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Purpose: To compare the models developed with a classical statistics method and a Machine Learning model to predict the possibility of orchiectomy using preoperative parameters in patients who were admitted with testicular torsion.Materials Method: Patients who underwent scrotal exploration due to the testicular torsion between the years 2000 and 2020 were retrospectively reviewed. Demographic data, features of admission time, and other preoperative clinical findings were recorded. Cox Regression Analysis as a classical statistics method and Random Forest as a Machine Learning algorithm was used to create a prediction model. Results: Among patients, 215 (71,6%) were performed orchidopexy and 85 (28,3%) were performed orchiectomy. The multivariate analysis revealed that monocyte count, symptom duration, and the number of previous Doppler Ultrasonography were predictive of orchiectomy. Classical Cox Regression analysis had an area under the curve (AUC) 0,937 with a sensitivity and specificity of 88% and 87%. The AUC for the Random Forest model was 0,95 with a sensitivity and specificity of 92% and 89%. Conclusion: The ML model outperformed the conventional statistical regression model in the prediction of orchiectomy.The ML methods are cheap, and their powers increase with increasing data input; we believe that their clinical use will increase over time.

Background. The gold standard treatment method for end-stage renal disease (ESRD) is renal transplantation (RT). RT can be done with open or minimally invasive surgical methods. We aimed to compare the outcomes between patients who underwent robot-assisted renal transplantation (RART) and open renal transplantation (ORT). Methods. Data of the patients who underwent ORT or RART in two institutions between June 2015 and February 2020 were retrospectively reviewed. Patients who underwent live donor RT were included, and all donor nephrectomy procedures were performed by the laparoscopic technique. Demographic data, ischemia times, anastomosis times, operation times, and postoperative complications were recorded. Results. 98 patients were included in the ORT group, while 91 patients were included in the RART group. There was a significant difference between the two groups regarding mean patient age. While total ischemia time was 86.9 ± 7 minutes in the RART group, it was calculated as 71.2 ± 3.3 minutes in the ORT group, with a significant difference. The anastomosis time was significantly shorter in the ORT group than in the RART group. The incision length and duration of hospital stay were significantly shorter, visual analogue scores were significantly lower, and estimated blood loss was less in the RART group than in the ORT group. Conclusion. Both ORT and RART are effective and safe methods for treating ESRD. According to our study, RART is associated with relatively longer ischemia times but lower complication rates and higher patient comfort.

Resumen Objetivo Incorporar los parametros basados en la tomografia computarizada sin contraste (TCSC) a las caracteristicas de los calculos y de los pacientes comunmente asociadas con el exito de la litotricia por ondas de choque (LEOCH) para evaluar la efectividad de este nuevo modelo en la prediccion del exito de LEOCH en calculos ureterales unicos situados en diferentes localizaciones. Materiales y metodos Se revisaron retrospectivamente los datos de los pacientes tratados con LEOCH por un unico calculo ureteral entre enero de 2017 y enero de 2019. Los parametros basados en la TCSC se evaluaron junto con los parametros demograficos de los pacientes y las caracteristicas de los calculos. Los parametros basados en TCSC incluyeron la presencia o ausencia de hidronefrosis, trabeculacion de la grasa perirrenal, edema periureteral, diametro del ureter proximal, grosor de la pared ureteral (GPU) en el sitio del calculo ureteral. Se utilizo el metodo de regresion logistica para desarrollar un modelo predictivo util. Posteriormente, se utilizo la curva ROC para determinar los puntos de corte, y se desarrollo un sistema de puntuacion para la prediccion del exito de LEOCH. Resultados La tasa libre de calculos fue del 77,1% (267/346) en toda la cohorte. El analisis univariante revelo que la edad, el volumen de los calculos, la densidad, la trabeculacion perirrenal, el diametro del ureter proximal y el GPU se asociaron con el exito de la LEOCH. En el analisis multivariante, la localizacion del calculo ureteral proximal, el volumen del calculo, la densidad y el GPU fueron predictores independientes del exito de la LEOCH. La formula utilizada en el analisis de regresion logistica fue: 1/ [1 + exp {-8,856 + 0,008(volumen del calculo) + 0,002 (densidad del calculo) + 0,673 (GPU) + 1026 (calculo ureteral proximal)}]. Las puntuaciones de 0, 1, 2, 3 y 4 se asociaron con un 97,8%, 83,4%, 60,8%, 33,2% y 11,1% de exito, respectivamente, en el modelo de prediccion basado en estos parametros. Conclusion Concluimos que nuestro modelo puede ser util en la eleccion del tratamiento con LEOCH de los calculos ureterales en diferentes localizaciones.

WOS:000730954400001 PMID: 34913804 Introduction We aimed to evaluate the impact of the resection technique (tumor enucleation (TE) or standard partial nephrectomy (SPN)) on trifecta outcomes in patients having undergone partial nephrectomy (PN). Materials and Methods We retrospectively analyzed the clinical and pathologic parameters in patients with localized renal cell carcinoma (pT1-2N0M0) who had undergone PN between January 2001-December 2018 at one of 15 different tertiary referral centers. Multivariable logistic regression analysis was applied to investigate independent predictors of trifecta failure, decreased postoperative renal functions (decreased estimated glomerular filtration rate (eGFR) > 10%), perioperative complications (Clavien-Dindo > 1), and positive surgical margins. Results A total of 1070 patients with a mean age 56.11 +/- 11.88 years were included in our study. PN was performed with TE in 848 (79.25%) and SPN in 222 (20.75%) patients. Trifecta failure rate was 56.2% for TE and 64.4% for SPN (p = 0.028). On multivariable analysis, TE was associated with less trifecta failure (p = 0.025) and eGFR decrease >10% rates (p = 0.024). On the other hand, there was no statistically significant difference between TE and SPN according to positive surgical margins (p = 0.450) and complication > Clavien-Dindo grade 1 (p = 0.888) rates. The only independent predictive factor for complications > Clavien-Dindo 1 was the Charlson comorbidity index (CCI) (p = 0.001). Conclusion TE is associated with less trifecta failure than SPN. This result is mainly due to better preservation of renal function with TE.

