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Background/Aim: Tension-free-vaginal tape (TVT) has been widely used for treatment of stress urinary incontinence as a mid-urethral sling operation. Cystoscopy is routinely performed during tension-free-vaginal tape operations to check for bladder perforation or injury. This study aims to check the applicability and accuracy of the bladder filling test for predicting bladder perforation in tension-free-vaginal tape operations. Methods: Between 2015 and 2020, 285 women who had TVT operations were subject to evaluation. Out of 285 cases, 23 cases were suspected subjectively by the operating surgeons to have visible or occult bladder perforation during the TVT procedure. A routine cystoscopy was performed at the end of all operations. Additionally, before the routine cystoscopy, in cases suspected of a visible or occult bladder perforation, the bladder was filled with 500 ml saline or diluted methylene blue dye through a urinary catheter (bladder filling test) to check for occult bladder perforation that might not be visualized by cystoscopy. Any fluid leakage through the paraurethral dissected canals or from the abdominal incisions was observed for the possibility of bladder perforation. The accuracy of the bladder filling test was compared to cystoscopy to diagnose bladder perforation in suspected cases. In addition, all cases were followed up for three months to record any cases with late or occult bladder perforations missed in the diagnosis using cystoscopy or the bladder filling test perioperatively. Results: Out of 23 cases suspected subjectively by the operating surgeons to have visible or occult bladder perforation, 11 had visible bladder perforations (3.9%) confirmed by both cystoscopy and the bladder filling test. After the filling test, leakage at the abdominal incision site and/or para-urethral dissected canal was observed in all cases with bladder perforation. No leakage was observed in the remaining patients (n = 12) suspected of, but not diagnosed with bladder perforation by cystoscopy. The bladder filling test did confirm the same diagnosis revealed by cystoscopy in all suspected cases. Conclusion: The bladder filling test was found to be very sensitive in predicting bladder perforation at tension-free-vaginal tape operations compared to cystoscopy. This test can decrease the need for routine cystoscopy at tension-free-vaginal tape insertion, and cystoscopy can be limited to cases with leakage in the bladder filling test.

Calyceal diverticular stones are rare clinical entities without a clearly defined consensus on the treatment. Treatment indicationsinclude recurrent urinary tract infections, chronic pain and renal impairment. Treatment modality of surgical approach is usuallybased on the location of calyceal diverticulum.A 23-year-old woman was presented with a calyceal diverticular stone of 16.5 mm. Her medical history revealed multiple urinary tractinfections caused by extended spectrum beta-lactamase (ESBL)-producing Escherichia coli of which the stone was predicted to be thereason. The patient was treated ureterorenoscopically, a decision of which was taken intra-operatively.In conclusion, insisting on performing nephroscopy following an intra-operative retrograde pyelography revealed no apparentostium which could be interpreted as ureterorenoscopic retriaval would fail and development of postoperative bacteremia despite allprecautions taken pre-and intra-operatively were two lessons indicating that all efforts must be exercised to reach the most minimalinvasive method for the treatment of calyceal diverticular stones.

Background/Aim: There is insufficient data on physiological and psychological alterations that may occur among health-care workers wearing various face masks during novel coronavirus-2019 (COVID-19) pandemic. In this study, we aimed to investigate the physiological effects of various types of face masking and associated discomfort among health-care workers. Methods: This prospective study included 33 healthy health-care workers. Each participant was asked to wear a single surgical mask, double mask, N95 type mask, and surgical mask on N95 type mask for an uninterrupted period of 2 hours. Oxygen saturation, heart pulse, blood pressure, respiratory rate, and step counts were recorded at baseline and every 30 min of 2 hours with a total of five times for each mask type. Self-assessment of fatigue, exhaustion, and headache were also graded. Intra- and inter-group analyses were performed. Results: There was no significant difference in the oxygen saturation, pulse and respiratory rates among the participants including intra- and inter-groups (p>0.05) Although no significant difference was seen in diastolic blood pressure, systolic blood pressures gradually and significantly increased with a double surgical mask (p

During novel coronavirus 2019 (COVID-19) pandemic, patients usually present with several reports showing symptoms of severe systemic or respiratory illness and, although rare, some genital complaints such as scrotal discomfort can be seen. In the majority of patients, however, genital complaints seem not to be the initial or sole symptoms. In this article, we report an unusual presentation of a male case with severe external genital pain which was suspected to be the first clinical sign of COVID-19.

