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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...

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

Resumo Introducao O presente estudo investigou a associacao entre Disfuncao Cognitiva Pos‐Operatoria (DCPO) e aumento do nivel serico de S100B apos Prostatectomia Radical Laparoscopica Assistida por Robo (PRLAR). Metodos O estudo incluiu 82 pacientes consecutivos submetidos a PRLAR. Os niveis sericos de S100B foram determinados: no pre‐operatorio, apos inducao anestesica, e aos 30 minutos e 24 horas do pos‐operatorio. A funcao cognitiva foi avaliada com testes neuropsicologicos no pre‐operatorio, no 7° dia pos‐operatorio (7 DPO) e aos 3 meses apos a cirurgia (3 MPO). Resultados Observamos 24 pacientes (29%) com DCPO no 7 DPO e 9 pacientes com DCPO (11%) apos 3 meses da cirurgia. Quando comparados com os pacientes sem DCPO, os niveis sericos de S100B estavam significantemente aumentados aos 30 minutos e as 24 horas do pos‐operatorio nos pacientes que apresentaram DCPO no 7 DPO (p = 0,0001 para os dois momentos) e 3 meses apos a cirurgia (p = 0,001 para os dois momentos) A duracao anestesica tambem foi significantemente maior em pacientes com DCPO no 7 DPO e 3 MPO em comparacao com pacientes sem DCPO (p = 0,012, p = 0,001, respectivamente), assim como a duracao da posicao de Trendelenburg (p = 0,025, p = 0,002, respectivamente). O escore Z composto nos testes realizados no 7 DPO foi significantemente correlacionado com a duracao da posicao de Trendelenburg e a duracao da anestesia (p = 0,0001 para ambos). Conclusao S100B aumenta apos PRLAR e o aumento esta associado ao desenvolvimento de DCPO. A duracao anestesica e o tempo decorrido em posicao de Trendelenburg contribuem para o desenvolvimento de DCPO. Numero de registro do estudo Clinicaltrials.gov (n° NCT03018522)

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: Bladder cancer (BCa) is the fifth most common cancer and the second most common urinary tract cancer in worldwide. BCa accounts for 3% of all cancers and is particularly common in developed countries. Material and methods: Eighteen of the 20 patients included in the study were male, 2 were female, mean age was 65.1±12.1(range:37-75) years. The control group consisted of 19 male one female, mean age was 60.3±11.2 (range:40-70) years. A total of seven miRNAs, let-7c, miR-155, miR-125b, miR-141 miR-145, miR 181 and miR 192 were evaluated in two groups. Results: MiRNAs of bladder cancer patients and healthy individuals were compared according to endogenous miR 181 and miR 192 Delta CT values, miR125b values of bladder cancer cases were found to be significantly higher than healthy controls.(p=0.021) In our study, miR125b, which we found specific and sensitive in endogenous controls, was compatible with studies in the literature. As conclusion, we emphasize that mir125b can be used as a predictor in bladder cancer compared with the literature. The current study was funded by Republic of Turkey, Ministry of Science and Industry, KOSGEB Antalya Directorate within the scope of the project entitled “MicroRNA kits in the early diagnosis of cancer” conducted by AGTC Özel Genetik Sağlık Hizm. Tur. San. Tic. Ltd. Şti. Grand Number: 0080785533

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.

Prostate cancer (PCa) is a common type of cancer in western countries and prominent cause of mortality in men. The aim of the study was to analyze circulating miRNAs as biomarkers in the sera of healthy individuals and prostate cancer cases without biopsy.Twenty prostate cases, age (mean and range) 61,4±12.1 (45-73), and twenty healthy men, age 59,3±11.2 (44-70) were included to the study. The mean and range of prostate spesific antigen (PSA) in cancer cases and healthy individuals were 6.79±2.84 ng/ml (2.25-14.7) and 3.8±2.2 ng/ml (1.3-7.8) respectively.Seven miRNAs including two internal controls (Let7c, miR125b, miR141, miR145, miR 155, miR181 ve miR192) were evaluated in two groups. The level of miR141 was significantly lower in PCa cases than healthy individuals (p=0,004), and miR155 was significantly higher (p=0,005) in PCa cases. Both miRNAs were explored sensitive and spesific in the ROC analysis. Tumor mass were found to be associated with the level of miR-125b and miR-145. Conclusion; validation studies are required in wider patient groups in the subject of tumor effect and miRNA biomarkers in prostate cancer.

