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We report the case of a patient who was admitted to the emergency department of our hospital with acute left upper quadrant abdominal pain. Computed tomography revealed perforated cholecystitis and two synchronous incidental solid mass lesions in the right kidney. The patient had situs inversus totalis anomaly. The patient was evaluated by a multidisciplinary board, and simultaneous laparoscopic cholecystectomy and laparoscopic partial nephrectomy (LPN) were planned 3 months after cholecystostomy and antibiotic therapy. After uneventful laparoscopic cholecystectomy, synchronous renal masses were successfully treated with LPN. To the best of our knowledge, this is the first case report in the literature concomitant two synchronous renal masses with situs inversus totalis, which were treated with LPN. [ABSTRACT FROM AUTHOR]

Objective: This study aims to review the parameters affecting tumour recurrence, tumour progression and cancer survival of patients with low-grade non-muscle invasive bladder cancer. Materials and Methods: We retrospectively reviewed 262 patients with primary, low-grade Ta bladder cancer. Recurrence was defined as the occurrence of a new tumour in the prostatic urethra or bladder. Tumour progression was defined as confirmed high-grade Ta, all T1 or carcinoma in situ, upper tract recurrence or progression to T2. The associations between factors that affect recurrence and progression were analysed. Results: Tumour recurrence and progression occurred in 119 (45.4%) and 25 (9.5%) patients during follow-up (median follow-up: 50.9±36.3 months), respectively. Univariate and multivariate analyses demonstrate that smoking, multiple tumours and large tumours (3 cm<) were significant. A Cox regression analysis revealed that progression was identified as a significant risk factor on survival. There was no effect of smoking on recurrence-free survival. A Kaplan-Meier analysis showed that one-, five- and ten-year progression-free survival rates were 99.6%, 88.2% and 70%, respectively. Conclusion: Multiple tumours, large tumours (>3 cm) and smoking were risk factors for recurrence and progression. Prevention of smoking and routine cystoscopic examination are essential in bladder cancer. [ABSTRACT FROM AUTHOR]

Aim: To investigate the effects of using 5 mg/day tadalafil on inflammatory indicators including lymphocyte to monocyte ratio (LMR) and monocyte to high-density lipoprotein ratio (MHR) in patients with erectile dysfunction (ED). Material and Methods: This retrospective study included 62 subjects that 31 patients with ED and 31 healthy controls with a normal erectile function. The patients with ED were given a daily 5 mg dose of tadalafil over eight weeks. Baseline and post-treatment erectile function was evaluated using the International Index of Erectile Function (IIEF-5). Changes in IIEF-5 score and inflammatory indicators including LMR and MHR have compared both in ED patients and with controls. Results: The patients and the controls were statistically comparable with respect to age, Diabetes Mellitus, hypertension, coronary artery disease, CRP, testosterone, serum creatinine, lipid profile, LMR, and MHR. The mean IIEF-5 score was 22.97 vs 14.32 (p=0.001) in control and patients with ED, respectively. Having been used 5 mg of tadalafil per day over 8 weeks, an increase in IIEF-5 score (p=0.001) and a decrease in the number of monocytes (p=0.008) were detected in patients with ED. However, there was no statistically significant difference found in LMR and MHR before and after the treatment. Conclusion: According to the results of this study, no significant effect was found daily use of 5mg tadalafil on inflammatory indicators including LMR and MHR. The decrease in the number of monocytes that play a key role in inflammation may have been considered a response to treatment, however, randomized prospective studies are needed to evaluate the relationship among LMR, MHR and tadalafil treatment. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate the influence of different ischaemia techniques on short-term and one year renal function following laparoscopic partial nephrectomy (LPN). Materials and Methods: Data of 359 patients who underwent LPN between November 2009 and April 2018 were reviewed, retrospectively. A total of 287 patients were included in the study. Patients were divided into 4 groups according to type of ischaemia as follows: group A (n=33) was warm ischaemia time (WIT) >20 minute, group B (n=202) was WIT =20 minute, group C (n=16) was selective arterial clamping and group D (n=36) was off-clamp. Demographic data, preoperative and postoperative outcomes were compared. The estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. Change in eGFR according to group and time was evaluated using two-way analysis of variance. P values <0.05 were adopted as significant. Results: The mean tumour size was 46, 34, 36 and 25 mm (p=0.001), and operation time was 123, 92, 100 and 79 minute (p=0.001) for groups A, B, C and D, respectively. There was no need for open surgery in any of the patients. Blood loss, intraoperative and postoperative complication rates were found to be nonsignificantly different (p>0.05) between groups. Only 4 patients in group B had positive surgical margin. The percentage of relative eGFR (% of eGFR) decline 1 year after LPN was significantly (p=0.001) higher in the ischaemic groups (A and B: 9.3% and 7.5%) compared to the zero-ischaemia groups (C and D: 5% and 3.7%). Conclusion: This study revealed that after LPN, cumulative renal function decreases to a certain extent regardless of the technique. However, it was found that cumulative renal functions are better preserved when ischaemia time is reduced to =20 min or eliminated. [ABSTRACT FROM AUTHOR]

