radical prostatectomy (RP) in patients with positive and negative surgical margin (SM)., Methods: Patients who underwent RP were retrospectively reviewed for the study. Demographic, clinical, pathological and oncological data were evaluated. All data were compared between patients with positive SM and negative SM to detect factors associated with SM status. Later, patients were divided into two groups as BCR-negative and BCR-positive groups. Data were separately compared between BCR groups for all patients, SM-negative and SM-positive patients, respectively., Results: A total of 254 patients with a mean age of 63.5 years and the mean prostate-specific antigen of 10.9 ng/ml were evaluated in the study. SM positivity was found to be an independent prognostic factor for BCR (p = 0.013, Odds Ratio (OR): 0.267, 95% Confidence Interval (CI): 0.094-0.755). In SM-positive patients, biopsy Gleason Score and International Society of Urological Pathology grade were found to be independent predictive factors for BCR (p < 0.05). However, only tumor to SM distance (TSMD) was found to be an independent risk factor for BCR (p = 0.024) in SM-negative patients. The predictive cutoff value of the TSMD was found to be 75 μm for BCR (100% sensitivity and 63.9% specificity) (AUC = 0.803, p = 0.024). Although all of 46 patients with >75 μm TSMD were recurrence free, 5 of 31 patients with <75 μm TSMD had BCR (p = 0.009; OR: 0.839 CI: 0.719-0.979)., Conclusion: High Gleason Score and International Society of Urological Pathology grade of biopsy were found to be associated with BCR in SM-positive patients. For SM-negative patients, only TSMD was found to be associated with BCR after RP., Competing Interests: All authors have no conflict of interest to declare., (© 2020 Asian Pacific Prostate Society. Publishing by Elsevier B.V.)

Objective: The aim of the present study was to evaluate the influence of preoperative hydronephrosis and ureteral orifice involvement (UOI) on survival of patients undergoing radical cystectomy (RC) for bladder cancer (BC)., Material and Methods: A total of 162 patients with BC underwent RC between January 2006 and March 2017. Patients were divided into two groups for both presences of preoperative hydronephrosis and orifice involvement at final pathology. Additionally, tumors with orifice involvement were subgrouped histopathologically after RC as those with only UOI and those with invasive to the ureter with an additional concurrent site at final pathology., Results: Preoperative hydronephrosis was detected in 57 patients. Preoperative and postoperative creatinine on month 3 were higher in the preoperative hydronephrosis (+) group (p<0.001). In addition, postoperative T stage, surgical margin positivity, invasion of urethra, and pathological upstaging were higher in this group. Cancer-specific survival (CSS) and overall survival (OS) were better in the hydronephrosis (-) group than in the hydronephrosis (+) group (p=0.001 and p=0.001, respectively). Preoperative hydronephrosis was found to be an independent factor in pathological upstaging. Patients were divided into two groups according to the presence of UOI. Group 1 consisted of patients without UOI, and group 2 with UOI. Preoperative hydronephrosis, hydronephrosis grade, and T stage were statistically higher in tumors with UOI. Moreover, CSS and OS were lower in group 2 than in group 1., Conclusion: Preoperative hydronephrosis and UOI are predicting factors on survival of patients undergoing RC for BC. Preoperative hydronephrosis was found to be an independent factor in pathological upstaging.

Objective: The aim of this study is to evaluate sexual functions and quality life of patients who are followed-up for non-muscle invasive bladder cancer (NMIBC)., Material and Methods: Between March 2015-June 2016, 50 patients underwent cystoscopy for NMIBC. At the end of the 1 st year follow-up patients were assessed for sexual functions using 5-item version of the International Sexual Function Index (IIEF-5) for male and the Female Sexual Function Index(FSFI) for female; for quality of life (QoL) by the European Organisation for Research and Treatment of Cancer-Non-Muscle Invasiv Bladder Cancer Quality of Life Questionnaire (EORTC QLQ-NMIBC24) and for emotional status by Beck depression inventory., Results: There were 44 male and 6 female patients with the mean age of 57.6±11.5 years. Twenty patients received intravesical treatment after transurethral resection of bladder tumour. The mean Beck (10.7±9.5) IIEF-5 (15.6±5.9), FSFI (19.2±10.9), and the EORTC-QLQ NMBIC 24 (38.2±7.7) scores of the patients were determined as indicated. Among the patients, 42 (84%) of them were not feeling bad about their bladder tumors and 37 (74%) were not worrying about their daily lives. Moreover, 12 (24%) patients were not interested with sexuality, while 27 (54%) of them did not feel comfortable about sexual sincerity. Interestingly, 27 patients receiving intravesical treatment were concerned that the treatment they received for prevention of recurrence and progression of bladder tumor infect their partners during sexual intercourse., Conclusion: NMIBC affects patients' sexual functions and QoL negatively. Therefore during the follow-up of these patients, it is important to inform these patients accurately about their treatments to be applied and predicted complications in the follow up period.

