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© 2023, The Author(s), under exclusive licence to Springer Nature Limited.Premature ejaculation (PE) is common, but its true pathophysiology is not clear, and treatments are limited. We aimed to investigate the effect of neuromuscular electrical stimulation applied in different modes and frequencies to the bulbospongiosus muscle on ejaculation parameters. In this study, 24 male Wistar albino rats were used. The rats were equally divided into three groups: control, high-frequency burst (HFB) and low-frequency (LF) (n = 8 each). Neuromuscular electrical stimulation was applied to the rats for 30 min. In the HFB group, this stimulation was applied in the burst mode at 80 Hz frequency using 200 microseconds (µs) transition time. In the LF group, manual stimulation was applied using a 2 Hz frequency and 200 µs transition time. Following the intraperitoneal administration of para-chloroamphetamine at a dose of 5 mg/kg, ejaculation time, increase in basal seminal vesicle pressure, seminal vesicle maximum pressure, number and interval time of seminal vesicle contractions and bulbospongiosus muscle electromyography activities were evaluated over 30 min. There was a significant difference between the groups in terms of ejaculation time (p = 0.002). The ejaculation times of the LF, HFB and control groups were 1344.71 ± 105.9, 908 ± 62 and 672 ± 149.7 s, respectively. The post hoc analysis revealed that the ejaculation time of the LF group was significantly longer than that of the HFB and control groups (p = 0.033 and p = 0.001, respectively). The remaining parameters did not differ significantly between the groups. The results showed that low-frequency (2 Hz) electrical stimulation applied to the male rats significantly prolonged the ejaculation time. It is thus considered that applying neuromuscular electrical stimulation before planned sexual activity can prevent the rhythmic contractions necessary for completing the ejaculatory process by maintaining subtetanic continuous contraction and prolonging the ejaculation time in patients with premature ejaculation complaints.

© 2023, The Author(s), under exclusive licence to Springer Nature Limited.The effects of hormone levels on ejaculation are known. In addition to thyroid hormone levels, testosterone levels are also associated with ejaculation, but no consensus has been reached on this issue. Thus, we investigated the effect of decreased testosterone levels due to bilateral orchiectomy on the chemical stimulation-induced ejaculation phases in rats. Twenty-one male Wistar rats were randomized into the orchiectomy, sham, and control groups, with seven rats in each group. Bilateral orchiectomy was performed. The ejaculation parameters were evaluated 5 days after the sham and bilateral orchiectomy operations and the waiting period in the control group. The seminal vesicle (SV) phasic contraction number and increase in basal pressure amplitude were significantly lower in the orchiectomy group (6.9 ± 3.3 and 0.6 ± 0.3 mmHg) than in the sham and control groups (11.2 ± 1.7 and 1.0 ± 0.4 mmHg, and 14.5 ± 6.6 and 1.1 ± 0.2 mmHg, respectively; p = 0.016 and p = 0.03, respectively). The interval between the SV contractions was significantly longer in the orchiectomy group (166.2 ± 104.3 s) than in the sham and control groups (76.0 ± 15.5 s and 63.1 ± 31.1 s, respectively; p = 0.014 (between groups), orchiectomy vs sham p = 0.040 and orchiectomy vs control p = 0.018). The SV weights of the rats were significantly lower in the orchiectomy group (0.14 ± 0.01 g) than in the sham and control groups (0.37 ± 0.05 g and 0.48 ± 0.03 g respectively; p < 0.0001 (between groups), orchiectomy vs sham p < 0.0001 and orchiectomy vs control p < 0.0001). The groups showed no significant differences in ejaculation time, SV basal pressure, SV maximum amplitude, and bulbospongiosus muscle contraction electromyographic activity. Our results partially clarified the relationship between decreased testosterone levels and ejaculation. Decreased testosterone levels caused statistically significant changes in SV functions and affected the ejaculation emission phase.

In the current study we hypothesized that total knee arthroplasty might improve the overactive bladder symptoms by providing pain relief and improving physical function.One hundred patients who underwent total knee arthroplasty were preoperatively evaluated for overactive bladder and 47 patients that met inclusion criteria were included in this study. All the patients included in the study were assessed both preoperatively and at the 3rd month postoperatively using the Overactive Bladder-Validated 8 (OAB-V8) questionnaire for overactive bladder symptoms, the Oxford Knee Score (OKS) for pain and physical function, and the International Physical Activity Questionnaire-Short Form (IPAQ-SF) for physical activity.The mean age of the patients was 65.4 ± 7 (56-83) years. The OAB-V8, OKS and IPAQ-SF scores significantly improved at the 3rd month postoperatively compared with the initial assessment. All the OAB-V8 domains, namely, frequency, urgency, nocturia, and urgency urinary incontinence, significantly improved following total knee arthroplasty.Our results showed that following total knee arthroplasty, overactive bladder questionnaire scores significantly improved at the 3rd month postoperatively.