BACKGROUND/AIM Cervical spondylotic myelopathy (CSM) develops as a result of compression of the spinal cord in the cervical region. Early diagnosis and surgical treatment can limit the progression of symptoms. Various surgical approaches and strategies have been described in the literature. This study aims to evaluate the clinical and radiological results of open-door laminoplasty for the treatment of CSM. MATERIALS AND METHODS In this study, we retrospectively analyzed the patients who underwent expansive open-door laminoplasty secured with titanium miniplates. Thirty-four patients with CSM who were followed up postoperatively for more than 12 months were included in the study.The modified Japanese Orthopedic Association(mJOA) score was used to assess the degree of myelopathy.We evaluated cervical sagittal alignment with C2-C7 Cobb angle, the ambulatory status with the Nurick grade, and measured postoperative neck pain with the Visual Analogue Scale(VAS). RESULTS The mean mJOA score was 11(range 6-15) preoperatively, and 13.5 (range 9-16) postoperatively with an average 55% recovery rate (range 0-75)(p

Purpose The main objective was to compare minor (Clavien I-II) and major (Clavien >= III) intra- and postoperative complications of living donor robotic assisted kidney transplantation (RAKT) in obese (>= 30 kg/m(2)BMI), overweight (< 30/ >= 25 kg/m(2)BMI) and non-overweight recipients (< 25 kg/m(2)BMI). Methods For the present retrospective study, we reviewed the multi-institutional ERUS-RAKT database to select consecutive living donor RAKT recipients. Functional outcomes, intra- and postoperative complications were compared between obese, overweight and non-overweight recipients. Results 169 living donor RAKTs were performed, by 10 surgeons, from July 2015 to September 2018 in the 8 European centers. 32 (18.9%) recipients were obese, 66 (39.1%) were overweight and 71 (42.0%) were non-overweight. Mean follow-up was 1.2 years. There were no major intra-operative complications in either study group. Conversion to open surgery occurred in 1 obese recipient, in 2 overweight recipients and no conversion occurred in non-overweight recipients (p = 0.3). Minor and major postoperative complications rates were similar in the 3 groups. At one-year of follow-up, median eGFR was similar in all groups [54 (45-60) versus 57 (46-70) versus 63 (49-78) ml/min/1.73 m(2)in obese, overweight and non-overweight recipient groups, respectively,p = 0.5]. Delayed graft function rate was similar in the 3 groups. Only the number of arteries was an independent predictive factor of suboptimal renal function at post-operative day 30 in the multivariate analysis. Conclusion RAKT in obese recipients is safe, compared to non-overweight recipients and yields very good function, when it performed at high-volume referral centers by highly trained transplant teams.

Objectives To develop a model for predicting biochemical recurrence (BCR) in patients with long follow-up periods using clinical parameters and the machine learning (ML) methods. Materials method Patients who underwent robot-assisted radical prostatectomy between January 2014 and December 2019 were retrospectively reviewed. Patients who did not have BCR were assigned to Group 1, while those diagnosed with BCR were assigned to Group 2. The patient's demographic data, preoperative and postoperative parameters were all recorded in the database. Three different ML algorithms were employed: random forest, K-nearest neighbour, and logistic regression. Results Three hundred and sixty-eight patients were included in this study. Among these patients, 295 (80.1%) did not have BCR (Group 1), while 73 (19.8%) had BCR (Group 2). The mean duration of follow-up and duration until the diagnosis of BCR was calculated as 35.2 ± 16.7 and 11.5 ± 11.3 months, respectively. The multivariate analysis revealed that NLR, PSAd, risk classification, PIRADS score, T stage, presence or absence of positive surgical margin, and seminal vesicle invasion were predictive for BCR. Classic Cox regression analysis had an area under the curve (AUC) of 0.915 with a sensitivity and specificity of 90.6% and 79.8%. The AUCs for receiver-operating characteristic curves for random forest, K nearest neighbour, and logistic regression were 0.95, 0.93, and 0.93, respectively. All ML models outperformed the conventional statistical regression model in the prediction of BCR after prostatectomy. Conclusion The construction of more reliable and potent models will provide the clinicians and patients with advantages such as more accurate risk classification, prognosis estimation, early intervention, avoidance of unnecessary treatments, relatively lower morbidity and mortality. The ML methods are cheap, and their powers increase with increasing data input; we believe that their clinical use will increase over time.

Objectives: Since the introduction of laparoscopic nephrectomies, laparoscopic surgeries in the field of urology have become increasingly popular. Laparoscopic surgery has its advantages but carries the risk of complications like all interventions. In our study, we aimed to discuss our complication rates according to difficulty level by presenting our experiences with urological laparoscopic procedures for the upper urinary system. Methods: This retrospective study includes 942 laparoscopic urological procedures performed by a single surgeon. The procedures divided into three groups according to the European Scoring System (ESS) Classification. The complication rate of each group was calculated separately. Results: A total of 127 (13.4%) complications were observed. Partial nephrectomy, nephroureterectomy and ureterolithotomy had the highest complication rates. Renal cyst excision, simple nephrectomy and radical nephrectomy had the lowest complication rates. According to the Clavien Complication Classification, the distributions of Grade 1, 2 and 3 complications were 29.1% (n =37), 57.4% (n = 73) and 13.3% (n = 17); respectively. The open conversion rate was 0.84%. When procedures were classified as “easy”, “difficult” and “very difficult” according to the ESS classification; complication rates were found 7.3% in the easy group, 13.3% in the difficult group and 16.6% in the very difficult group. There was no significant difference between the three groups in terms of complication rates (p = 0.329). Conclusions: Performing easier operations according to ESS in the first years of the learning curve is beneficial in preventing complications. With increasing experience, more complicated procedures can be performed with similar complication rates.

Living-donor kidney transplantation is one of the treatment options of end-stage renal failure. In many transplant centers, laparoscopic live-donor transplantation is recognised as the standard pro- cedure. Chylous ascites (CA) is a very rare complication after laparoscopic donor nephrectomy (LDN). We aimed to present the management of the first case report in Turkey. 62-year-old male patient underwent laparoscopic transperitoneal left donor nephrectomy. One month after discharge, he was admitted with abdominal distention and imaging revealed diffuse free fluid in the abdomen. After diagnosis, milky colored chylous fluid was collected by inserting a percutenous drainage cathe- ter. The patient was treated with combination of percutaneous drainage, somatostatin analogue and total parenteral nutrition., Son dönem böbrek yetmezliğinin tedavilerinden biri canlı verici böbrek naklidir. Birçok nakil merkezinde, laparoskopik canlı donör nefrektomi standart yaklaşım olarak uygulanmaktadır. Şiloz asit, laparoskopik donör nefrektomi (LDN) sonrası çok nadir görülen bir komplikasyondur. Tü- kiye’deki donör nefrektomi sonrası ilk şilöz asit vakasının yönetimini sunmayı amaçladık. 62 yaşında erkek hastaya laparoskopik transperitoneal sol donör nefrektomi yapıldı. Taburcu olduktan bir ay sonra batında distansiyon ile başvuran hastaya yapılan görüntülemelerde batında yaygın serbest sıvı saptandı. Perkütan drenaj kateteri takılan hastada drenaj kateterine gelen sıvının süt renginde, şilöz vasıfta olduğu görüldü. Hasta perkütan drenaj, somatostatin analogu ve total parenteral nutrisyon kombinasyonu ile tedavi edildi.