Background: The present study investigated the association between Postoperative Cognitive Dysfunction (POCD) and increased serum S100B level after Robotic-Assisted Laparoscopic Radical Prostatectomy (RALRP). Methods: The study included 82 consecutive patients who underwent RALRP. Serum S100B levels were determined preoperatively, after anesthesia induction, and at 30 minutes and 24 hours postoperatively. Cognitive function was assessed using neuropsychological testing preoperatively, and at 7 days and 3 months postoperatively. Results: Twenty four patients (29%) exhibited POCD 7 days after surgery, and 9 (11%) at 3 months after surgery. Serum S100B levels were significantly increased at postoperative 30 minutes and 24 hours in patients displaying POCD at postoperative 7 days (p = 0.0001 for both) and 3 months (p = 0.001 for both) compared to patients without POCD. Duration of anesthesia was also significantly longer in patients with POCD at 7 days and 3 months after surgery compared with patients without POCD (p = 0.012, p = 0.001, respectively), as was duration of Trendelenburg (p = 0.025, p = 0.002, respectively). Composite Z score in tests performed on day 7 were significantly correlated with duration of Trendelenburg and duration of anesthesia (p = 0.0001 for both). Conclusions: S100B increases after RALRP and this increase is associated with POCD development. Duration of Trendelenburg position and anesthesia contribute to the development of POCD. Trial Registry Number: Clinicaltrials.gov (N° NCT03018522). Resumo Introdução: O presente estudo investigou a associação entre Disfunção Cognitiva Pós-Operatória (DCPO) e aumento do nível sérico de S100B após Prostatectomia Radical Laparoscópica Assistida por Robô (PRLAR). Métodos: O estudo incluiu 82 pacientes consecutivos submetidos à PRLAR. Os níveis séricos de S100B foram determinados: no pré-operatório, após indução anestésica, e aos 30 minutos e 24 horas do pós-operatório. A função cognitiva foi avaliada com testes neuropsicológicos no pré-operatório, no 7° dia pós-operatório (7 DPO) e aos 3 meses após a cirurgia (3 MPO). Resultados: Observamos 24 pacientes (29%) com DCPO no 7 DPO e 9 pacientes com DCPO (11%) após 3 meses da cirurgia. Quando comparados com os pacientes sem DCPO, os níveis séricos de S100B estavam significantemente aumentados aos 30 minutos e às 24 horas do pós-operatório nos pacientes que apresentaram DCPO no 7 DPO (p= 0,0001 para os dois momentos) e 3 meses após a cirurgia (p= 0,001 para os dois momentos) A duração anestésica também foi significantemente maior em pacientes com DCPO no 7 DPO e 3 MPO em comparação com pacientes sem DCPO (p= 0,012, p= 0,001, respectivamente), assim como a duração da posição de Trendelenburg (p= 0,025, p= 0,002, respectivamente). O escore Z composto nos testes realizados no 7 DPO foi significantemente correlacionado com a duração da posição de Trendelenburg e a duração da anestesia (p= 0,0001 para ambos). Conclusão: S100B aumenta após PRLAR e o aumento está associado ao desenvolvimento de DCPO. A duração anestésica e o tempo decorrido em posição de Trendelenburg contribuem para o desenvolvimento de DCPO. Número de registro do estudo: Clinicaltrials.gov (n° NCT03018522)

Background To compare long-term oncological and renal functional outcomes of laparoscopic and robotic partial nephrectomy for small renal masses. Methods A total of 103 patients who underwent laparoscopic (n = 31) and robotic (n = 72) partial nephrectomy between April 2015 and November 2018 were included in the study. Perioperative parameters, long-term oncological and functional outcomes were compared between the laparoscopic and robotic groups. Results No significant differences were found in terms of age, tumour size, RENAL and PADUA scores, pre-operative estimated glomerular filtration rate (eGFR), and presence of chronic hypertension and diabetes (P = .479, P = .199, P = .120 and P = .073, P = .561, and P = .082 and P = .518, respectively). Only estimated blood loss was significantly higher in the laparoscopic group in operative parameters (158.23 ± 72.24 mL vs. 121.11 ± 72.17 mL; P = .019), but transfusion rates were similar between the groups (P = .33). In the laparoscopic group, two patients (6.5%) required conversion to open, while no conversion was needed in the robotic group (P = .89). There were no differences in terms of positive surgical margin and complication rates (P = .636 and P = .829, respectively). No significant differences were observed in eGFR changes and post-operative new-onset chronic kidney disease at 1 year after the surgery (P = .768, P = .614, respectively). The overall mean follow-up period was 36.07 ± 13.56 months (P = .007). During the follow-up period, no cancer-related death observed in both group and non-cancer-specific survival was 93.5% and 94.4% in laparoscopic and robotic groups, respectively (P = .859). Conclusions In this study, perioperative and long-term oncological and functional outcomes seems to be comparable between laparoscopic and robotic partial nephrectomies.