Ongun, Şakir (Balikesir Author), Introduction Following the COVID-19 pandemic, the face-to-face meetings are delayed to a future date, which is still not clear. However, seminars, meetings and conferences are necessary for updating our knowledge and skills. Web-based seminars (webinars) are the solutions to this issue. This study aimed to show the participant behaviour when webinars present at the COVID-19 pandemic era. Methods From December 2017 to July 2020, 58 webinars were broadcasted via the Uropedia, electronic library of SUST. Data of all webinars were collected with the YouTube analytics and application of the Uropedia. Data of streaming webinars included participant behaviours such as content views, engagement time, total unique attendees, average engagement time and the number of audience to leads. Data were split into two groups; group-1 is webinars before COVID-19 (before March 2020) and group-2 is the webinars during COVID-19. Results Total broadcast time and total page view number were found to be 112.6 hours (6761 minutes) and 15 919, respectively. The median participant age was 40.1 y. Median content view and median engagement time were found to be 261.0 and 12.2 minutes, respectively. Comparison of two groups revealed a significant increment in the content views (group-1; 134.0 range = 86.0-87.0 and group-2; 414.0 range = 296.0-602.0, P < .001) and the number of the unique attendees (group 1; 18.0 range = 10.0-26.0 and group-2; 57.0 range = 27.0-100.0, P < .001) following COVID-19. However, the median engagement time of the audience did not seem to change with the COVID-19 pandemic (group-1; 11.5 range = 10.0-13.3 minutes and group-2; 13.2 range = 9.4-18.1 minutes, P = .12). Conclusion The webinars are effective ways to share information and have many advantages, including low cost, reaching a high number of audiences. Audience number and page visits seemed to increase following the COVID-19 pandemic. However, this era did not seem to affect the critical attitude of the audience, which is engagement time.

We aimed to investigate the relationship between premature ejaculation and the age when men had been circumcised before adulthood. A total of 2,768 sexually active male patients aged between 18 and 65 years were included in this study. A multicentre study was conducted prospectively with the participation of 20 centres. A survey consisting of 12 questions prepared by the researchers, as well as the validated Turkish versions of the five-item Premature Ejaculation Diagnostic Tool, was administered to all participants. The study included 1,603 participants who met the inclusion criteria. There was no significant difference in the Premature Ejaculation Diagnostic Tool and self-reported ejaculation time between the participants who had been circumcised at different ages during childhood. Remembering circumcision experience with fear or anxiety did not increase the risk of sexual dysfunction compared to the participants who described their experience with happiness or with no particular emotion. There was no significant difference in Premature Ejaculation Diagnostic Tool scores or the self-reported ejaculation time of the participants circumcised at different ages. The age of childhood circumcision, having a fearful or anxious circumcision experience, does not affect the risk of premature ejaculation in adult life.

Introduction: Following the Covid-19 pandemic, the face-to-face meetings are delayed to a future date , which is still not clear. However, seminars, meetings, and conferences are necessary for updating our knowledge and skills. The web-based seminars (webinars) are the solutions to this issue. This study aimed to show the participant behavior when webinars present at the Covid-19 pandemic era. Methods: Between December 2017 – July 2020, 58 webinars were broadcasted via the Uropedia, electronic library of SUST. Data of all webinars were collected with the YouTube analytics and application of the Uropedia. Data of streaming webinars included participant behaviors such as content views, engagement time, total unique attendees, average engagement time, and the number of audience to leads. Data were split into two groups; group-1 is webinars before Covid-19 (before March 2020), group-2 is the webinars during Covid-19. Results: Total broadcast time and total page view number were found to be 112.6 hours (6761 min.) and 15919, respectively. The median participant age was 40.1 years. Median content view and median engagement time were found to be 261.0 min., and 12.2 min., respectively. Comparison of two groups revealed a significant increment in the content views (group 1;134.0 range=86.0-87.0 and group 2; 414.0 range=296.0-602.0, p

Aims of the study To investigate the effect of mirabegron 50 mg/daily for JJ stent-related symptoms after ureteroscopic stone surgery. Methods Medical records of 145 patients who were given a single daily oral dose of 50 mg of mirabegron for relieving stent-related symptoms were retrospectively analysed. Demographic and clinical data and stone parameters were recorded. All participants completed the Turkish version of the Ureter Symptom Score Questionnaire (USSQ-T) on the postoperative 7th day, and again after at least 3 weeks, before JJ stent removal. The severity of stent-related symptoms was statistically compared before and after the mirabegron treatment. Results The mean urinary symptoms score decreased significantly from 30.87 +/- 9.43 to 22.61 +/- 6.78 (P < .0001), mean body pain score decreased significantly from 21.82 +/- 11.22 to 14.03 +/- 7.52 (P < .0001), mean work performance score decreased from 10.50 +/- 8.61 to 7.02 +/- 6.51 (P < .0001) and mean general health score decreased significantly from 15.43 +/- 6.50 to 11.12 +/- 3.70 (P < .0001). The mean sexual matters score significantly decreased from 3.88 +/- 3.40 to 2.48 +/- 2.03 (P < .0001), the additional problem score decreased from 9.31 +/- 4.61 to 6.51 +/- 2.83 (P < .0001) and the overall quality of life (QoL) score decreased from 5.18 +/- 1.94 to 4.23 +/- 1.71 after mirabegron use (P < .0001). Conclusion Daily use of 50 g of mirabegron significantly improved stent-related symptoms, sexual matters and quality of life.