We aimed to investigate the parameters that have an effect on the length of stay and mortality rates of patients with Fournier's gangrene.A retrospective review was performed on 80 patients who presented to the emergency department and underwent emergency debridement with the diagnosis of Fournier's gangrene between 2008 and 2017. The demographic and clinical characteristics, length of stay, Fournier's Gangrene Severity Index score, cystostomy and colostomy requirement, additional treatment for wound healing and the mortality rates of the patients were evaluated.Of the 80 patients included in the study, 65 (81.2 %) were male and 15 (18.7 %) female. The most common comorbidity was diabetes mellitus. The mean time between onset of complaints and admission to hospital was 4.6 ± 2.5 days. As a result of the statistical analyses, it was found that Fournier's Gangrene Severity Index score, hyperbaric oxygen therapy, negative pressure wound therapy and the presence of sepsis and colostomy were significantly positively correlated with length of stay. Also it was found that the Fournier's Gangrene Severity Index score, administration of negative pressure wound therapy and the presence of sepsis were correlated with mortality.Fournier's gangrene is a mortal disease and an emergency condition. With the improvements in Fournier's gangrene disease management, mortality rates are decreasing, but long-term hospital stay has become a new problem. Knowing the values predicting length of stay and mortality rates can allow for patient-based treatment and may be useful in treatment choice.Wir wollten die Parameter untersuchen, die sich auf die Aufenthaltsdauer und die Sterblichkeitsrate der Patienten mit Fournier-Gangrän auswirken.Eine retrospektive Überprüfung wurde an 80 Patienten durchgeführt, die sich zwischen 2008 und 2017 der Notaufnahme vorstellten und ein Notfalldebridement mit der Diagnose Fournier's Gangrene durchliefen. Die demografischen und klinischen Merkmale, die Verweildauer, der Fournier-Gangrän-Schweregrad-Index, die Anforderungen an Zystostomie und Kolostomie, die zusätzliche Behandlung der Wundheilung und die Sterblichkeitsrate der Patienten wurden bewertet.Von den 80 in die Studie einbezogenen Patienten waren 65 (81,2 %) männlich und 15 (18,7 %) weiblich. Die häufigste Komorbidität war Diabetes Mellitus. Die mittlere Zeit zwischen dem Einsetzen der Beschwerden und der Einlieferung ins Krankenhaus betrug 4,6 ± 2,5 Tage. Als Ergebnis der statistischen Analysen wurde festgestellt, dass der Fournier-Gangrän-Schwereindex-Score, die Hyperbare Sauerstofftherapie, die Unterdruck-Wundtherapie und das Vorhandensein von Sepsis und Kolostomie signifikant positiv mit der Verweildauer korrelierten. Es wurde festgestellt, dass der Fournier-Gangrän-Schwereindex-Score, die Verabreichung einer Unterdruck-Wundtherapie und das Vorhandensein einer Sepsis mit der Mortalität korrelierten.Fournier's Gangrene ist eine tödliche Krankheit und ein Notfall. Mit den Verbesserungen im Gangrän-Krankheitsmanagement von Fournier sinken die Sterblichkeitsraten, aber der langfristige Krankenhausaufenthalt ist zu einem neuen Problem geworden. Die Kenntnis der Werte, die die Aufenthaltsdauer und die Sterblichkeitsrate vorhersagen, kann eine patientenbasierte Behandlung ermöglichen und bei der Wahl der Behandlung hilfreich sein.

Amaç: Açık radikal prostatektomi ve robot yardımlı laparoskopik prostatektomide (RYLP) cerrahi alanın net görülmesi için eksize edilen anterior prostatik yağ dokusunda (APYD) lenf nodu insidansı ve lenf nodu metastazını etkileyen faktörlerin incelenmesi Materyal ve method: Ocak 2018 ve Ocak 2020 arasında tek merkezde RYLP yapılan 219 hastadan eksize edilen APYD lenf nodu varlığı ve lenf nodu metastazı açısından histopatolojik olarak incelendi. Tanımlayıcı istatistikler ve çok değişkenli analiz kullanılarak APYD’da lenf nodu metastazını predikte eden faktörler araştırıldı. Bulgular: APYD’da lenf nodu oranı %9.5 olarak belirlendi. Bu olgular içerisinde 6 olguda (%2.7) lenf nodu metastazı saptandı. 6 olgunun ikisi pelvik lenf nodu diseksiyonu (PLND) yapılmayan düşük ve orta riskli hastaydı. Diğer 4 olgunun ikisinde eş zamanlı olarak pelvik lend nodunda metastaz izlendi. APYD’da metastaz izlenen olgularda toplam tümör volümü, ISUP skoru ve patolojik T evresi tek değişkenli analizde metastaz olmaksızın lenf nodu olanlara göre daha yüksek saptandı. Çok değişkenli analizde ise bu faktörlerin APYD’da lenf nodu metastazını predikte etmediği görüldü. Sonuç: APYD lenf nodu barındırdığı ve mevcut lenf nodlarında metastaz geliştiği kanıtlanan bir dokudur. APYD’da lenf nodu eksizyonunun sadece radikal prostatektomi sırasında cerrahi alanın net görülmesi için uygulanan rutin bir prosedür olmaktan ziyade standart lenf nodu diseksiyonu şablonlarında yer alması gereken bir prosedür olduğu kabul edilmelidir.

Sleep disorders in intensive care units after a craniotomy can decrease melatonin secretion and increase the inflammatory stress response. The aim of this study was to investigate the influence of improving sleep quality via eye patches and earplugs on melatonin secretion and inflammatory mediator release.The study enrolled 41 patients who underwent craniotomy. Patients were randomized into 2 groups. "Group Intervention" received a sleep-promoting intervention with eye patches and earplugs to provide light and noise isolation, while "Group Control" received standard care. Blood levels of C-reactive protein and interleukin 1 and interleukin 6 along with urine levels of 6-sulphatoxymelatonin (aMT6) were measured preoperatively (baseline) and on postoperative days 1 and 3. Sleep quality was assessed with the Richards-Campbell Sleep Questionnaire.Sleep quality was higher in the intervention group (Richards-Campbell score:80.61 ± 11.96 vs. 33.50 ± 16.32; P0.001). Urine aMT6 levels increased significantly in the intervention group in spot urine samples from 10.15 (5.38-14.40) ng/mL at baseline to 14.52 (6.24-29.11) and 11.51 (7.88-29.05) ng/mL on postoperative days 1 and 3. They also increased in 24-hour urine samples from 25.73 (8.24-52.73) ng/mL at baseline to 35.38 (11.48-95.65) and 39.18 (2.36-125.23) ng/mL on postoperative days 1 and 3 (P = 0.001 and P = 0.005, respectively). The aMT6 concentration did not change significantly in the control group. The C-reactive protein concentrations increased postoperatively compared with baseline concentrations in both groups (P = 0.001 and P0.001).Melatonin secretion significantly increased as a result of improving postoperative sleep quality by noise and light isolation in neurosurgical intensive care unit patients after craniotomy.