OBJECTIVE: The objective of the study was to evaluate the effect of peritoneal re-approximation at the end of the procedure in transperitoneal robot-assisted radical prostatectomy (tRARP) and extended pelvic lymphadenectomy (ePLND) on operative, oncologic, and symptomatic lymphocele rates. MATERIAL AND METHODS: A total of 79 patients were included in the study who underwent tRARP and bilateral ePLND performed by two different experienced surgeons. One of the surgeons performed the peritoneal re-approximation (Group 1, n=41) and the other did not re-approximate the peritoneum (Group 2, n=38) at the end of the procedure in tRARP and ePLND. Operative parameters and symptomatic lymphocele rates were compared between the groups. RESULTS: There were no significant differences between the preoperative parameters age, body mass index, and preoperative prostate-specific antigen values (p>0.05). The perioperative parameters were as follows: the operation time and estimated blood loss (EBL) was less, and the number of removed lymph nodes was higher in Group 2. However, only the difference in the EBL was statistically significant (p=0.03). Hospitalization time, symptomatic lymphocele, intervention requiring lymphocele, and complication rates were found to be less in Group 2, but only hospitalization time was statistically significant (p=0.04). Pathological parameters were similar for both groups. There was a significant correlation between lymph node positivity and the presence of symptomatic lymphocele in the correlation analysis (p=0.05). CONCLUSION: It has been shown in this study that the re-approximation of the peritoneum does not provide any additional benefit in terms of complications. Considering that this process also increases the operation time and lymphocele formation, we think there is no need for re-approximation after robot-assisted radical prostatectomy and pelvic lymphadenectomy.

OBJECTIVE In this study, we aimed to assess renal outcomes of delayed diagnosis of dilating primary vesicoureteral reflux (VUR) following recurrent febrile urinary tract infections (fUTIs) and its diagnostic imaging procedures. MATERIAL AND METHODS The medical records of patients who underwent ultrasonography (US), non- acute dimercaptosuccinic acid (Tc-99mDMSA) scintigraphy and voiding cystourethrography (VCUG), and who were older than 2 years at the time of VUR diagnosis were retrospectively reviewed. RESULTS A total of 32 children (female, n=27: 84.4%) with a mean age of 7.67±3.34 years at the time of diagnosis of VUR were included in the study. Grade III, IV, V VUR were found in 22%, 69%, and 9% of the patients, respectively. At the time of VUR diagnosis, abnormal US findings were detected in 75% of the cases. Tc-99mDMSA detected abnormalities in 83.9% (7 with a single scar, 7 with multiple lesions, 12 with reduced kidney function) of the patients. Estimated glomerular filtration rate of 3 patients with bilateral grade IV VUR was

Objective: To compare standard urotherapy with a combination of urotherapy and biofeedback sessions and to determine the changes that these therapies promote in children with dysfunctional voiding. Patients and Methods: The data of 45 patients who participated in the study from January 2010 to March 2013 were evaluated. All patients underwent urinary system ultrasonography to determine post-void residual urine volumes and urinary system anomalies. All patients were diagnosed using uroflowmetry - electromyography (EMG). The flow pattern, maximum flow rate, and urethral sphincter activity were evaluated in all patients using uroflowmetry - EMG. Each patient underwent standard urotherapy, and the results were recorded. Subsequently, biofeedback sessions were added for all patients, and the changes in the results were recorded and statistically compared. Results: A total of forty - five patients were included, of which 34 were female and 11 were male and the average age of the patients was 8.4 ± 2.44 years (range: 5 - 15 years). After the standard urotherapy plus biofeedback sessions, the post-void residual urine volumes, incontinence rates and infection rates of patients were significantly lower than those with the standard urotherapy (p < 0.05). A statistically significant improvement in voiding symptoms was observed after the addition of biofeedback sessions to the standard urotherapy compared with the standard urotherapy alone (p < 0.05). Conclusions: Our study showed that a combination of urotherapy and biofeedback was more effective in decreasing urinary incontinence rates, infection rates and post - void residual urine volumes in children with dysfunctional voiding than standard urotherapy alone, and it also showed that this combination therapy corrected voiding patterns significantly and objectively.