Ongun, Şakir (Balikesir Author), Introduction: Coronavirus disease 2019 (COVID-19) pandemic caused unprecedented restrictions in outpatient services and surgical practices in urology as in other medical branches as well as in all areas of life. Aim: To investigate whether there have been variations in the presentations of male patients with sexual and reproductive health problems to the outpatient urology clinics during the COVID-19 pandemic and to understand the underlying factors for these variations, if any. Methods: Male patients aged >= 18 years who presented to the outpatient urology clinics in 12 centers across Turkey from February 1, 2020 to June 1, 2020 were retrospectively evaluated. The patients were divided into 2 groups: those who presented to the outpatient clinic from February 1, 2020 to March 11, 2020 comprised the "pre-COVID-19 pandemic period" group, whereas those who presented to the outpatient clinic from March 12, 2020 to June 1, 2020 comprised the "COVID-19 pandemic period" group and compared with each other. Main Outcome Measures: The main outcome of this study was the number and diagnose of patients presented to urology outpatient clinics. Results: Andrological problems were detected in 721 of 4,955 male patients included in the study. During the COVID-19 pandemic period, there was a significant increase in andrological diagnosis in these patients compared with the pre-COVID-19 pandemic period (n = 293 [17%] vs n = 428 [13.2%], P < .001, respectively). Similarly, there was a statistically significant increase in the number of patients diagnosed with male reproductive or sexual health problems during the COVID-19 pandemic period (n = 107 [6.2%] vs n = 149 [4.6%], P = .016 and n = 186 [10.8%] vs n = 279 [8.6%], P = .013, respectively). The number of patients diagnosed with erectile dysfunction during the pandemic was also significantly higher than the pre-COVID-19 pandemic period (n = 150 [8.7%] vs n = 214 [6.6%], P = .008). Conclusion: Presentations to the outpatient urology clinics owing to andrological problems markedly increased during the pandemic period. Although these problems are of multifactorial origin, psychogenic factors are also considered to significantly trigger these problems. Copyright (C) 2020, The Authors. Published by Elsevier Inc. on behalf of the International Society for Sexual Medicine.

Ongün, Şakir (Balikesir 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.

OBJECTIVE We aimed to investigate the predictive ability of the Hounsfield unit (HU) on non-contrast computed tomography (NCCT) for the success of medical expulsive therapy (MET) using silodosin in distal ureteric stones of 4-10 mm. METHODOLOGY The data of patients who underwent MET were retrospectively screened. The patients were divided into two groups as Groups 1 and 2 depending on the presence or absence of stone expulsion, respectively. In addition to HU calculated using the NCCT images, state of the collecting systems, daily fluid intake, number of emergency department visits, and number of pain attacks were compared. RESULTS A total of 88 patients were included in the study. Sixty-four patients (72.7%) expelled the stone after MET while the treatment was not successful in 24 patients (27.3%). The stone area was significantly larger in Group 2 (28.4 ± 15.7 mm2 vs 46.8 ± 16.1 mm2 ; P

OBJECTIVE We aimed to evaluate the use of computed tomography (CT) as the first imaging modality in patients with renal colic and microscopic haematuria. METHODOLOGY The patients that presented to the emergency service of six health centers with renal colic between January 2017 and January 2018 and were found to have microscopic hematuria on urinalysis were retrospectively evaluated. Only patients for whom non-contrast CT was used as the first imaging modality were included in the study. Patients were divided into two groups according to the stone presence (stone +, stone -) and the groups were compared in terms of demographics and clinical characteristics of patients. RESULTS A total of 834 patients were included in the study and 711 (85.3%) were diagnosed with urolithiasis. CT also revealed additional pathology in 26 (3.1%) patients. The male patients had a significantly higher rate of stones than female patients (89.5% vs 75.2%; P

Objective: To identify pathophysiological mechanisms of nocturia and the correlation of these mechanisms with nocturia severity. Methodology: After approval by the local ethics committee, all patients with nocturia (≥1 nocturnal void/night) were included and filled the overactive bladder questionnaire (OABq), nocturia quality of life (N-QoL), ICIQ-MLUTS (male), ICIQ-FLUTS (female) and 3-day frequency-volume chart. Patients were divided into three groups according the severity of nocturia: group 1 consisted of patients with mild (1-2 voids/night), group 2 with moderate (3-4 voids/night) and group 3 with severe nocturia (>4 voids/night). Comparative analysis were performed between groups, p

WOS: 000451975400005, Objective: To analyze the effect of the anesthesia method (spinal and general) on the outcome of ureteroscopy (URS) in patients treated for proximal ureteral stones. Materials and Methods: Patients, who underwent URS for proximal ureteral stones at various urology clinics in Turkiye, were included in the study. The patients were divided into two groups according to the anesthesia method performed; the procedure was performed under spinal anesthesia (SA) in group 1 and general anesthesia (GA) in group 2. Patients' demographic, perioperative data and complication rates were compared between the two groups in a retrospective manner. Results: There were 309 and 329 patients in groups 1 and 2, respectively. The mean stone area and Hounsfield unit in GA group were higher (p0.05). The rate of success of URS, which is accepted as complete stone-free status, was higher in the SA group (p=0.041). Conclusion: URS, which is used in the treatment of proximal ureteral stones, has a high success rate, independent of the anesthesia method used. It is important to keep in mind the patient's comorbidities prior to selecting the anesthesia method and that the stone area and the Hounsfield unit are the important factors affecting the outcomes.

To contribute to the diagnosis and treatment of ureteral stones by investigating the relationship between the ureteral jet flow measurements of patients with ureteral stones and the size of the stones and the patients' pain scores.The sample consisted of patients who presented acute renal colic between December 2014 and 2015 and from a noncontrast computed tomography were found to have a urinary stone. The ureteral jet flow velocities were determined using Doppler ultrasonography. The patients were all assessed in terms of stone size, localization and area, anteroposterior pelvis (AP) diameter, and visual analogue scale (VAS) scores.A total of 102 patients were included in the study. As the VAS score decreased, the peak jet flow velocity on the stone side increased, whereas the flow velocity on the other side, AP diameter, and stone area were reduced (P .05). As the stone size increased, the peak jet flow velocity was reduced and the AP diameter increased significantly (P .05). Ureteral jet flow was not observed in 17 patients on the stone side. A statistically significant difference was found between these patients and the remaining patients in terms of all parameters (P .05).For patients, in whom the peak flow velocity of ureteral jet is low and with a severe level of pain or the peak flow velocity of ureteral jet cannot be measured, there is a low possibility of spontaneous passage and a high possibility of a large stone, and therefore the treatment should be started immediately.