OBJECTIVEIn daily practice, neurosurgeons face increasing numbers of patients using aspirin (acetylsalicylic acid, ASA). While many of these patients discontinue ASA 7–10 days prior to elective intracranial surgery, there are limited data to support whether or not perioperative ASA use heightens the risk of hemorrhagic complications. In this study the authors retrospectively evaluated the safety of perioperative ASA use in patients undergoing craniotomy for brain tumors in the largest elective cranial surgery cohort reported to date.METHODSThe authors retrospectively analyzed the medical records of 1291 patients who underwent elective intracranial tumor surgery by a single surgeon from 2007 to 2017. The patients were divided into three groups based on their perioperative ASA status: 1) group 1, no ASA; 2) group 2, stopped ASA (low cardiovascular risk); and 3) group 3, continued ASA (high cardiovascular risk). Data collected included demographic information, perioperative ASA status, tumor characteristics, extent of resection (EOR), operative blood loss, any hemorrhagic and thromboembolic complications, and any other complications.RESULTSA total of 1291 patients underwent 1346 operations. The no-ASA group included 1068 patients (1112 operations), the stopped-ASA group had 104 patients (108 operations), and the continued-ASA group had 119 patients (126 operations). The no-ASA patients were significantly younger (mean age 53.3 years) than those in the stopped- and continued-ASA groups (mean 64.8 and 64.0 years, respectively; p < 0.001). Sex distribution was similar across all groups (p = 0.272). Tumor locations and pathologies were also similar across the groups, except for deep tumors and schwannomas that were relatively less frequent in the continued-ASA group. There were no differences in the EOR between groups. Operative blood loss was not significantly different between the stopped- (186 ml) and continued- (220 ml) ASA groups (p = 0.183). Most importantly, neither hemorrhagic (0.6%, 0.9%, and 0.8%, respectively; p = 0.921) nor thromboembolic (1.3%, 1.9%, and 0.8%; p = 0.779) complication rates were significantly different between the groups, respectively. In addition, the multivariate model revealed no statistically significant predictor of hemorrhagic complications, whereas male sex (odds ratio [OR] 5.9, 95% confidence interval [CI] 1.7–20.5, p = 0.005) and deep-extraaxial-benign (“skull base”) tumors (OR 3.6, 95% CI 1.3–9.7, p = 0.011) were found to be independent predictors of thromboembolic complications.CONCLUSIONSIn this cohort, perioperative ASA use was not associated with the increased rate of hemorrhagic complications following intracranial tumor surgery. In patients at high cardiovascular risk, ASA can safely be continued during elective brain tumor surgery to prevent potential life-threatening thromboembolic complications. Randomized clinical trials with larger sample sizes are warranted to achieve a greater statistical power.

Resumen Introduccion y objetivos La clasificacion de Bosniak para las lesiones renales quisticas se publico por primera vez en 1986 con base en los hallazgos de tomografia computarizada (TC). El objetivo de nuestro estudio fue investigar el rol de la resonancia magnetica (RM) y su impacto en la clasificacion de Bosniak para compararla con la TC, y determinar como la RM puede alterar el tipo de tratamiento de los quistes renales complejos. Material y metodos Se recogieron retrospectivamente los datos de 144 pacientes. Despues de aplicar los criterios de exclusion, 2 radiologos especialistas en ecografia abdominal evaluaron 102 lesiones quisticas renales con una categoria Bosniak de al menos IIF en TC o RM entre 2013 y 2016. Se registraron los datos demograficos, la categoria de Bosniak, la concordancia interobservador y las enfermedades de los pacientes tratados con cirugia. Resultados La concordancia entre la RM y la TC fue del 75,5%. La categoria Bosniak se vio incrementada tras la RM en 17 pacientes, y se cambio el tipo de tratamiento en 10 pacientes, que posteriormente fueron tratados quirurgicamente. Tras la RM, la categoria Bosniak paso de III a IIF en 6 pacientes de 8 y provoco un cambio en el tipo de tratamiento. Se realizo cirugia en un paciente de estos 6, y el informe de anatomia patologica se informo como benigno. Se detecto progresion durante el seguimiento al decimoctavo mes en un paciente de 5, y se practico cirugia en este caso. La enfermedad se informo como carcinoma de celulas renales (CCR). De los 51 pacientes tratados mediante cirugia, 35 (68,6%) recibieron informe anatomopatologico de CCR. Se detecto progresion en 7 pacientes de 51 que recibieron seguimiento (13,7%), y los resultados de la enfermedad se informaron como CCR. La mayoria de los tumores malignos eran de grado y estadio bajo. Conclusiones La RM se puede emplear con exito en la evaluacion de lesiones quisticas renales. En particular, el manejo de las lesiones Bosniak IIF y de todas aquellas clasificadas como Bosniak III debe incluir evaluacion mediante RM antes de optar por el tratamiento quirurgico. El incremento en la categoria de Bosniak es mas factible con RM que con TC, debido a su resolucion de alto contraste. Por lo tanto, se requieren mas estudios para identificar si esta fue la causa del sobretratamiento en pacientes con lesiones Bosniak III.