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.

To assess the oncologic results of our robot-assisted laparoscopic prostatectomy (RALP) cases and investigate whether the learning curve (LC) affects the oncological outcomes. Materials and Methods: Between March 2015 and September 2017, 111 patients underwent RALP by a single surgeon in our clinic. The learning curve was analyzed using the moving average method. We compared the rate of positive surgical margins(PSM) and oncological outcomes, operation times, hematocrit changes and duration of hospitalization among the patients during and after the LC. Complications were also noted according to Clavien system.LC analysis using the moving average method showed that the LC stabilized between cases 51-60. So, patients were classified into two groups; 1-50 cases (Group 1) and 51-111 cases (Group 2). PSM rates were 36% for group 1 and 18% for group 2, and statistically different (p=0,032). Extracapsular invasion (ECI) was significantly higher in group 1 (56,5%) than in group 2 (29,5%) (p=0,005). Multiple logistic regression analysis revealed that presence of ECI was an independent factor for PSM associated with the groups (OR: 2.512; 95% CI: 1.055-5.979). Both operation time and duration of postoperative hospitalization were significantly reduced from group 1 to group 2. A total of 11 patients (10%) had complications and one of them (0,9%) required surgical intervention.We can conclude that at least 50 RALP cases are needed to gain proficiency even for an experienced surgeon in laparoscopic radical prostatectomy. Our study demonstrates that surgeons experience can affect the perioperative variables but the LC does not affect PSM status 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.

PURPOSE The aims of this study were to evaluate using testicle apparent diffusion coefficient (ADC) values in patients with varicocele and compare them with those of healthy individuals, to identify an optimal ADC threshold level to predict abnormal semen analysis using diffusion-weighted imaging. MATERIALS AND METHODS Thirty-one patients with the diagnosis of varicocele and 20 healthy controls were enrolled in the study. All subjects underwent testicle diffusion-weighted imaging at b values of 0, 400, and 800 s/mm and semen analysis. Student t tests were used to compare continuous variables between 2 groups. Testicle ADC values were correlated with semen analysis parameters. The relationship between ADC values and impaired semen analysis parameters was evaluated using Pearson correlation coefficient analysis. Receiver operating characteristic curves were formed. Cut-off values for ADC, sensitivity, and specificity values were measured. RESULTS There was a negative correlation between mean ADC values and plexus pampiniformis vein diameter (r = -0.467, P < 0.001) and a positive correlation between mean ADC values and sperm count (r = 0.838, P < 0.001) as well as sperm morphology (r = 0.548, P < 0.05). Sensitivity values of 94.3% and 86.6% and specificity values of 87.5% and 43.8% were determined for the best cut-off ADC values in diagnosing the sperm count and morphology, respectively (area under the curve, 0.961 and 0.781). CONCLUSIONS Decreased testicular ADC values in patients with varicocele are significantly correlated with semen parameters. This method may be used to determine the degree of testicular parenchymal destruction. In addition, testicular ADC cut-off values might be useful in dyspermia patients for the management of patients with varicocele.

Objective Understanding genetic polymorphisms might facilitate the analysis of differences between individuals in their susceptibility to developing cancers as a result of environmental carcinogens. Skin, lung, colon and bladder cancers emerge from biological defects in GSTM1, GSTT1 and GSTP1 gene expressions. In this study, we aimed to investigate whether there was an association between CYP1A1 and GSTP1 gene polymorphisms and bladder cancer in a Turkish population. Material and methods Blood samples were collected from 120 individuals (60 patients with bladder cancer and 60 healthy individuals), and their DNAs were isolated. A polymerase chain reaction-restriction fragment length polymorphism (PCR - RFLP) method was used to detect the frequencies of CYP1A1 NM_000499.3: c.*1189T > C and GSTP1 NM_000852.3: c.313A > G polymorphisms in bladder cancer patients. Results The frequency of the CYP1A1: c.*1189 TC genotype and C allele were significantly different between bladder cancer patients and healthy individuals (p=0.001 and p=0.005, respectively). However, there was no significant difference for the GSTP1: c.313 AG genotype or G allele between both study groups (p=0.699 and p=0.360, respectively). Conclusion A polymorphic site of the CYP1A1 gene might be involved in the development of bladder cancer. However, the investigated GSTP1 polymorphic site did not represent an important risk factor for the development of bladder cancer in a Turkish population.