Objective: Laparoscopic adrenalectomy (LA) is the treatment of choice for benign tumours of less than 6 cm. However, there is still an ongoing debate regarding the exact cut-off value of the tumour size. The aim of this study was to determine the effect of tumour size on intraoperative and postoperative outcomes in patients undergoing LA and also to estimate the learning curve for large adrenal tumours. Materials and Methods: The data of 102 patients who underwent LA from April 2010 to October 2018 was retrospectively analysed. The patients were allocated to 2 groups according to tumour size: <6 cm (group 1 =76) and =6 cm (group 2 =26). Both groups were compared in terms of age, gender, body mass index, tumour characteristics, operative data and complication rates. The patients were also allocated to four groups (A, B, C and D) according to the chronological order of their surgery in order to evaluate the learning curve. Results: The mean age, gender, tumour laterality and BMI were similar in both groups. Tumour size (32.7 vs 79.5 mm, p=0.001), operation time (53.3 vs 72.6 minute, p=0.001), blood loss (65.8 vs 86.35 mL, p=0.042) were significantly different between groups 1 and 2, respectively. Intraoperative and postoperative complication rates were also found to be significantly higher in group 2. The first 25 cases were sufficient to complete the initial learning curve. It showed that surgical experience increased and operation time and blood loss decreased as the mean tumour size that is managed by LA increases. Conclusion: LA is a reliable approach for the management of large adrenal tumours. However, we can conclude that the most important factor determining the safety and efficacy of LA is the surgical experience. [ABSTRACT FROM AUTHOR]

Leiomyomas are rare, benign and solid tumors of the kidney. Although the developments in radiological imaging methods provide early detection of kidney tumors, it is difficult to differentiate leiomyomas radiologically from other malignant renal tumors. Moreover, the definitive diagnosis of leiomyomas can only be achieved by histopathological and also immunohistochemical evaluation after surgical intervention. Immunohistochemically, positive staining with smooth muscle actin and vimentin, whereas negative staining with cytokeratin, S100, Mart1 and HMB45 are the methods used in the differential diagnosis of leiomyomas. In this case series, after preoperative radiological evaluation, two female and two male patients between 45 and 89 years of age underwent laparoscopic treatment with the diagnosis of a malignant mass in the kidney. We aimed to illustrate the clinical, radiological and histopathological relationship of four adult patients who were managed by laparoscopic approach and diagnosed with renal leiomyoma. Renal leiomyomas should be kept in mind in patients with a renal mass before definitive treatment. [ABSTRACT FROM AUTHOR]

Traditionally, the standard treatment of bladder-prostate rhabdomyosarcoma (BP-RMS) is being implemented to be total cystoprostatectomy and urinary diversion. However, current multimodal treatment approaches emphasize the importance of bladder-sparing surgery. In this case series, it was aimed to indicate the results of the laparoscopic bladder-sparing approach of two pediatric patients with BP RMS. They have admitted to the emergency department due to acute urinary retention (AUR). The tumors located in the prostate causing AUR were detected by Magnetic resonance imaging (MRI) and the pathological diagnosis was confirmed by biopsy. The patients were managed in a prosperous manner by implementing laparoscopic surgery with the cause of detection of a significant decrease in the size as well as the enhancement pattern of the tumors following neoadjuvant chemotherapy. No urinary incontinence, tumor recurrence or metastasis was observed at 36 and 28 months follow-up in case 1 and case 2, respectively. Laparoscopic bladder-sparing approaches may have an advantage in patients with BP RMS to decrease morbidity and mortality related to radical surgery. To our knowledge, these are the first cases of laparoscopic bladder-sparing approach in the treatment of pediatric prostate-derived embryonal RMS (PDERMS). [ABSTRACT FROM AUTHOR]