Objective: The aim of this study is to examine the usefulness of preoperative neutrophile-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and lymphocyte-to-monocyte ratios to predict pathological upstaging of invasive bladder cancer who underwent radical cystectomy., Material and Methods: A total of 126 patients who underwent radical cystectomy at our clinic between January 2006 and March 2015 were retrospectively analysed. One hundred and twelve patients with organ-confined invasive bladder tumors (T2) detected at histopathological examination of transuretral resection material were included in the study. Upstaging was seen at histopathological examination of radical cystectomy specimens of 42 patients. We compared preoperative neutrophile-to-lymphocyte ratio, platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio between upstaged and not-upstaged groups., Results: There were no statistically significant correlation between age, time to radical cystectomy, gender, lymphocyte-to-monocyte ratio, platelet-to-lymphocyte ratio ratios and carcinoma in situ in upstaged and non-upstaged groups. Statistical analyses showed that preoperative neutrophile-to-lymphocyte ratio was higher in upstaged patients (p=0.009). In multivariate analysis preoperative neutrophile-to-lymphocyte ratio and positive surgical margin were significantly higher in upstaged group., Conclusion: In organ-confined muscle invasive bladder cancer neutrophile-to-lymphocyte ratio seems to be an acceptable parameter to predict locally advanced disease., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors.

Objective: We updated our data on penile fractures and investigated the significance of the time interval from the incident of the fracture until the operation on the erectile functions and long-term complications., Material and Methods: Between January 2001 and June 2014, 64 patients were operated on with a preoperative diagnosis of penile fracture. We could evaluate 54 of these patients. The patients were classified into 3 groups according to the time interval from the time of fracture until surgery. The validated Turkish version of the erectile components of International Index of Erectile Function (IIEF) was answered by every patient 3 times after the surgery; before the incident of fracture, at first postoperative year, and at the time of the study (IIEF-5 and question #15 were used). The complications were noted and an erectile function index score was calculated for every patient., Results: Mean follow up period was 44.9 (±2.8) months for all patients There was no statistically significant difference between the 3 groups in terms of the erectile components of IIEF questionnaire scores for the time periods and for individual patients in each separate group. Complications for all groups were also similar., Conclusion: In consideration of long-term results, neither serious deformities nor erectile dysfunction occur as a consequence of a delay in surgery performed within the first 24 hours in patients without urethral involvement., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors.

Objectives: In this study we compared neutrophil-to-lymphocyte ratio (NLR) and neutrophilto- monocyte ratio(NMR) between patients with prostate cancer after first transrectal ultrasound (TRUS)- guided biopsy and patients with benign prostate hyperplasia(BPH) after second TRUS-guided biyopsy., Methods: A total of 224 patients who underwent multi (≥12)-core TRUS -guided biopsy at our clinic for elevated PSA or abnormal digital rectal examination in between January 2008 and March 2015 were retrospectively analyzed. There were 2 groups. Group 1 consisted of 146 patients with a diagnosis of prostate cancer after the first TRUSguided biyopsy and group 2 consisted of 78 patients with a diagnosis of benign prostate hyperplasia after second TRUS-guided biyopsy. Age, PSA, NLR and NMR values were compared between the two groups., Results: There were no statistically significant correlation between PSA and NLR(p=0.46). The mean of age, PSA, NLR, NMR values in the group 1 and 2 were respectively 64.6±7.7 and 61.6±6.9, 6.5±1.9 and 5.3±1.2, 2.8±1.5 and 2.3±1.1, 9.2±3.9, 8.1±2.9 (p=0.03, p=0.001, p=0.012 and p=0.30). The mean PSA, NLR ,NMR values of the group 1 were significantly higher than those in group 2 (p=0.002). Gleason grade and pathological stage were significantly increases as NLR increases., Conclusion: NLR and NMR in patients with BPH after second TRUS-guided biopsy were lower than that of those with a diagnosis of prostate cancer after the first TRUS-guided biopsy.White blood test subtypes can be considered for the decision to perform a second TRUSguided biopsy in patients with previous negative biopsy with persistently elevated PSA.