Objectives: To assess treatment effectiveness and safety of bilateral same-session ureterorenoscopy (BSSU) for the management of stone disease involving the entire urinary system. Patients and methods: We reviewed the records of 64 patients who underwent BSSU for the treatment of bilateral ureteric and/or kidney stones. Size, number, location per side, and the total burden of stones were recorded. Data on stenting, lithotripsy, and stone retrieval, and details of hospital stay and operation times were investigated. Treatment results were assessed using intraoperative findings and postoperative imaging. The outcome was considered successful in patients who were completely stone-free or who had only residual fragments of â¤2â¯mm. Results: The outcome was successful in 82.8% of the patients who received BSSU (54.7% stone-free and 28.1% insignificant residual fragments). The success rate per renal unit was 89.8%. There were no adverse events in 73.4% of the patients. The most common intraoperative complication was mucosal injury (36%). The complications were ClavienâDindo Grade I in 9.4% and Grade II in 7.8%. Grade IIIa and IIIb (9.4%) complications required re-treatments. Statistical evaluation showed no association between complication grades and stone, patient, or operation features. Stone burden had no negative impact on BSSU results. The presence of impacted proximal ureteric stones was significantly related to unsuccessful outcomes. Conclusion: BSSU is safe and effective for the management of bilateral urolithiasis. BSSU can prevent recurrent surgeries, reduce overall hospital stay, and achieve a stone-free status and complication rates that are comparable to those of unilateral or staged bilateral procedures. Keywords: Ureteroscopy, Bilateral, Kidney stones, ureter stones, Flexible ureterorenoscopy, Treatment outcomes

Objective: In this study, we tried to assess whether power Doppler ultrasonography (PDU) evaluation along with transrectal ultrasound (TRUS) has an additional benefit in the diagnosis of prostate cancer in patients with prostate-specific antigen (PSA) levels of 4-10 ng/mL, when combined with the other methods proposed for this range of PSA. Materials and Methods: Fifty-six patients with PSA values of 4-10 ng/mL were included in the study. Digital rectal examinations, evaluation of total and free PSA, and PDU assessments were done simultaneously with TRUS and eight-core systematic prostate biopsies. Along with the latter, additional biopsies were taken from the suspicious areas detected on PDU. The free/total PSA ratios, PSA density values, TRUS, PDU findings, and biopsy results of 56 patients were recorded and evaluated. Results: Specificity and positive predictive values in detecting prostate cancer in patients with PSA range of 4-10 ng/mL, calculated using the criteria of free/total PSA values 15\%, and PDU findings, were 94.87\% and 75\%, respectively. These values were significantly higher than those of 89.75\% and 69.73\%, respectively, defined for the criteria of free/total PSA values 15\%. Conclusion: The results of this study highlighted that PDU may be useful to detect prostate cancer, and decrease the number of unnecessary biopsy recommendations in patients with PSA values of 4-10 ng/mL, when used in combination with free/total PSA ratio and PSA density.

Objective To determine the possible effect of climate parameters on prostate specific anigen (PSA) levels. Materials and Methods Among 2.150 males, 757 individuals participating in a general checkup service at our hospital group in the past one year were enrolled in this study. The mean age was 48.52 and all the individuals underwent PSA screening tests, abdominal ultrasonography examinations including prostatic evaluation, and urine examinations including microscopic evaluation. The data on climate parameters including daily minimum and maximum temperatures and their average values as well as daily moisture levels were obtained from the records of the Turkish State Meteorological Service, including 2 meteorological stations existed in the Anatolian part of Istanbul. First of all, the differences in climatic parameters between the two stations were analyzed. Then, the relationship of PSA levels with daily minimum, maximum and average temperatures along with moisture levels recorded by the two stations was statistically evaluated. Results The mean age of the subjects was 48.52 (15-90) years and the percentage of individuals in age groups below 30, 31-40, 41-50 and over 50 were 5.2\%, 23.2\%, 31.8\%, and 39.8\%, respectively. The mean prostate volume measured by ultrasonography was 30.52 ml which increased with age in compatible with the literature. The mean PSA value was 1.19 ng/ml in all age groups. PSA values were higher in older participants and in those with larger prostate volume. Only PSA and mean humidity levels were statistically different between the two stations (p0.05 for all parameters). As for months and seasons, a statistically significant difference was observed between four seasons in all parameters of temperatures and humidity levels (p0.18 and p>0.5, respectively). Conclusion Since any proven effect of climate on PSA will increase the sensitivity of PSA in diagnosing prostate cancer and may prevent the decision of an unnecessary biopsy, humidity with a possible influential effect on serum PSA level according to our study definitely needs clarification and confirmation. Therefore, future studies including large number of subjects with detailed data facilitating calculation of thermal sensation are needed to give clearer answers to this topic.

Objective We report our experience with percutaneous nephrolithotomy (PNL) therapy for staghorn or complex pediatric renal calculi. Patients and methods We retrospectively analyzed the case records of 105 patients younger than 17 years who underwent PNL. The cases included 53 complex calculi analyzed in 51 patients. We defined complex calculi as either staghorn or those with a stone bulk larger than 300 mm2, involving more than one calix, the upper ureter or stone in anomalous kidney. Results Mean age of patients with complex calculi was 9.7 ± 0.7 years and stone burden was 654 ± 92.4 mm2. The median duration of PNL was 90 ± 4.7 (30–220) min. Complete clearance was achieved in 39 patients (73.6%). Of these, 32 (60.4%) required a single tract, while 21 (39.6%) required multiple tracts. With subsequent shock wave lithotripsy and PNL, the clearance rate increased to 86.8%. The average hemoglobin drop was 1.6 ± 0.16 g/dL. Assessing the factors affecting the hemoglobin drop, the number of tracts (P = 0.01) and size of tracts (P = 0.002) were found to be significant. The mean change in serum creatinine concentration between preoperative and postoperative measurements was −0.01 ± 0.02 mg/dL, for both patients with a single tract and those with multiple tracts. Conclusions PNL is safe and effective in the management of staghorn and complex renal calculi in children. Tract dilatation and number of tracts are important factors in reducing blood loss.

