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Objective: To determine which preoperative patient characteristics are predictive of intraoperative complications (IOC) and postoperative complications (POC) in patients undergoing nephrectomy for non-oncological diseases. Materials and Methods: Demographics, pre-operative characteristics, the surgical technique and perioperative outcomes of 295 adult patients who had underwent simple nephrectomy between 2002 and 2019 in a single reference institution were analyzed retrospectively. Univariate and multivariable statistical analyses were performed to determine the factors affecting POC (Clavien-Dindo score =1) and IOC. All statistical analyses were performed using the Statistical Package for the Social Sciences v. 24.0 (SPSS Inc., Chicago, IL, USA) software for Windows. Results: The mean age of the patients was 44.84±15.51 years, with a female-to-male ratio of 154/141. The statistically significant factors associated with IOC in the multivariable analysis were male gender, higher American Society of Anesthesiologists (ASA) score and urgent surgical intervention (p=0.002, p=0.001, p=0.021, respectively). In multivariable analysis, preoperative anemia, emergency surgery and open surgery were found to be statistically significant and associated with POC (p<0.001, p=0.004, and p=0.049, respectively). Conclusion: Improved surgical outcomes can be achieved through treatment adapted to individual preoperative characteristics such as ASA score, pre-operative hemoglobin level and male gender. An elective laparoscopic approach should be used whenever possible. [ABSTRACT FROM AUTHOR]

Objectives: The objective of the study was to determine the effect of variant histology on pathological outcomes and survival in patients operated for the upper urinary tract urothelial carcinoma (UTUC). Methods: Data of 128 patients who were operated for UTUC between 2001 and 2019 were retrospectively analyzed. Patients with pure urothelial carcinoma and patients with variant histology were compared in terms of demographics, pathological outcomes, and survival. Results: The mean age of the patients was 65±11 years, female to male ratio was 30/98 and median follow-up period was 26.5 (1-176) months. Variant histology was detected in 14.8% of patients. Variant histology was found to be associated with surgical margin positivity, lymph node metastasis, presence of lymphovascular invasion, high tumor stage and grade (p=0.001, p=0.012, p=0.001, p=0.002, and p=0.009, respectively). Three-year cancer-specific and overall survival rates were 79.6% and 77.3%, respectively. There was no statistically significant relationship between variant histology with cancer-specific and overall survival (p=0.514 and p=0.515, respectively). Conclusion: Variant histology of UTUC was found to be associated with locally advanced disease, but its effect on survival could not be demonstrated. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effect of second transurethral resection (TUR) on oncological outcomes, according to the presence or absence of detrusor muscle in the initial TUR of patients with pTa Grade 3/high grade (G3/HG) tumours, who received at least 1 year of maintenance Bacillus Calmette‐Guerin (BCG) therapy. Patients and methods: In this retrospective study, we evaluated the effect of second TUR on oncological outcomes of 93 patients with pTa G3/HG tumours, according to the presence or absence of muscle in the initial TUR. All patients received maintenance BCG therapy according to the SWOG protocol. Results: Median follow‐up was 36 months. If muscle is present in the initial TUR, a second TUR significantly increased median time to first recurrence, compared to those without a second TUR (77.6 vs 36.9 mos, P =.0086). If muscle is missing in the initial TUR, a second TUR significantly decreased recurrence rate (20% vs 66.7%, P =.002), increased median time to first recurrence (78.9 vs 42.7 mos, P =.0001) and median time to progression (22 vs 7 mos, P =.05), compared to those without a second TUR. Conclusion: In patients with pTa G3/HG tumours, if the muscle is missing in the initial TUR, a second TUR should be performed in order to attain lower recurrence rates and longer median time to recurrence and progression. If the muscle is present in the initial TUR, a second TUR will only increase median time to first recurrence. [ABSTRACT FROM AUTHOR]

Among males aged between 15 and 35 years, testicular cancer is the most commonly diagnosed cancer. Testicular germ cell tumours are generally considered curable and respond dramatically to adjuvant treatment. Cisplatin-based chemotherapy regimens are used ubiquitously, inevitably leading to iatrogenic morbidity. Herein, we represent a case of a patient diagnosed with a non-seminomatous germ cell tumour, who underwent adjuvant cisplatin-based chemotherapy treatment and subsequently developed an acute ischemic stroke. In cancer patients, a malignancy-induced hypercoagulability state can cause thromboembolic events. Nonetheless, anti-cancer therapy may dramatically increase the risk of thromboembolic events, by analogue mechanisms, such as the release of pro-coagulant mediators, direct endothelial injury or stimulation of tissue factor production by host cells. Among various chemotherapy agents correlated with thromboembolism, cisplatin is expected to carry a higher risk for thromboembolic complications. Acute cerebrovascular events secondary to anti-neoplastic agents require an interdisciplinary approach, including referral to more experienced centres when needed. [ABSTRACT FROM AUTHOR]