Purpose: Patients receiving treatment for benign prostate hyperplasia may have persistent storage symptoms. There has been increasing debate on the precision and accuracy of the International Prostate Symptom Score questionnaires over other questionnaires in evaluating all the complaints of lower urinary tract symptoms (LUTS). The aim of this study was to perform the validity and reliability analysis of the Turkish version of the Internatinal Consultation on Incontinence Questionnaire-Male LUTS (ICIQ-MLUTS)., Methods: Linguistic validation was studied (i.e., translation and back translation). Intelligibility was completed between October 2013 and November 2013. Data was collected between November 2013 and March 2014. The stability and reliability of the form were measured with the Cronbach test., Results: In total, 117 male patients were included in the study. At the first visit, the mean age of the patients was 59 years (range, 18-84 years). For reliability, the Cronbach alpha value was 0.798, demonstrating the internal consistency of the form (r>0.7). The internal consistency of each question was examined separately and found to be over 0.7. For the evaluation of test-retest reliability, the test was administered to 116 patients for a second time with an interval of 2-4 weeks. The first and second test scores for each question were found to be correlated (r=0.741)., Conclusions: ICIQ-MLUTS is a new questionnaire, which can be used for evaluating male LUTS in Turkey. We believe that the Turkish version of the ICIQ-MLUTS is an important breakthrough in our country.

Purpose: To determine the proportion of patients with undetected symptoms of overactive bladder by using the overactive bladder-validated 8 (OAB-V8) screening questionnaire and investigate these symptoms were undetected in female patients who were hospitalized., Methods: We invited 2,250 female patients hospitalized in the Aegean region of Turkey to answer a self-administered questionnaire. The questionnaire included questions on evidence of lower urinary tract symptoms (OAB-V8), relevant medical history, and demographic data. Patients with a total OAB-V8 score≥8 were defined as having OAB symptoms., Results: The proportion of patients with OAB symptoms in this study was 40.6%. Nearly 57% of the patients with OAB symptoms had not been previously admitted to any hospital for lower urinary tract symptoms (LUTS). The two most common reasons why women with OAB symptoms did not admit themselves to a hospital because of LUTS were as follows: "I did not think I had a disease" and "The symptoms did not bother me," with a response rate of 74.7%. The mean OAB-V8 scores of the patients with these two responses were significantly lower than those of the other patients (P<0.001)., Conclusions: This is the first study to demonstrate a significant proportion of women with undetected OAB symptoms. The main reasons the women did not admit themselves to a hospital were their unawareness of the disease and because the LUTS were not bothersome. Public awareness programs on this disease may resolve this problem.

Objective: To discuss the indications and the results of the patients treated with ureterocutaneostomy (UCN) for urinary diversion in our center., Material and Methods: Between March 2008 and November 2012, 27 patients (19 males and 8 females) were treated with UCN in our clinic. Patients' ages ranged between 56-78 years. Radical cystectomy was performed on 21 of these patients. The patients underwent transureteroureterostomy and UCN or unilateral or bilateral side-by-side UCN on the abdominal wall. Double-J stents were placed inside the ureters and changed every 12 weeks. Comorbidities and American Society of Anesthesiologists (ASA) scores were noted., Results: The patients had invasive bladder cancer (n=24), multiple tumors within and outside of a diverticulum and intractable recurrent bleeding (n=1), recurrent hemorrhage (n=1), and bladder contracture (n=1). As comorbidities, hypertension (n=14), chronic obstructive pulmonary disease (n=11), diabetes mellitus (n=10), coronary artery disease (n=8), chronic renal failure (n=1), and Crohn's disease (n=1) were detected. The ASA score was 3 or greater in 14 patients. During follow-up period, 3 patients experienced pyelonephritis, and one of them had a strictured ureteral orifice., Conclusion: UCN can be used as a method of urinary diversion in selected patients.