Objectives To assess the early functional and oncological outcomes of a large series of patients who underwent robot-assisted radical perineal prostatectomy (RPP). Materials and methods We retrospectively analysed the patients who underwent robot-assisted RPP for localized prostate cancer between November 2016 and September 2018. Patients who had locally advanced disease proven on biopsy or were suspected to have locally advanced disease on multiparametric magnetic resonance imaging and patients who had a contraindication for the exaggerated lithotomy position were not included in this study. Patient demographics, preoperative and postoperative variables, complications and follow-up times were recorded. Results A total of 95 patients were included. Their mean ± sd age was 61.5 ± 6.5 years. The median (interquartile range [IQR]) preoperative prostate-specific antigen level was 6.1 (3.7) ng/mL, the median (IQR) operating time was 140 (25) min, and the mean ± sd blood loss was 67.4 ± 17 mL. Pelvic lymph node dissection (PLND) was performed for 12 patients (12.6%). The median (IQR) hospital stay was 1 (1) days. Positive surgical margins were present in eight patients (8.4%). After catheter removal, the immediate continence rate was 41%. Continence rates were 78%, 87% and 91%, respectively, 3, 6 and 12 months after surgery. Potency rates were 49%, 69% and 77%, respectively, 3, 6 and 12 months after surgery for patients who had adequate potency preoperatively. The median (IQR) follow-up time was 13 (3.1) months. Conclusion We conclude that robot-assisted RPP is a reliable and effective surgical technique that can be employed in the treatment of localized prostate cancer regardless of prostate volume, especially in patients with a history of abdominal surgery. As an additional advantage, PLND can be performed through the same incision.

The necessity of computed tomography (CT) has been questioned in pediatric mild traumatic brain injury (mTBI) because of concerns related to radiation exposure. Distinguishing patients with lower and higher risk of clinically important TBI (ciTBI) is paramount to the optimal management of these patients.This study aimed to analyze the imaging predictors of ciTBI and develop an algorithm to identify patients at low and high risk for ciTBI to inform clinical decision making using a large single-center cohort of pediatric patients with mTBI.We retrospectively identified pediatric patients with mTBI with repeat CT within 48 hours of injury using an institutional database.Among 3867 pediatric patients, 219 patients with mTBI with repeat CT were included. Thirty-eight had ciTBI (17%), 16 (7%) required intensive care unit admission, and 6 (3%) underwent surgery. Median time interval between initial and repeat CT was 7 hours (range, 4-10). Clinical worsening and radiologic progression were evident in 36 (16%) and 24 (11%) patients, respectively. Multivariate analysis showed that 5 pathologic findings (depressed skull fracture, pneumocephalus, epidural hematoma, subdural hematoma, and contusion) on initial CT and radiologic progression on repeat CT were independent predictors of ciTBI. A new scoring system based on these 5 factors on initial CT (IniCT [Initial CT scoring system] score) had excellent discrimination for ciTBI, need for intensive care unit admission, and neurosurgery (area under the curve0.8).The IniCT scoring system can successfully differentiate low-risk and high-risk patients based on initial CT scan. Zero score can eliminate the need for a routine repeat CT, whereas scores ≥2 should prompt serial neurologic examinations and/or repeat CT depending on the clinical situation.

Radical prostatectomy (RP) is the gold standard treatment method of localized prostate cancer. Today, this surgery is performed with open or minimally invasive methods. The history of open perineal RP (RPP) is very old, but it is not often preferred by urologists. The use of robot-assisted laparoscopic RP (RALP) is very frequently applied today. Robotic perineal RP (r-RPP) by using a Gel-Point and insufflating CO(2) into the perineal region was first described in 2014. In this case report, we report a 68-year-old patient with localized prostate cancer in whom we successfully performed gasless r-RPP, and according to our knowledge, this is the first case of gasless r-RPP to be reported.

Objective:To compare the results of robotic partial nephrectomy (RPN) and laparoscopic partial nephrectomy (LPN) operations and to determine whether they have any superiority to each other in terms of oncological and functional outcomes.Materials and Methods:The data of patients who underwent partial nephrectomy due to renal tumor in our clinic were evaluated retrospectively. The data included demographic information, operative technique, tumor size, operative time, duration of warm ischemia, amount of intraoperative bleeding, length of hospital stay and complications.Results:A total of 60 patients were included in the study. There was no significant difference between age (52.5±13.3 years vs 50.1±12.4 years, p=0.48), body mass index (26.9±3.7 vs 27.3±3.3 kg/m2, p=0.69) and tumor size (3.2±1.4 cm vs 3.4±1.2 cm, p=0.79) of patients who underwent LPN and RPN. The mean operative time (194.5±44.6 min vs 203.3±22.2 min, p

Percutaneous nephrolithotomy (PNL) for upper urinary tract stones is a minimally invasive, effective treatment modality. Despite its high success rates, its potential complications pose a risk. In this study, we aimed to determine the risk factors associated with bleeding which is one of PNL's most important complications.The data of patients who underwent PNL between January 2017 and December 2018 were retrospectively analyzed. The median reduction in post-operative hemoglobin levels compared to preoperative levels was found to be 1.6 g/dl, which was accepted as the threshold value. The patients with hemoglobin decrease above the threshold were assigned as Group 1, and below the threshold as Group 2. Pre-operative, perioperative data, and stone characteristics of the patients were recorded.169 patients, 85 patients in Group 1 and 84 patients in Group 2 were included in the study. The mean age of Group 1 was significantly higher (47.4±7.9 and 32±9.4 years, respectively, p=0.001) Sixteen in Group 1 (18.8%) and six in Group 2 (7, 1%) had a diagnosis of hypertension (HT) and a significant difference was found (p=0.038). The average stone burden was 2733±1121.3 mm3 in Group 1, and 2326.5±975.6 mmIn this study; advanced age, presence of HT, and high stone burden were found to be predictive of reductions in hemoglobin levels. Furthermore, a correlation of decreased hemoglobin levels was detected with operative times and occurrence of complications.

Purpose: To investigate the quality of life (QoL) in patients with end-stage renal disease who underwent open or robot-assisted renal transplantation (ORT and RART). Materials and Methods: Patients who underwent ORT and RART at Bakirkoy Sadi Konuk Training and Research Hospital between June 2016 and December 2018 constituted the target population of this study. The patient group was divided into two groups as per the surgical technique (i.e., open vs. robot-assisted). Demographic data, preoperative and postoperative data of all patients were collected prospectively. The QoL of the patients was assessed preoperatively and on the postoperative 30th day. Results: 67 patients who underwent ORT and 60 patients who underwent RART were included. The mean patient age and BMI were calculated as 40,9 ± 11,6 years and 24,4 ± 2,9 kg/m2, respectively. While mean total ischemia time was shorter in the ‘open’ group, incision length, duration of surgical drainage and hospital stay were shorter in the ‘robot-assisted’ group. The physical component scores of the QoL questionnaire revealed that postoperative impairment of quality of life was more significant in the ORT than the RART. Conclusion: Patients who underwent RART have a higher QoL than the patients who were treated with ORT as per their self-reported QoL scores in the early postoperative period. Keywords: End-stage renal disease; Open renal transplantation; Robot-assisted renal transplantation; Quality of life