Background Alpha-adrenergic antagonist treatment for benign prostatic hyperplasia (BPH) and drug-related sexual side effects are frequent in aging men. Aim To investigate functional changes in erectile and ejaculatory aspects of male sexuality under Silodosin 8 mg per day treatment for BPH. Methods Sexually active patients diagnosed with BPH and who initiated Silodosin treatment were the subjects of the study. The International Prostate Symptom Score, premature ejaculation patient profile (PEP-male) questionnaire, Sexual Health Inventory for Men (SHIM) questionnaire, and estimated intravaginal ejaculation latency time (IELT) values of the participants were used to evaluate sexual functions. Data evaluation was performed in 8 urology clinics retrospectively. Outcomes Participant ratings for SHIM, PEP, and estimated IELT were the primary outcome measures in the study. Results Among 187 recruited patients, data of 98 patients, who completed the trial period in the study, were eligible. The median age of the eligible participants who completed the trial period for 3 months was 59.5 years (range 45–82). 16 patients of 187 (8%) reported a desire for drug withdrawal for anejaculation during the recruitment period. 46 (46.9%) and 49 (50%) patients reported anejaculation in the first and third month of the treatment, respectively. De novo erectile dysfunction was noticed in 15 patients (15.3%). There was a significant increase in the estimated IELT of subjects in both the first (P = .01) and third (P = .002) month. SHIM-1 (P = .008), SHIM-total (P = .009), and PEP scores (P = .008) were also improved in the third month of the treatment. Neither baseline patient characteristics nor changes in the International Prostate Symptom Score after treatment predicted final outcomes with multivariable analysis. The subgroup analysis of participants who reported “anejaculation” also revealed better outcomes compared with participants ejaculating naturally in the third month as per SHIM ratings. Clinical Implications Despite several male patients having dry orgasms due to Silodosin-induced anejaculation, the majority experienced improved erectile function. Strengths & Limitations The present study demonstrated pioneering results while investigating both erectile and ejaculatory dimensions of the male sexual function during Silodosin treatment for BPH. However, lack of partner evaluation, low follow-up rates, and lack of knowledge about reasons why subjects are lost to follow-up after drug initiation have limited our interpretation. Conclusion Most patients using Silodosin 8 mg per day for BPH treatment experienced improvement in their erectile function, estimated IELT, and premature ejaculation profile in the third month of the treatment. Underlying mechanisms and reasons for individual differences necessitate further investigation.

Ongün, Şakir (Balikesir Author), Objective To identify the pathophysiological mechanisms of nocturia and the correlation of these mechanisms with nocturia severity. Methodology After approval by the local ethics committee, all patients with nocturia (>= 1 nocturnal void/night) were included and filled the Overactive Bladder questionnaire, Nocturia Quality of Life, Incontinence Questionnaire - Male Lower Urinary Tract Symptoms (male), International Consultation on Incontinence Questionnaire - Female Lower Urinary Tract Symptoms (female) and 3-day frequency-volume chart. Patients were divided into three groups according to the severity of nocturia: group 1 consisted of patients with mild (1-2 voids/night), group 2 with moderate (3-4 voids/night) and group 3 with severe nocturia (>4 voids/night). Comparative analysis was performed between groups, andP About 68.1%, 64.1% and 8.7% of the patients had nocturnal polyuria (NP), reduced bladder capacity and global polyuria, respectively. 42.7% of the patients had mixed nocturia. 6.1% of the patients did not comply with the aforementioned subtypes and defined as isolated nocturia. Regarding the severity of nocturia, 155 (41%) patients had mild, 167 (45%) patients had moderate and 57 (15%) patients had severe nocturia. Increased nocturia severity was related with decreased quality of life; higher age, urinary tract symptom scores, nocturnal urine volume, evening fluid consumption and beta-blocker medication rates. Increased nocturia severity was also associated with higher NP, global polyuria and reduced bladder capacity rates. Conclusions Nocturia mechanisms may vary between mild and moderate to severe nocturia groups according to the present study. Nocturia grading with identification of subtypes may help for better standardisation of the diagnostic and treatment approaches as well as for the design of future clinical trials.

Introduction: We aimed to evaluate the predictive factors in a holistic manner for ureterorenoscopy (URS) outcomes in proximal ureteral stones by a multicenter study. Materials and Methods: The data of patients who underwent URS for proximal ureteral stones between the years 2015 and 2018 in eight centers were recorded retrospectively. Patients were divided into two groups according to URS success: Group 1 consisted of patients with successful URS, and Group 2 consisted of patients with unsuccessful URS. The two groups were compared in terms of risk factors, stone, and clinical characteristics of patients. Results: A total of 638 patients were included in the study. Group 1 consisted of 527 (82.6%) patients, and Group 2 consisted of 111 (17.4%) patients. In multivariate logistic analysis, the key risk factors for URS success was found to be age (OR = 0.980, 95% [CI] = 0.963–0.996, p = 0.018), stone area (OR = 0.993, 95% [CI] = 0.989–0.997, p = 0.002), and operation time (OR = 0.981, 95% [CI] = 0.968–0.994, p = 0.005). Conclusions: To make the treatment decision of proximal ureteral stones, it is necessary to examine several parameters including available equipment, stone, and patient characteristics. Physicians should keep these risk factors in mind in the decision of treatment options.

Objective: The incidence of the prostate adenocarsinome (PCA) in the repeat prostate biopsy after the high grade prostatic intraepithelial neoplasia (HGPIN) diagnosis has decreased with the increase of the quadrant numbers. Contrary to the former literature, PCA incidence after the HGPIN diagnosis was not increased as compared to cases without HGPIN. In this study the re-biopsy results of the patients whose first prostate biopsy results were HGPIN were evaluated.