Objectives: Tumor heterogeneity is a common finding and led to realization of a tertiary Gleason component (TGC) in prostate cancer. In an attempt to further investigate its prognostic value, we analyzed the association of tertiary Gleason pattern in Gleason score ≤ 7 tumors with pathologic stage and biochemical disease-free survival., Material and Methods: A total of 331 radical prostatectomy specimens were analyzed retrospectively. The primary, secondary, and the tertiary patterns were evaluated by reviewing all of the pathologic slides. TGC was defined as Gleason grade pattern 4 or 5 for Gleason score < 7 tumors and Gleason grade pattern 5 for Gleason score 7 tumors. The pathologic prognostic factors, (extraprostatic extension, seminal vesicle and lymph node invasion, surgical margin status) of Gleason score < 7, 3+4, and 4+3 tumors with or without TGC were compared. Biochemical recurrence-free survival (BRFS) was calculated using Kaplan-Meier method with log rank test, and the influence of TGC was assessed in a Cox regression model., Results: TGC observed more frequently with higher Gleason scores (21% of the GS < 7 cases, 23% of the GS 3+4 cases, and 58% of the GS 4+3 cases). In terms of adverse pathologic prognostic factors and BRFS, GS < 7 tumors with TGC behaved significantly worse than GS < 7 tumors without TGC (P = 0.01 and P = 0.001, respectively) with properties similar to GS 3+4 tumors without TGC. Gleason score 3+4 and 4+3 tumors without TGC were statistically similar and had better features than corresponding tumors of same Gleason score with TGC. Furthermore, Gleason score 7 tumors with TGC had similar features with GS 8-10 tumors. During follow-up, 73 (22%) subjects had PSA recurrence. In the Cox regression model TGC was an independent variable for BRFS (HR = 2.63, 95% CI = 1.39-4.98, P = 0.003)., Conclusion: According to the present study, 3 different prognostic groups were observed; good prognostic group: GS < 7, intermediate prognostic group: GS < 7+TGC, GS 3+4, and GS 4+3, and finally bad prognostic group: GS (3+4)+TGC, GS (4+3)+TGC, GS > 7. Presence of a TGC appears to upgrade the total score and adjuvant treatment decisions may further be refined by considering the tertiary pattern., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Transurethral electrovaporization of the prostate (TVP) has been introduced as an alternative to standard transurethral resection of the prostate (TURP) with lesser morbidity. However, the efficacy of this new technique has not been well known. To compare the results of standard TURP and TVP, 76 patients with symptomatic benign prostatic hyperplasia (BFH) were divided into two groups in a randomized clinical trial. Preoperative assessment included AUA Symptom score, maximum flow rates (Qmax), digital rectal examination, serum prostate specific antigen, and transrectal ultrasonography, with biopsy if the patient was randomized to vaporization. Transrectal temperature measurements and the hemoglobin concentration of the irrigation fluid were investigated in all the patients during the procedure. Although the transrectal temperature was higher in the TVP group (0.53-1.27 degrees C; mean 0.83 degrees C), no associated complication were determined. However, blood loss was significantly lesser than with TURP (340 mL v 60 mL). Two patients in the TURP group required blood transfusions, and one had sphincteric incontinence, whereas one postoperative retention, one reoperation with bladder perforation, and one sphincteric incontinence were seen in the TVP group. On the other hand, 12-month follow-up demonstrated that the uroflow rates improved in a similar manner. The Qmax increased in the TURP and TVP groups from 8.8 and 8.3 mL/sec to 19.6 and 17.2 mL/sec, respectively. The mean AUA Symptom Score decreased from 13.7 to 7.9 and 6.1 at 6 and 12 months, respectively. In the TVP group and from 14.6 to 7.3 and 7.0 at 6 and 12 months, respectively, in the TURP group. There were significant differences in the mean catheterization time (P < 0.0001) and hospital stay (P < 0.0001) in favor of TVP. Our results suggest that TVP is a safe and effective alternative treatment for symptomatic BPH.