Objective: Infections play an important part in post-transplantation causes of morbidity and mortality. The purpose of this study is to evaluate short-, and long-term infections encountered in after renal transplantations. Material and methods: Two hundred and thirteen cases that consisted of both living and cadaver donors, who suffered from late period renal insufficiency and had renal transplant between June 2011 and January 2016 at the Transplantation Center of Sanko University School of Medicine were included in the study. In this study the short-, and long-term infections seen in post renal transplantation were examined retrospectively. Infection types, frequency and periods of infection, infection agents and predisposing factors were determined as the examination parameters. Results: Of the 213 patients who received renal transplant, 139 were males (65.3%) and 74 were women (34.75%) and the mean age was 42±11,8 (range, 14-70) years. Twelve (5.6%) patients exited after renal transplantation. Post-transplant infections were seen in 49 patients (23.1%) within 1-6 months; in 13 patients (6.1%) within 6-12 months; and in 5 patients (2.4%) after the 12th month. The most common infections after renal transplantation were associated with urinary tract (70 patients, 34.3%). The most frequently isolated agents were E. coli (n=66; 30.9%), Kebsiella spp. (n=18; 8.4%) and Enterococci (n=18; 8.4%) respectively. The renal transplants from the cadavers were observed to contract infections 1.78 times more frequently compared to the living donors (OR=1.78, 95% CI=1.03-3.09). Conclusion: The most common complication after renal transplantation are infections. The majority of the infections are seen within the first year especially between 1-6 months. Post-transplant infections are often related to urinary system. E.coli is the most frequently isolated agent and it may be responsible for urosepsis in renal transplant patients. Infection more often seen in renal transplantations from cadavers. [ABSTRACT FROM AUTHOR]

Active Surveillance (AS) is an alternative modality to radical treatment in patients with low-risk prostate cancer. There is a considerable role for AS in carefully selected patients. However the differentiation of clinically important prostate cancer from low risk disease is a major problem. Although more accurate grading was provided with the developments in prostate biopsy techniques, imaging and tumor markers still there is no standard method. This review was aimed to evaluate new developments that might affect the treatment decision in AS patients with prostate cancer. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to investigate the surgical and functional outcomes of laparoscopic partial nephrectomy (LPN) in patients with renal angiomyolipoma (RAML). Materials and Methods: From April 2014 to February 2018, the data of a total of 346 patients who underwent LPN were retrospectively reviewed. Twenty-one patients with final pathology report indicating RAML were included in the study. Demographic data, operative indications, intraoperative and postoperative outcomes as well as complications were evaluated. Results: Eighteen female (85.7%) and 3 male (14.3%) patients were included in this study. The mean age was 55.14±11.95 years. Of the RAMLs, 52.4% were in the right kidney and 47.6% in the left kidney. The mean tumor size was 31.38±16.72 mm and the mean RENAL Nephrometry score was 5.90±1.51 (4-10). RAML could not be differentiated from RCC in 12 patients (57.1%) by preoperative computer tomography and/or magnetic resonance images. In 4 patients, LPN was implemented by off-clamp technique whereas, in 17 patients it was implemented by global ischemia technique. The mean operation duration was 67.86±20.77 (40-110) minutes (min) and the mean estimated blood loss was 117.14±59.7 (30-220) milliliters. In 17 patients who underwent LPN by global ischemia technique, the mean warm ischemia time was 10.88±5.19 (6-22) min. According to the Modified Clavien-Dindo classification, grade 1 complications were detected in 3 patients, postoperatively. The most considerable renal functional changes were detected between preoperative and postoperative- 1st day levels. However, at the end of the first year, the difference was found to decrease. Conclusion: LPN is a safe and effective treatment option for the treatment of RAMLs that are not able to be distinguished from renal cell carcinoma radiologically. Besides the definitive treatment, the exact pathological diagnosis can be ensured by LPN. [ABSTRACT FROM AUTHOR]

Objective: To present a nation-wide analysis of the workload of urology departments in Turkey week-by-week during Covid-19 pandemic., Methodology: The centres participating in the study were divided into three groups as tertiary referral centres, state hospitals and private practice hospitals. The number of outpatients, inpatients, daily interventions and urological surgeries were recorded prospectively between 9-March-2020 and 31-May-2020. All these variables were recorded for the same time interval of 2019 as well. The weekly change of the workload of urology during pandemic period was evaluated, also the workload of urology and the distributions of certain urological surgeries were compared between the pandemic period and the same time interval of the year 2019., Results: A total of 51 centres participated in the study. The number of outpatients, inpatients, urological surgeries and daily interventions were found to be dramatically decreased by the 3rd week of pandemics in state hospitals and tertiary referral centres; however, the daily urological practice were similar in private practice hospitals throughout the pandemic period. When the workload of urology in pandemic period and the same time interval of the year 2019 were compared, a huge decrease was observed in all variables during pandemic period. However, temporary measures like ureteral stenting, nephrostomy placement and percutaneous cystostomy have been found to increase during Covid-19 pandemic compared with normal life., Conclusions: Covid-19 pandemic significantly affected the routine daily urological practice likewise other subspecialties and priority was given to emergent and non-deferrable surgeries by urologists in concordance with published clinical guidelines., (© 2020 John Wiley & Sons Ltd.)