Purpose Purpose of this study is to investigate the quality of life (QoL) in patients with end-stage renal disease who underwent open or robot-assisted kidney transplantation (OKT and RAKT). Materials and methods Patients who underwent OKT and RAKT at Bakirkoy Sadi Konuk Training and Research Hospital between June 2016 and December 2018 constituted the target population of this study. The patient group was divided into two groups as per the surgical technique (ie, open vs. robot-assisted). Demographic data, preoperative and postoperative data of all patients were collected prospectively. The QoL of the patients was assessed preoperatively and on the postoperative 30th day. Results Sixty-seven patients who underwent OKT and 60 patients who underwent RAKT were included. The mean patient age and BMI were calculated as 40.9 ± 11.6 years and 24.4 ± 2.9 kg/m2 , respectively. Patients in the RAKT group were significantly younger than the patients in the OKT group (P = .002). There were no significant differences between the two groups in terms of gender, BMI, ASA and the ratio of premptive patients. The mean preoperative hemoglobin level was significantly higher in the OKT group than the RAKT group (P = .003). While mean total ischemia time was shorter in the "open" group, intraoperative blood loss and incision length were shorter in the RAKT group. Duration of surgical drainage and hospital stay was shorter in the "robot-assisted" group. There was no significant difference between the groups in terms of SF-36 subparameters preoperatively. The physical component scores of the QoL questionnaire revealed that postoperative impairment of quality of life in the early postoperative period was more significant in the OKT than the RAKT. Conclusion Patients who underwent RAKT have a higher QoL than the patients who were treated with OKT as per their self-reported QoL scores in the early postoperative period.

Objective :The pre-op differentiation of testicular tumors from paratesticular masses cannot be made clearly. Generally, radical orchiectomy is performed with pre-diagnosis of testicular tumor and a clinical approach is planned according to the final pathological result.When clinicians diagnose a scrotal mass, they should considered that this mass may be originated from epididymidis, tunica vaginalis, spermatic cord, fat-muscle-connective tissue, and embryonic remnants and should determine the treatment management accordingly. Materials and Methods :The pathology results of 140 patients, who were admitted to our center between 2008 and 2018 presenting scrotal mass and underwent inguinal radical orchiectomy considering as testicular tumor, were retrospectively analyzed. Preoperative and postoperative data, clinical course, and treatment management of the cases reported to be paratesticular mass by pathology were discussed in the light of the literature. Results :Paratesticular mass(PTM)was detected in 13 cases of our retrospectively analyzed series. Of these, 10 patients were found to have adenomatoid tumors(AT) 2 patients have rhabdomyosarcoma(RMS), and 1 patient angiomyxoma(AM). Conclusion :The differential diagnosis of whether intrascrotal masses are originating from testicular tissues or paratesticular structures is usually cannot be made. Therefore, radical orchiectomy is performed in the same way as testicular tumors and a definite diagnosis can be made by pathological examination. The paratesticular masses, 2-3% of the scrotal masses, should be considered in the differential diagnosis. In this regard, there is a need for studies with a higher number of series.

Transplantasyon ve diyaliz son dönem böbrek yetmezliğinin temel tedavi seçenekleridir. Kalıcı çözüm sağlayan nakil işlemi kadavradan ve canlıdan olmak üzere iki farklı şekilde yapılabilir. Kadavradan nakil arzu edilen seçenek olsa da ülkemizde yapılan böbrek nakillerinin yaklaşık yüzde 70’i canlıdan yapılmaktadır. Canlıdan yapılan donör nefrektomilerde sağladığı avantajlar nedeniyle genellikle sol böbrek tercih edilir ve minimal invaziv yöntem olan laparoskopi kılavuzlarca önerilmekte ve cerrahlarca tercih edilmektedir. Bu çalışmamızda sağ pelvik yerleşimli ve kompleks renal vasküler yapısı olan ve 99mTc-Dimerkaptosüksinik asit sintigrafide fonksiyonu % 45 olması nedeniyle tercih edilen ve laparoskopik sağ pelvik donör nefrektomi yapılan olgu sunulmuştur., Transplantation and dialysis are the main treatment options for end-stage renal failure. Transplant, which provides a permanent solution, can be done in two different ways: cadaver and living. Although transplantation from cadaver is the desired option, approximately 70 percent of kidney transplants in our country are made from live donors. In living donor nephrectomies, the left kidney is generally preferred due to its advantages, and laparoscopy, a minimally invasive method, is recommended by guides and is preferred by surgeons. In this study, we present a case with right pelvic location and complex renal vascular structure and preferred for laparoscopic right pelvic donor nephrectomy due to its function on 99mTc-Dimercaptosuccinic acid scintigraphy.

OBJECTIVE To report the results of the robot-assisted kidney transplantation (RAKT) experience performed in 10 European centres by members of the European Robotic Urology Section (ERUS)-RAKT group. PATIENTS AND METHODS This is a multicentre prospective observational study of RAKT. Descriptive analysis of recipients and donor characteristics, surgical data, intraoperative outcomes, complications rate and functional results were collected and analysed. RESULTS Between July 2015 and September 2019, 291 living-donor RAKTs were performed. Recipients were mostly male (189 [65%]), the mean Standard deviation (sd) age was 45.2 (13.35) years, the mean (sd) body mass index was 27.13 (19.28) kg/m2 , and RAKT was pre-emptive in 155 (53.8%) cases. Right and multiple arteries kidneys were used in 15.4%. The mean (sd) total surgical and re-warming time was 244 (70.5) min and 53.16 (15.27) min, respectively. In all, 17 patients presented with postoperative bleeding (5.7%). Five kidneys had delayed graft function; five (2%) were lost due to thrombosis and one due to acute rejection. Two patients had arterial stenosis, three had incisional hernias, six had ureteric stenosis, and nine had lymphoceles. Neither surgical nor re-warming times were correlated with postoperative serum creatinine levels (P > 0.05). Comparison of surgical data between the first 120 cases and the following 171 cases showed a significantly shorter total surgical time in the second group (265 vs 230 min, P = 0.005). CONCLUSIONS This is the largest European multicentre study of RAKT with good surgical and functional results competitive with open kidney transplant series, with a relatively short learning curve when performed in centres with a wide experience in open kidney transplantation and robotic surgery.