Ongün, Şakir (Balikesir Author), Objective: To investigate the relationship of spontaneous ureteral stone passage with stone size (width-length) and area. Materials and Methods: Patients who presented to the urology outpatient clinic with acute renal colic between January and December 2016 and were found to have a distal ureteral stone of 10 mm or smaller on unenhanced computed tomography (CT) were retrospectively evaluated. Using the CT images, the size of the stones was measured and the data of the patients were compared in terms of spontaneous passage status. Results: A total of 245 patients were included in the study. The mean stone size on the axial plane and coronal plane was 4.72 +/- 1.55 mm and 4.75 +/- 1.84 mm, respectively and the spontaneous passage rate was 77.6%. In logistic regression analysis, the most important factor in predicting spontaneous passage was the stone size on coronal measurement (p=0.020). The spontaneous passage rate was 70.8% in cases where the stone size on the axial plane was the same as or larger than on the coronal plane, 56.2% when the size on the the coronal plane was 1 mm greater than on the axial plane, and 34.7% when the stone size on the the coronal plane was 2 mm or more than 2 mm greater than on the axial size. Chi-square analysis revealed that the difference between spontaneous passage rates was statistically significant (p=0.001). Conclusion: When planning treatment for ureteral stones, the length of the stone in coronal measurement should be considered as a priority. It should be remembered that the probability of spontaneous passage is significantly low, especially if the length of the stone is 2 mm or more than 2 mm greater than its width., Amaç: Distal üreter taşlarının spontan pasajı ile taş boyut ölçümleri (en-boy) ve taş alanı arasındaki ilişkiyi araştırmayı amaçladık. Gereç ve Yöntem: Ocak 2016 ile Aralık 2016 tarihleri arasında akut renal kolik ile üroloji polikliğine başvuran ve kontrastsız bilgisayarlı tomografide (BT) 10 mm ve daha küçük distal üreter taşı saptanan hastaların bilgileri retrospektif olarak değerlendirildi. BT görüntüleri kullanılarak taş boyutları hesaplanarak spontan pasaj durumuna göre hastaların verileri karşılaştırıldı. Bulgular: Çalışmaya 245 hasta alındı. Hastaların aksiyal taş boyutu ortalaması 4,72±1,55 mm, koronal taş boyutu ortalaması 4,75±1,84 mm olarak ölçüldü. Hastaların en büyük taş boyutu ortalamaları ise 5,2±1,73 mm idi. Hastaların takiplerinde %77,6’sının (156) taşını düşürdüğü saptandı. Yapılan logistik regresyon analizinde spontan pasajı öngörmede en etkili faktörün taşın koronal ölçümünün olduğu saptanmıştır (p=0,020). Hastaların spontan pasaj oranları aksiyal boyutun koronal boyut ile aynı veya daha büyük olduğu durumlarda %70,8 olarak saptandı. Koronal boyut ile aksiyal boyuttan 1 mm daha büyük olduğu durumlarda spontan pasaj %56,2, 2 mm ve daha büyük olduğu durumlarda ise %34,7 olarak bulundu. Yapılan ki-kare analizinde spontan pasaj oranları arasındaki farkın istatistiksel olarak anlamlı olduğu saptandı (p=0,001). Sonuç: Üreter taşlarında tedavi planı yapılırken taşın koronal ölçümdeki boyu (uzunluğu) öncelikli olarak dikkate alınmalıdır. Özellikle taşı boyu eninden 2 mm ve daha fazla ise spontan pasaj olasığının ciddi oranda düşük olduğu akılda bulundurulmalıdır.

Ongün, Şakir (Balikesir Author), Introduction: Although premature ejaculation (PE) is the most common sexual dysfunction in young men, its true pathophysiology has not yet been clearly elucidated. Aim: To investigate the quantitative changes that occurred in an ejaculation model induced by para-chloroamphetamine (PCA) after botulinum-A toxin injection into the bulbospongiosus (BS) muscle in rats. Methods: A total of 21 male rats weighing 300 to 350 grams were used in the study. The animals were divided into 3 groups: control, 1 unit of botulinum-A toxin injected, and 5 units of botulinum-A toxin injected. The botulinum-A toxin was percutaneously injected into the BS muscle, and the experiment was carried out 96 hours (5 days) after the injection. Main Outcome Measure: The seminal vesicle (SV) was cannulated, and the BS muscle was dissected and connected to an amplifier (Biopac; Goleta, CA) to record the pressure and electromyography measurement. The ejaculation parameters were obtained after the PCA injection. Results: The ejaculation latency time of the group receiving 5 units of botulinum-A toxin was statistically significantly longer (1092 +/- 657 seconds) compared to the control group (298 +/- 81 seconds) and the group receiving 1 unit of botulinum-A toxin (439 +/- 100 seconds) (P = .003). Furthermore, the BS EMG area under the curve values for the group receiving 5 units of botulinum-A toxin were significantly lower (7.4 +/- 1.2 V/s x 10(-4)) than those of the control group (13.6 +/- 4.0 V/s x 10(-4)) and the group receiving 1 unit of botulinum-A toxin (13.6 +/- 5.0 V/s x 10(-4)) (P = .009). No statistically significant difference was found between the groups in terms of the basal SV pressure, number of SV phasic contractions, maximum amplitude of the SV phasic contraction, and intervals between the SV phasic contractions and the BS muscle contractions. Clinical Implications: Botulinum-A toxin injection is a potential treatment option for PE and should be further investigated by future clinical studies. Strengths and Limitations: Ease of administration and prolonged duration of botulinum-A toxin are advantages of the existing treatment options. The risk of anejaculation due to the dosage should be kept in mind. Conclusions: Injection of botulinum-A toxin into the BS muscle in rats significantly delayed the ejaculation latency time and affected the expulsion phase. Copyright (C) 2019, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved., Dokuz Eylul University