Objective: To reveal possible associations between non-malignant bladder disease and malignancy by evaluating the pathologic examination results of patients who underwent cystectomy for non-malignant diseases and to suggest a point of view for disease management. Materials and Methods: Medical records of patients, who underwent cystectomy in our clinic between January 2005 and January 2015 for non-malignant diseases, were examined retrospectively. Results: A total of 14 patients were included in the study. The mean age of the patients was 58.7±9.3 years. Of the patients eight of them were followed up with interstitial cystitis (IC), five with neurogenic bladder and one with hemorrhagic cystitis. Time from diagnosis to cystectomy was 6.1±5.8 years on average in IC patients, 13.8±9.8 years in neurogenic bladder patients and 10 years in hemorrhagic cystitis patients. No malignancy finding was observed according to the pathologic examination results of the cystectomy specimens. However, either chronic or active inflammation was observed in all the patients. In addition to other pathologies non-keratinized squamous metaplasia was detected in five patients. Conclusion: Patients with non-malignant diseases should be followedup with cystoscopy and bladder biopsy as a pre-malign lesion caution. Although cystectomy and urinary diversion are surgery methods with high complication rates, they could be suggested to well-informed patients as treatment alternatives. [ABSTRACT FROM AUTHOR]

Seminal vesicle (SV) cystic masses are rarely encountered entities in daily clinical practice. They are mostly asymptomatic and require no treatment; however, surgical removal of the cyst is highly effective treatment in symptomatic cases. Due to embryological mesonephric duct abnormality, surgical SV cysts most often present as a part of Zinner’s syndrome (renal agenesis, ipsilateral SV cyst and ejaculatory duct obstruction). In this video article, we summarise our minimally invasive surgical approach to two consecutive cases of symptomatic SV cyst at our institution. [ABSTRACT FROM AUTHOR]

Objectives: The objective of the study was to determine the effect of variant histology on pathological outcomes and survival in patients operated for the upper urinary tract urothelial carcinoma (UTUC)., Methods: Data of 128 patients who were operated for UTUC between 2001 and 2019 were retrospectively analyzed. Patients with pure urothelial carcinoma and patients with variant histology were compared in terms of demographics, pathological outcomes, and survival., Results: The mean age of the patients was 65±11 years, female to male ratio was 30/98 and median follow-up period was 26.5 (1-176) months. Variant histology was detected in 14.8% of patients. Variant histology was found to be associated with surgical margin positivity, lymph node metastasis, presence of lymphovascular invasion, high tumor stage and grade (p=0.001, p=0.012, p=0.001, p=0.002, and p=0.009, respectively). Three-year cancer-specific and overall survival rates were 79.6% and 77.3%, respectively. There was no statistically significant relationship between variant histology with cancer-specific and overall survival (p=0.514 and p=0.515, respectively)., Conclusion: Variant histology of UTUC was found to be associated with locally advanced disease, but its effect on survival could not be demonstrated., Competing Interests: None declared., (© Copyright 2022 by The Medical Bulletin of Sisli Etfal Hospital.)

Aim: To assess the power of nephrometry scores to predict the intraoperative conversion from partial nephrectomy (PN) to radical nephrectomy (RN)., Methods: We identified all the patients at our institution who were scheduled for PN between April 2012 and December 2017. Patients who underwent robotic or laparoscopic surgery were excluded. A total of 149 patients (94 men) who underwent open surgery and had complete data were included. The power of the R.E.N.A.L., PADUA, SPARE, and DAP scores to predict the conversion to RN, and the threshold values were assessed. In the multivariate analysis, the predictive power of the nephrometry scores was tested by separately including them in different models., Results: The median age was 57 (48-67) years, while the median follow-up was 15 (7-29.5) months. The overall conversion rate was 10.7%. The optimal cut-off values for the R.E.N.A.L., PADUA, SPARE, and DAP scores were 7.5, 9.5, 5.5 and 7.5, respectively. The SPARE score had the highest area under the curve (AUC=0.807, P<0.001). In the multivariate analysis, the SPARE score had the highest odds ratio (OR 12.561; confidence interval 3.456-45.534, P<0.001]., Conclusion: A high SPARE score was significantly associated with the conversion to RN in patients who underwent open PN.