To outline and evaluate the incidence, management and follow-up of the residual fragments (RFs) following retrograde intrarenal surgery (RIRS) of renal stones by the Turkish Academy of Urology Prospective Study Group (ACUP Study). Following the ethical committee approval, 15 centers providing data regarding the incidence, management, and follow-up of RFs after RIRS were included and all relevant information was recorded into the same electronic database program ( https://acup.uroturk.org.tr/ ) created by Turkish Urology Academy for Residual Stone Study. A total of 1112 cases underwent RIRS for renal calculi and RFs were observed in 276 cases (24.8%). Of all the parameters evaluated, our results demonstrated no statistically significant relation between preoperative DJ stenting and the presence of RFs (χ2 (1) = 158.418; p = 0.099). RFs were significantly higher in patients treated with UAS (82 patients, 29.3%) during the procedure compared to the cases who did not receive UAS (194 patients, 23.3%) (χ2 (1) = 3.999; p = 0.046). The mean period for a secondary intervention after RIRS was 28.39 (± 12.52) days. Regarding the procedures applied for RF removal, re-RIRS was the most commonly performed approach (56%). Despite the reported safe and successful outcomes, the incidence of RFs is higher, after the RIRS procedure particularly in cases with relatively larger calculi. Such cases need to be followed in a close manner and although a second flexible ureteroscopy is the treatment of choice for fragment removal in the majority of these patients, shock wave lithotripsy and percutaneous nephrolithotomy may also be preferred in selected cases.

To present our results of first 12 patients on whom we performed gasless robotic perineal radical prostatectomy (r-PRP).We performed gasless r-PRP on 12 patients between August 2018 and October 2018. Multiparametric magnetic resonance imaging was performed forall patients to exclude local advanced disease. Demographic characteristics, technical details, and intra and postoperative data were analyzed.The mean age of the patients was 62.6 ± 6years. The mean body mass index of the patients was 27 ± 4 kg/m2. Four patients had a history of major abdominal surgery. The mean preoperative prostate-specific antigen (PSA) was 7.4 ± 2.5 ng/mL. The mean prostate volume was 40 ± 10.2 cc. The mean perineal dissection time was 45.6 ± 5.8 minutes. The mean console time and total operative time were 117.8 ± 28.1 and 163.3 ± 30.7 minutes, respectively. The mean urethral catheter removal time was 9.2 ± 1.9 days. The immediate continence rate was 25% after the urethral catheter removal and the continence rate was 75% and 91.67% at the 3rd and 6th month follow-up, respectively.Gasless r-PRP is an efficient and safe method in prostate cancer surgery. However, prospective randomized and comparative studies are required with large patient series.Presentar nuestros resultados en los primeros 12 pacientes en los que hemos realizado prostatectomía radical perineal robotica sin gas.MÉTODOS: Se realizó la prostatectomia radical robótica perineal sin gas en 12 casos entre agosto 2018 y octubre 2018. RNM multiparamétrica se realizó en todos los pacientes para excluir enfermedad avanzada local. Las características demográficas, detalles técnicos y datos intra e postoperatorios fueron analizados.La mediana de edad de los pacientes fue de 62,6 ± 6 años. El IMC medio fue de 27 ± 4 kg/m2, cuatro pacientes tenían historia de cirugía abdominal previa. EL PSA preoperatorio fue de 7,4 ± 2,5 ng/mL. El tamaño prostático medio fue de 40 ± 10,2 cc. El tiempo medio de disección perineal fue de 45,6 ± 5,8 minutos. El tiempo medio de consola y el tiempo quirúrgico total fueron de 117,8 ± 28,1 y 163,3 ± 30,7 minutos, respectivamente. El tiempo medio a la retirada de sonda fue de 9,2 ± 1,9 dias. La continencia inmediata fue de 25% después de la retirada de la sonda y la tasa de continencia fue de 75% y 92% al 3r y 6º mes de seguimiento, respectivamente.La prostatectomía radical robótica perineal sin gas es un procedimiento eficiente y seguro en la cirugía del cáncer de próstata. Aunque estudios prospectivos randomizados y estudios comparativos son necesarios con más series de pacientes.

INTRODUCTION AND OBJECTIVE:Robotic assisted kidney transplantation (RAKT) has recently been introduced in many centers in Europe with an important expansion over the last year, because of the good ...

Gossypiboma refers to a retained foreign object that was forgotten in the body cavity during an operation. It is a rare surgical complication that most commonly occurs after intraperitoneal abdominal emergency surgical procedures, but may also occur after virtually any type of operation. Gossypiboma can be confused with neoplastic lesions and abscess. Clinical examination and radiological findings may sometimes mislead the physician. We intend to present our cases, which is thought to be a kidney tumour and bladder cancer but resulted gossypiboma which is a condition that is caused by a forgotten sponge during the operation and it can mimic the cancer. During the operation, the team must work in coordination and be careful. Unnecessary operations in such situation can significantly increase the patient’s morbidity.

Amaç: Paratestiküler kitlelerin testis tümörleri ile pre-op ayrımı net olarak yapılamamaktadır. Genellikle testis tümörü ön tanısıyla radikal orşiektomi yapılıp nihai patoloji sonucuna göre klinik yaklaşım planlanmaktadır. Bu noktadan hareketle, klinisyenler skrotal kitle ile karşılaştıklarında, bu kitlenin testis tümörü dışında; epididimidis, tunika vaginalis, spermatik kord, yağ-kas-bağ dokusu gibi destek dokular ve embriyonel kalıntılardan da orijin alabileceğini akılda tutmalı ve tedavi yönetimini buna göre belirlemelidir..Gereç ve Yöntemler: Merkezimize 2008-2018 yılları arasında skrotal kitle ile başvurmuş, testis tümörü kabul edilerek ingüinal radikal orşiektomi yapılan 140 hastanın patoloji sonucu geriye dönük olarak incelendi. Patoloji sonucu paratestiküler kitle rapor edilen olguların preoperatif ve postoperatif verileri, klinik seyri, tedavi yönetimi literatür eşliğinde tartışıldı.Bulgular: Retrospektif olarak incelenen serimizde 13 olguda paratestiküler kitle(PTK) saptandı. Bunlardan 10 hastada Adenomatoid tümör, 2 tanesinde Rabdomiyosarkom, 1 hastada Anjiomiksoma saptandı. Sonuç: İntraskrotal yerleşimli kitlelerin köken aldığı dokunun testis kaynaklı ya da paratestiküler yapılardan mı kaynaklandığının ayırıcı tanısı sıklıkla yapılamamaktadır. Bu nedenle genelde testis tümörleri ile benzer şekilde radikal orşiektomi yapılıp kesin tanı patolojik inceleme ile konulabilmektedir. Tüm skrotal kitlelerin %2-3 ‘ünü oluşturan paratestiküler kitleler, skrotal kitle ile başvuran ve tedavi planlanması yapılan hastaların ayırıcı tanısında akla gelmesi gereken tanılar arasında kendine yer bulmalıdır. Bu konuda daha fazla sayıda hastayla ileri düzey çalışmalara ihtiyaç vardır., Objective:The pre-op differentiation of testicular tumors from paratesticular masses cannot be made clearly. Generally, radical orchiectomy is performed with pre-diagnosis of testicular tumor and a clinical approach is planned according to the final pathological result.When clinicians diagnose a scrotal mass, they should considered that this mass may be originated from epididymidis, tunica vaginalis, spermatic cord, fat-muscle-connective tissue, and embryonic remnants and should determine the treatment management accordingly.Materials and Methods:The pathology results of 140 patients, who were admitted to our center between 2008 and 2018 presenting scrotal mass and underwent inguinal radical orchiectomy considering as testicular tumor, were retrospectively analyzed. Preoperative and postoperative data, clinical course, and treatment management of the cases reported to be paratesticular mass by pathology were discussed in the light of the literature.Results:Paratesticular mass(PTM)was detected in 13 cases of our retrospectively analyzed series. Of these, 10 patients were found to have adenomatoid tumors(AT) 2 patients have rhabdomyosarcoma(RMS), and 1 patient angiomyxoma(AM). Conclusion:The differential diagnosis of whether intrascrotal masses are originating from testicular tissues or paratesticular structures is usually cannot be made. Therefore, radical orchiectomy is performed in the same way as testicular tumors and a definite diagnosis can be made by pathological examination. The paratesticular masses, 2-3% of the scrotal masses, should be considered in the differential diagnosis. In this regard, there is a need for studies with a higher number of series.