Traditionally, the standard treatment of bladder-prostate rhabdomyosarcoma (BP-RMS) is being implemented to be total cystoprostatectomy and urinary diversion. However, current multimodal treatment approaches emphasize the importance of bladder-sparing surgery. In this case series, it was aimed to indicate the results of the laparoscopic bladder-sparing approach of two pediatric patients with BP RMS. They have admitted to the emergency department due to acute urinary retention (AUR). The tumors located in the prostate causing AUR were detected by Magnetic resonance imaging (MRI) and the pathological diagnosis was confirmed by biopsy. The patients were managed in a prosperous manner by implementing laparoscopic surgery with the cause of detection of a significant decrease in the size as well as the enhancement pattern of the tumors following neoadjuvant chemotherapy. No urinary incontinence, tumor recurrence or metastasis was observed at 36 and 28 months follow-up in case 1 and case 2, respectively. Laparoscopic bladder-sparing approaches may have an advantage in patients with BP RMS to decrease morbidity and mortality related to radical surgery. To our knowledge, these are the first cases of laparoscopic bladder-sparing approach in the treatment of pediatric prostate-derived embryonal RMS (PDERMS).

Objective: Infections play an important part in post-transplantation causes of morbidity and mortality. The purpose of this study is to evaluate short-, and long-term infections encountered in after renal transplantations., Material and Methods: Two hundred and thirteen cases that consisted of both living and cadaver donors, who suffered from late period renal insufficiency and had renal transplant between June 2011 and January 2016 at the Transplantation Center of Sanko University School of Medicine were included in the study. In this study the short-, and long-term infections seen in post renal transplantation were examined retrospectively. Infection types, frequency and periods of infection, infection agents and predisposing factors were determined as the examination parameters., Results: Of the 213 patients who received renal transplant, 139 were males (65.3%) and 74 were women (34.75%) and the mean age was 42±11,8 (range, 14-70) years. Twelve (5.6%) patients exited after renal transplantation. Post-transplant infections were seen in 49 patients (23.1%) within 1-6 months; in 13 patients (6.1%) within 6-12 months; and in 5 patients (2.4%) after the 12 th month. The most common infections after renal transplantation were associated with urinary tract (70 patients, 34.3%). The most frequently isolated agents were E. coli (n=66; 30.9%), Kebsiella spp. (n=18; 8.4%) and Enterococci (n=18; 8.4%) respectively. The renal transplants from the cadavers were observed to contract infections 1.78 times more frequently compared to the living donors (OR=1.78, 95% CI=1.03-3.09)., Conclusion: The most common complication after renal transplantation are infections. The majority of the infections are seen within the first year especially between 1-6 months. Post-transplant infections are often related to urinary system. E.coli is the most frequently isolated agent and it may be responsible for urosepsis in renal transplant patients. Infection more often seen in renal transplantations from cadavers.

Management of kidney stone disease in pediatric population is a challenging condition in urology practice. While the incidence of kidney stone is increasing in those group, technological innovations have conrtibuted to the development of minimally invasive treatment of urinary stone disease such as mini-percutenous nephrolitotomy (mini-PCNL), micro-PCNL, ultra mini-PCNL. In this review we tried to evaluate the effect of new teratment techniques on pediatric kidney stones.

Urolithiasis is a common disease that affects urinary tract in all age groups. Both in adults and in children, stone size, location, renal anatomy, and other factors, can influence the success of treatment modalities. Recently, there has been a great advancement in technology for minimally invasive management of urinary stones. The epoch of open treatment modalities has passed and currently there are much less invasive treatment approaches, such as percutaneous nephrolithotomy, ureteroscopy, shockwave lithotripsy, and retrograde internal Surgery. Furthermore, advancement in imaging technics ensures substantial knowledge that permit physician to decide the most convenient treatment method for the patient. Thus, effective and rapid treatment of urinary tract stones is substantial for the preservation of the renal function. In this review, the effects of the treatment options for urinary stones on renal function have been reviewed.