The aim of this study was to explore clinical features of renal infarction (RI) that may have a role in diagnosis and treatment in our patient cohort and provide data on midterm renal functions. Medical records of patients with diagnosis of acute RI, established by contrast enhanced computed tomography (CT) and at least 1 year follow-up data, who were hospitalized in our clinic between 1998 and 2012 were retrospectively reviewed; including descriptive data, clinical signs and symptoms, etiologic factors, laboratory findings, and prescribed treatments. Patients with solitary infarct were treated with acetylsalicylic acid (ASA) only, whereas patients with atrial fibrillation (AF) or multiple or global infarct were treated with anticoagulants. Estimated Glomerular Filtration Rate (eGFR) referring to renal functions was determined by the Modification of Diet in Renal Disease (MDRD) formula. Twenty-seven renal units of 23 patients with acute RI were identified. The mean age was 59.7 +/- 15.7 years. Fourteen patients (60.8%) with RI had atrial fibrillation (AF) as an etiologic factor of which four had concomitant mesenteric ischemia at diagnosis. At presentation, 20 patients (86.9%) had elevated serum lactate dehydrogenase (LDH), 18 patients (78.2%) had leukocytosis, and 16 patients (69.5%) had microscopic hematuria. Two patients with concomitant mesenteric ischemia and AF passed away during follow up. Mean eGFR was 70.8 +/- 23.2 mL/min/1.73 m(2) at admission and increased to 82.3 +/- 23.4 mL/min/1.73 m(2) at 1 year follow up. RI should be considered in patients with persistent flank or abdominal pain, particularly if they are at high risk of thromboembolism. Antiplatelet and/or anticoagulant drugs are both effective treatment options according to the amplitude of the infarct for preserving kidney functions. Copyright (C) 2015, Kaohsiung Medical University. Published by Elsevier Taiwan LLC. All rights reserved.

Objective: the aim of this study is to compare the efficacy and complications of holmium laser and pneumatic lithotripsy used in the ureterorenoscopic treatment of proximal ureteral stones. Materials and Methods: Data of 638 patients, who underwent ureterorenoscopy (URS) due to proximal ureteral stones in different centers, were obtained from patient files. the patients were divided into two groups according to the type of lithotripter used: group 1; laser lithotripter (n=324; 50.8%) and group 2; pneumatic lithotripter (n=314; 49.2%). URS was considered successful upon determination stone-free status with the imaging methods after treatment. the effectiveness and the complications of holmium:yttrium-aluminum-garnet laser and pneumatic lithotripsy were compared. Results: the total success rate of URS was 82.6% and the complication rate was 8.1%. the mean age of patients was similar between the groups; however, the body mass index values, stone surface area and stone Hounsfield unit were significantly higher in group 1. Although the mean operative time, complication rate and the mean length of hospital stay were similar between the groups; the URS success and postoperative ureteral J stent use rates were significantly higher in group 1 and the push-back rate was significantly higher in group 2. Conclusion: If laser lithotripsy is available in a clinic, we believe that it is better to use it as the first option in the treatment of proximal ureter stones. However, considering that it is not easy to access laser lithotripters due to their high cost in Turkey, pneumatic lithotripters may be an effective and inexpensive alternative that can also be safely used in these cases., Amaç: Bu çalışmanın amacı proksimal üreter taşlarının üreterorenoskopi (URS) ile tedavisinde kullanılan holmiyum lazer ve pnömatik litotriptörlerin etkinlik ve komplikasyonlarını karşılaştırmaktır. Gereç ve Yöntem: Proksimal üreter taşı nedeni ile farklı referans merkezlerde URS yapılan toplamda 638 hastanın verileri retrospektif olarak tarandı. Hastalar kullanılan litotriptör türüne göre 2 gruba ayrıldı: Grup 1; lazer litotriptör (n=324; %50,8) ve grup 2; pnömatik litotriptör (n=314; %49,2). URS başarısı, tedavi sonrası yapılan görüntüleme tetkiklerinde taşsızlık saptanması olarak alındı. Holmium:yttrium-aluminum-garnet lazer ve pnömatik litotriptörlerin başarı ve komplikasyon oranları karşılaştırıldı. Bulgular: Toplamda URS başarısı %82,6 ve genel komplikasyon oranı ise %8,1 idi. Lazer litotriptör kullanılan hastalarla pnömatik litotriptör kullanılan hastalar demografik veriler ve taş özelliklerine göre karşılaştırıldıklarında; her iki grubun yaş ortalamaları benzerdi ancak hastaların vücut kitle indeks değerleri, taş alanı ve Hounsfield ünitesi değerleri grup 1’de anlamlı olarak yüksek saptandı. Grup 1 hastalarında şok dalgasıyla böbrek taşı kırdırma öyküsü olanlar anlamlı olarak daha fazla saptandı. Her iki grup operasyon sonuçlarına göre ve komplikasyon oranlarına göre karşılaştırıldığında; operasyon süresi, komplikasyon oranları ve hastanede yatış süreleri açısından benzer olarak saptansa da URS başarısı ve postop üreteral J stent kullanımı grup 1’de anlamlı olarak yüksek; push back oranları ise grup 2’de anlamlı olarak yüksek saptandı. Her iki gruptaki komplikasyonlar ClavienDindo sınıflamasına göre karşılaştırıldığında anlamlı bir fark saptanmadı. Sonuç: Eğer kliniklerde lazer litotiripsi mevcutsa, proksimal üreter taşları tedavisinde ilk seçenek litotriptör olarak kullanılmasının daha uygun olacağı kanısındayız. Ancak ülkemizde yüksek maliyetleri nedeni ile lazer litotriptörlere ulaşımın çok da kolay olmadığını düşünürsek; etkin ve ucuz bir yöntem olan pnömatik litotriptörler de güvenle bu olgularda kullanılabilir.