Background Kidney transplantation using grafts with multiple vessels (GMVs) is technically demanding and may be associated with increased risk of complications or suboptimal graft function. To date, no studies have reported on robot-assisted kidney transplantation (RAKT) using GMVs. Objective To report our experience with RAKT using GMVs from living donors, focusing on technical feasibility and early postoperative outcomes. Design, setting, and participants We reviewed the multi-institutional, prospectively collected European Association of Urology (EAU) Robotic Urology Section (ERUS)-RAKT database to select consecutive patients undergoing RAKT from living donors using GMVs between July 2015 and January 2018. Patients undergoing RAKT using grafts with single vessels (GSVs) served as controls. In case of GMVs, ex vivo vascular reconstruction techniques were performed during bench surgery according to the case-specific anatomy. Intervention RAKT with regional hypothermia. Outcome measurements and statistical analysis Intraoperative outcomes and early (30 d) postoperative complications and functional results were the main study endpoints. Multivariable logistic regression analysis evaluated potential predictors of suboptimal renal function at 1 mo. Results and limitations Overall, 148 RAKTs were performed during the study period. Of these, 21/148 (14.2%) used GMVs; in all cases, single arterial and venous anastomoses could be performed after vascular reconstruction. Median anastomoses and rewarming times did not differ significantly between the GMV and GSV groups. Total and cold ischemia times were significantly higher in the GMV cohort (112 vs 88 min, p = 0.004 and 50 vs 34 min, p = 0.003, respectively). Overall complication rate and early functional outcomes were similar among the two groups. No major intra- or postoperative complications were recorded in the GMV cohort. At multivariable analysis, use of GMVs was not significantly associated with suboptimal renal function at 1 mo. Small sample size and short follow-up represent the main study limitations. Conclusions RAKT using GMVs from living donors is technically feasible and achieved favorable perioperative and short-term functional outcomes. Larger studies with longer follow-up are needed to confirm our findings. Patient summary In this study, we evaluated for the first time in literature the results of RAKT from living donors using kidneys with multiple arteries and veins. We found that, in experienced centers, RAKT using kidneys with multiple vessels is feasible and achieves optimal results in terms of postoperative kidney function with a low number of postoperative complications.

Background: After almost two decades, transabdominal robotic radical prostatectomy techniques have been fully developed and are widely practiced by many robotic urologists. Recently, a transperineal robotic radical prostatectomy, a technique not yet popular to many, was introduced as an alternative approach in patients with previous abdominal surgery. Here, we present our unique experience with robotic perineal radical prostatectomy (r-PRP) on a kidney transplant recipient. Case Presentation: A 71-year-old man who had a kidney transplant 4 months previously was diagnosed with prostate cancer (PCa) and underwent r-PRP using the da Vinci Xi robotic system. The operative time was 110 minutes and blood loss was minimal. After the perineal drain was removed on postoperative day 3, the patient was discharged. The urethral catheter was subsequently removed on postoperative day 8. Pathologic analysis revealed localized PCa with negative surgical margins. Conclusion: The r-PRP offers all the advantages of minimally invasive surgery. Moreover, in a kidney transplant recipient, it provides additional benefits, such as avoidance of allograft vascular and ureteral injuries, while maintaining an equivalent oncologic efficacy and surgical safety compared with its transabdominal counterpart.

Cutouts – perforations that are often made in wind turbine towers to allow access or passage – can also reduce the towers’ ultimate strength. Thus, cutouts may need to be included in the ultimate strength formulations for wind turbine towers as an influential parameter, where significant. The aims of this study are to examine the effects of cutouts on the ultimate-strength characteristics of wind turbine towers and to propose empirical formulae to predict the reduced ultimate strength under axial compression and pure bending. The structural features of cutouts and towers in real wind turbines are investigated, and the effects of different design variables – such as shape, location, aspect ratio, column slenderness ratio, and column aspect ratio – on the ultimate-strength behaviour are described. The ultimate strengths of the towers are computed using elastic–plastic large-deflection finite element analyses. Empirical formulae accommodating a whole range of actual dimensional characteristics of cut...

Objective To present our experience with laparoscopic donor nephrectomy (LDN), our complications and management modalities. Material and methods: Fifty-one transperitoneal LDNs performed in our clinic between the years 2011, and 2015, were evaluated retrospectively. Demographic characteristics of the patients, operative and postoperative data and complications were evaluated. Results Nineteen female and 32 male patients with ages ranging from 24 to 65 years underwent left- (n=44), and right-sided (n=7) LDNs. Six patients had two, and one patient three renal arteries. Mean operation time was 115±11 (min-max: 90-150) minutes, and mean warm ischemia time 111±9 (min-max: 90-140 sec) seconds. Mean hospital stay was found to be 2.5±0.5 days. No patient needed to switch to open surgery. In one patient, lumbar vein was ruptured, and hemostatic control was achieved laparoscopically. Postoperative paralytic ileus developed in two patients. Three patients had postoperative atelectasis, and a febrile (38.1°C) episode. Conclusion LDN is a minimally invasive method with advantages of short hospital stay, less analgesic requirement, and better cosmetic results. However it should be performed by surgeons with advanced laparoscopic experience.