The intervention time of asymptomatic lower pole calculi remains controversial. In this prospective study we evaluated the natural history and progression rate of asymptomatic lower pole stones.Patients were followed every 6 months. Computerized tomography in even years, ultrasound scan in odd years after initial visit and abdominal plain films between these visits were evaluated. The largest diameter was measured for each calculus and the cumulative diameter was calculated for cases of multiple stones. Disease progression was defined as pain experienced during followup, stone growth or the need for intervention.A total of 24 patients, 14 male and 10 female, were followed for a mean of 52.3 months (range 24 to 72). Of the 24 patients 3 had bilateral lower pole stones. Mean cumulative stone diameter at presentation was 8.8 mm (range 2.0 to 26.0). Progression in stone size was demonstrated in 9 of 27 renal units (33.3%) with 2 (11.1%) requiring intervention. There was no need for intervention during the first 2 years of followup. Three stones passed spontaneously without any symptoms. Pain developed in 3 patients during followup, and 2 of them passed a stone and responded to the analgesics without further treatment. None of the patients had a pyelonephritic attack during followup.Our results showed that observation could be considered for patients with asymptomatic lower pole stones. However, patients should be counseled about the 33% disease progression and 11% intervention rates.

Purpose We prospectively evaluated the role of stone location and size in the efficacy of SWL for the treatment of urinary calculi in children. Material and methods Between January 2006 and March 2007, 94 pediatric patients (108 renoureteral units) were treated by Siemens Lithostar under sedo-analgesia. There were 58 boys and 36 girls, with a mean-age of 57.4 (8- 180) months. The stones were localized in the renal pelvis, lower, middle, upper calices and ureteropelvic junction in 24, 30, 17, 7 and 10 renal units. 14 renal units had stones in multiple locations. Four patients had proximal and 2 had distal ureteral calculi. Stone free rates and efficiency quotients were assessed 3 months after SWL. Results The mean stone burden was 74.6mm2 (20-380). Sixtysix (61.1%) renal units were stone-free within 12 weeks after an average of 1.48 (1-4) SWL sessions. Stone-free rates for pelvis, lower, middle, upper pole, ureteropelvic junction, upper and lower ureter were 83.3 %, 43,%, 52.9%, 71.4%, 60%, 100% and 50% respectively. Efficiency quotients for stones Conclusions Our results indicated SWL in the treatment of pediatric urolithiasis has acceptable stone-free rates with lower efficiency quotients, the latter compensated by the minimally invasive nature of this treatment modality. Stone-size seems to be the only factor affecting the efficiency.

Purpose This study was conducted to investigate the cons and pros of percutaneous stone treatment in a large population of children in a retrospective manner. Material and methods Three centers with experience in pediatric stone disease were included in this study. The data regarding the patients, stones, surgery and postoperative course were collected from each center. Results 346 renal units were operated in 311 (M:211, F:100) pediatric patients. The ages ranged from 9 months to 16 year old (mean:8.6). The mean stone area was 338.7 mm 2 (25-2075). Five had horseshoe kidneys, 2 had stones in caliceal diverticula, 9 had solitary kidney and 5 children had chronic renal failure. The procedure was carried out using different sizes of instruments within a mean surgery time of 90 min (10-270) and a mean fluoroscopy time of 12.9 min. (1.5-53). 267 (77%) renal units were rendered completely stonefree without major complications. The mean hospitalization time was 5.1 days (2-31). Blood transfusion rate was 14.7%, re-PCNL was performed in 8, adjuvant SWL was done in 6. Two had nonfunctional kidneys on follow-up. Conclusions Percutaneous nephrolithotomy is a standard treatment option for most of the large stones in pediatrics with acceptable morbidity. The technique is well established and is no longer of concern for this age group. Future studies should focus on randomized comparative trials with SWL.

Purpose: The intervention time of asymptomatic lower pole calculi remains controversial. In this prospective study we evaluated the natural history and progression rate of asymptomatic lower pole stones.Materials and Methods: Patients were followed every 6 months. Computerized tomography in even years, ultrasound scan in odd years after initial visit and abdominal plain films between these visits were evaluated. The largest diameter was measured for each calculus and the cumulative diameter was calculated for cases of multiple stones. Disease progression was defined as pain experienced during followup, stone growth or the need for intervention.Results: A total of 24 patients, 14 male and 10 female, were followed for a mean of 52.3 months (range 24 to 72). Of the 24 patients 3 had bilateral lower pole stones. Mean cumulative stone diameter at presentation was 8.8 mm (range 2.0 to 26.0). Progression in stone size was demonstrated in 9 of 27 renal units (33.3%) with 2 (11.1%) requiring intervention. There wa...