Introduction: To evaluate the pathological outcomes of Turkish men meeting the criteria for Active Surveillance (AS), who elected to undergo immediate radical prostatectomy (RP). Material and Methods: Retrospective analysis including 1,212 patients with clinically localized prostate cancer (PCa) who met the eligibility criteria for AS. The primary outcomes were pathological upstaging and pathological upgrading. Results: Nine hundred ninety-one patients were eligible for analysis after the central review of the submitted data. The mean prostate-specific antigen (PSA) level was 6.89 (0.51–15) ng/mL and the mean biopsy core number was 12 (8–47). The mean tumor positive core on final biopsy pathology was 1.95 (1–6) (16.6% [2.1–33.3%]). Overall, 30.6% of the men experienced a Gleason sum (GS) upgrade and 13.2% had pathological upstaging. For GS upgrade, the percentage of tumor-positive cores and free-to-total-PSA ratio were significant both in univariate analysis and multivariate logistic regression analysis. Variables predicting pathological upstaging were percentage of tumor-positive cores and PSA density, which were significant in univariate analysis. However, only PSA density was significant in multivariate logistic regression. Although biochemical recurrence-free survival was longer in patients without GS upgrade, it was not statistically significant between patients with and without any GS upgrade (mean 133.7 vs. 148.2 months, p = 0.243). A similar observation was made for patients with or without pathological upstaging (mean 117.1 vs. 148.3 months, p = 0.190). Conclusions: Upgrading and upstaging at RP are quite common among Turkish men with clinically low-risk PCa, who are candidates for AS, and a great majority of them experienced long-term PSA control.

To evaluate the possible alterations in ureteral jet dynamics which inform physicians about ureteral physiology and peristaltism in nonobstructive kidney stone formers with this prospective-controlled study.All patients with flank pain eligible for the study underwent Doppler ultrasonoghraphy examination for evaluation of ureteral jet dynamics and non-contrast-enhanced computed tomography for diagnostic reasons. Patients with unilateral nonobstructive lower-pole kidney stone ≤1 cm were defined as group 1 and patients with no evidence of urinary tract stone as group 2. Ureteral jet dynamics were compared between the affected and healthy renal units in group 1 and also between affected renal units in group 1 and all renal units in group 2.There were 31 and 20 patients in groups 1 and 2, respectively. Mean average jet flow rates (JETave) were significantly lower in affected renal units in group 1 when compared with healthy renal units in group 1 and also when compared with group 2 (10.9 ± 7.6 cm/s, 13.6 ± 5.9 cm/s, and 12.5 ± 3.9 cm/s, respectively; P.05). Affected renal units were more likely to have continuous jet flow pattern. Odds ratio was 19.3 for patients with JETave9 cm/s compared with patients with JETave ≥9 cm/s in terms of kidney stone formation.Decreased JETave and continuous jet flow pattern, both of which may refer to decreased ureteral peristaltism, may precede kidney stone formation. Ureteral jet dynamics should be evaluated in patients with previously known risk factors and especially patients with JETave9 cm/s need close follow-up. However, further prospective cohort trials may enlighten our findings.

© 2014 Informa Healthcare.Objective. There is no sufficient evidence to demonstrate whether more challenging pelvic anatomy affects the functional and oncological outcomes of radical retropubic prostatectomy (RP). The aim of this study was to investigate the impact of pelvic biometric measurements, visceral and subcutaneous adipose tissue areas on trifecta outcome (cancer control, continence and potency) and surgical margin status after open RP. Materials and methods. A retrospective study was performed on 270 patients who were diagnosed with clinically localized prostate cancer between 2005 and 2011 and underwent computed tomography imaging before RP. Pelvic bony and soft-tissue measurements, and visceral and subcutaneous adipose tissue area calculations were performed. Patients were evaluated for trifecta outcome and surgical margin status on univariate and multivariate analyses. Subgroup analysis was performed for prostate volume, body mass index (BMI) and D'Amico risk classification. Results. Univariate analysis revealed that patients with trifecta were younger, and had lower prostate-specific antigen (PSA) levels, wider symphysis angle, and narrower prostate width and soft-tissue width (p < 0.05). Patients with positive surgical margins were older, and had higher PSA levels, lower prostate volume and narrower prostate width (p < 0.05). Visceral adipose tissue area was lower in patients with trifecta when BMI was below 25 kg/cm (p < 0.05). In multivariate analysis, PSA level and symphysis angle were statistically significant for trifecta while PSA level was the only statistically significant variable for positive surgical margins (p < 0.05). Interfemoral index was significant in the low-risk group of D'Amico classification for trifecta outcome. Conclusion. Pelvic biometric measurements and adipose tissue area calculations may help in preoperative planning and the management of RP.

Resumen Objetivos Examinar los resultados del tratamiento en pacientes con cancer de prostata (CP) tratados con prostatectomia radical (PR) que podrian ser buenos candidatos para vigilancia activa (VA) y evaluar la confianza y fiabilidad de los criterios de VA para predecir la enfermedad en estadios avanzados (puntuacion de Gleason en PR ≥ 7 o estadio patologico T3). Metodos Entre 2005 y 2012 se examinaron los registros de 401 pacientes sometidos a PR con un diagnostico de CP. De estos pacientes 173 resultaron ser candidatos para VA. Los criterios de inclusion fueron los siguientes: estadio clinico T2a o inferior, PSA Resultados Los analisis univariantes revelaron que los pacientes con un estadio mas avanzado de la enfermedad tenian una densidad del antigeno prostatico especifico (PSAD) mas elevada, un mayor porcentaje maximo (%max) de nucleos positivos y un mayor volumen tumoral en PR. En los analisis multivariantes la PSAD, el %max de nucleos positivos y el volumen tumoral en PR eran factores estadisticamente significativos de enfermedad en estadios avanzados. Los analisis ROC revelaron que el volumen tumoral en PR es un buen test de la enfermedad en estadio avanzado. Conclusiones Se deberia considerar reducir los valores umbral de PSAD y %max en nucleos positivos como criterios de inclusion para VA. Si se pudiera calcular el volumen tumoral antes de la PR podriamos minimizar los fracasos del tratamiento (exceso o falta de tratamiento) de CP. Quizas los nuevos protocolos de biopsias, los biomarcadores de tejidos y la tecnologia de imagenes moleculares puedan perfeccionar los criterios para VA.

To examine the treatment outcomes of the prostate cancer (PCa) patients treated by radical prostatectomy (RP) who could be good candidates for active surveillance (AS) and test the confidence and reliability of the AS criterias for predicting advanced stage disease (RP Gleason score≥7 or Pathological stage T3).Between 2005 and 2012 the records of the 401 patients who underwent RP with a diagnosis of PCa were examined. Of these patients, 173 were found to be candidates of AS. The inclusion criteria were as follows; clinical stage T2a or less, PSA10ng/ml, 2 or fewer cores involved with cancer, no single core with 50% or greater maximum involvement of cancer, and no Gleason grade greater than 3 in the specimen.Univariate analyzes revealed that patients with advanced stage disease have higher prostate specific antigen density (PSAD), higher maximum percent (max%) in positive cores and higher RP tumor volumes. In multivariate analyzes PSAD, max% in positive cores and RP tumor volumes were statistically significant determinants for advanced stage disease. ROC analyzes revealed that the RP tumor volume is a good test on advanced stage disease.Decreasing the cutoff values for PSAD and max% in positive cores should be considered for AS inclusion criteria. If we could calculate the tumor volume before RP, we can minimize the treatment failures (over or undertreatment) of PCa. Perhaps new biopsy protocols, tissue biomarkers, and molecular imaging technology may refine AS criteria.

Most of the bladder tumors are urothelial carcinoma, squamous cell carcinoma and adenocarcinoma. Trophoblastic differentiation of urothelial carcinoma is a rare tumor of the bladder. These tumors secrete Human chorionic gonadotropin (beta-HCG) and HPL and they have different immunohistochemical characteristics from placental trophoblastic tumors. These tumors are aggressive tumors with poor prognosis and multiple metastases. Primary treatment method is chemotherapy for these tumors.

Penile schwannomas are schwann cell originated, usually sporadic, benign and encapsulated rare tumors. The definitive diagnosis and treatment is surgical excision. The point of excision should be considered that in order to prevent postoperative erectile dysfunction related nerve damage careful dissection and excision of the nodule. In this article, 54-year-old male patient undergoing careful surgical excision due to 2 cm sporadic schwannoma nodule in the root of penis was presented with the literature.

A 31-year-old female presented with acute left flank pain; she had a C/S at the postpartum day 24. Ureteral stone was suspected but ultrasound examination was normal. Then Doppler ultrasound revealed a trombus in left renal vein and inferior vena cava. Contrast enhanced MDCT scan showed swelled and nonfunctional left kidney, a trombus including distal part of left ovarian vein, left renal vein, and inferior vena cava. We started anticoagulation treatment. Further examination revealed diagnosis of chronic myeloproliferative disease. The trombus was completely recanalized at 3-month followup.

Objectives: It was the aim of this study to evaluate the efficacy of single-dose fosfomycin prophylaxis as an alternative to fluoroquinolone-based prophylaxis in transrectal ultrasound-guided biopsy of the prostate (TRUSBP). Methods: We evaluated the records of 620 patients who had undergone TRUSBP from January 2010 to July 2011. Patients received a single dose of 3 g oral fosfomycin or a single dose of 500 mg oral levofloxacin or 500 mg oral ciprofloxacin twice daily administered for 5 days starting 1 day before the prophylaxis procedure. We reviewed all febrile and afebrile urinary tract infections (UTIs) within 1 month after TRUSBP. Results: Of the 620 patients, 19 (3.0%) developed febrile UTI and 51 (8.2%) developed afebrile UTI after biopsy. Of the 19 patients with febrile UTI, 1/19 (5.2%) received fosfomycin, 4/19 (21%) received levofloxacin and 14/19 (73.6%) received ciprofloxacin for prophylaxis. Of the 51 patients with afebrile UTI, 4/51 (7.8%) received fosfomycin, 8/51 (15.6%) received levofloxacin and 39/51 (76.4%) received ciprofloxacin for prophylaxis. There were a total of 10 fluoroquinolone-resistant infections, and all of them occurred after the ciprofloxacin or levofloxacin prophylaxis and none after fosfomycin prophylaxis. Conclusions: The ease of use of fosfomycin, reducing the rate of fluoroquinolone-resistant infections and hospitalizations shows that it would be an alternative and effective drug for antimicrobial prophylaxis in TRUSBP.