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OBJECTIVE After radical prostatectomy, prostate-specific antigen(PSA) value measuring ≥0.1 ng/mL is defined as persistent PSA(pPSA) and in many studies, it was found to be associated with aggressive disease and poor prognosis. Our aim in this study is to point out the pathological and clinical factors affecting pPSA among the patients who underwent robot-assisted radical prostatectomy(RARP) in an experienced academic centre and to make a useful risk grouping algorithm that can predict pPSA value based on operative data. METHODS We examined records of 1273 patients who underwent RARP retrospectively. Preoperative, operative and postoperative data were collected. Based on the PSA values (ng/mL) measured after 4-to-8 weeks of RARP, patients were divided into two groups as pPSA group (Group1)(n = 97) with PSA values ≥0.1 ng/mL and undetectable PSA group (Group2)(n = 778) with PSA values

Objective:After radical prostatectomy,prostate-specific antigen(PSA) value measuring ≥0.1ng/ml is defined as persistent PSA(pPSA) and in many studies,it was found to be associated with aggressive disease and poor prognosis.Our aim in this study is to point out the pathological and clinical factors affecting pPSA among the patients who underwent robot-assisted radical prostatectomy(RARP) in an experienced academic center and to make a nomogram,predicting pPSA value based on operative data,useful. Methods:We examined records of 1273 patients who underwent RARP retrospectively. Preoperative,operative,and postoperative data were collected.Based on the PSA values (ng/ml) measured after 4-to-8 weeks of RARP,patients were divided into 2 groups as pPSA group (Group1)(n=97) with PSA values ≥0.1ng/ml and undetectable PSA group (Group2)(n=778) with PSA values 20ng/ml,operation time,a postoperative international society of urological pathology (ISUP) grade of ≥4, pT 3-4, and pN were independently associated with pPSA.According to the results, a nomogram predicting pPSA was developed(Table 4).By looking at the nomogram pPSA was found in 98.9% of the cases with a PSA value of ≥20ng/ml, an operation time of 150 minutes, a postoperative ISUP grade of 4-5, a positive lymphovascular invasion (LVI) status, pT3-T4, and pN+; while pPSA was found in 25.5% of the cases with a PSA value of

Introduction: Leiomyomas of the genitourinary tract are rare and their manifestation in the ureter is even rarer. To our knowledge, only 14 cases of leiomyoma of the ureter have been reported worldwide since 1955, therefore this case will be 15th. Case presentation: We present a rare case of primary leiomyoma of the right ureter. Ureteroscopy did not show any abnormal findings in the ureteral mucosa. The primary leiomyoma was resected with distal ureterectomy and partial cystectomy that was followed with ureteroneocystostomy due to extraluminal mass that caused hydronephrosis and back pain. Conclusion: Although rare, we believe that leiomyoma should be considered in the differential diagnoses of well-circumscribed ureteral masses and kidney-sparing surgery should be performed.

To assess the relationship between prostate cancer and thiol/disulphide homeostasisas an important indicator of oxidative stress.After ethics committee approval (546/2015); 388 patients aged between 46-75 years who underwent transrectal ultrasound guided prostatebiopsy in three different centers between July 2015-2016 owing to serum prostate specific antigen (PSA) levels ≥2.5 ng/ml and/or abnormal digital rectal examination were involved in this study. The plasma levels of thiol/disulphide homeostasis parameters were compared in patients with and without prostate cancer.The mean age of the patients was 62.9±7 years. In patients with prostate cancer (n=130, 33.5% ) the mean plasma levels of native thiol and total thiol were lower (332.9 vs 362.1 μmol/L and 363 vs 392.6 μmol/L, p=0.001). Plasma disulphide levels were not statistically different between the groups (15 vs 15.3 μmol/L, p=0.936). In prostate cancer group; patients with Gleason score ≥7 had lower plasma native thiol levels than patients with Gleason score7 (321.3 vs 342.6 μmol/L, p=0.029) while there were no significant differences in total thiol and disulphide levels (352.3 vs 371.9 μmol/L, ptotal Thiol =0.064 and 15.5 vs 14.6 μmol/L, pdisulphide =0.933).Lower plasma levels of thiol in patients with prostate cancer and high Gleason score is an oteworthy result. We believe that our results should be supported by further studies.Establecer la relación entre cáncer de próstata y la homeostasis del tiol/disulfito como un importante indicador de estrés oxidativo.MÉTODOS: Con la aprobacion del comité ético (546/2015), 388 pacientes entre 46 y 75 años que recibieron una biopsia transrectal prostática ecoguiada en diferentes centros entre julio 2015 y 2016 por un PSA superior a 2,5 ng/ml o tacto rectal anómalo, fueron incluidos en este estudio. Los niveles plasmáticos de la homeostasis de tiol/disulfito se compararon en pacientes con y sin cáncer de próstata.La edad media de los pacientes fue de 62,9 =/- 7 años. En pacientes con cáncer de próstata (n=130, 33,5%) el nivel plasmático de tiol nativo y tiol total fue menor (332,9 vs 362,1 μmol/L y 363 vs 392,6 μmol/L, p=0,001). Los niveles de disulfito en plasma no fueron estadísticamente diferentes entre los grupos (15 vs 15,3 μmol/L, p=0,936). En el grupo con cáncer de próstata; pacientes con Gleason 7 o más tuvieron niveles menores de tiol nativo en relación a los pacientes con Gleason menor de 7 (321,3 vs 342,6 μmol/L, p=0,029), mientras no hubo diferencias en eltiol total y los disulfitos (352,3 vs 371,9 μmol/L, ptotaltiol =0,064 y 15,5 vs 14,6 μmol/L, pdisulfito =0,933).Niveles bajos de tiol en pacientes con cáncer de próstata y Gleason alto es un resultado notable. Creemos que nuestros resultados deberian tenerse en cuenta para otros estudios.

Introduction Urinary stone disease is a major urological condition. Endourologic techniques have influenced the clinical approach and outcomes. Open surgery holds a historic importance in the management of most conditions. However, complex kidney stone burden may be amenable to successful results with open stone surgery. In this article, we report our eighteen cases of complex urinary stone disease who underwent open stone removal. Material and methods A total of 1701 patients have undergone surgical treatment for urinary stone disease in our clinic between July 2012 and July 2016, comprising eighteen patients who underwent open stone surgery. Patients' demographic data, stone analysis results, postoperative clinical data, and stone status were evaluated retrospectively. The choice of surgical approach is mostly dependent on the surgeon's preference. In two patients, open surgery was undertaken because of perioperative complications. Results We did not observe any Clavien-Dindo grade 4 or 5 complications. Three patients were managed with a course of antibiotics due to postoperative fever. One patient had postoperative pleurisy, one patient had urinoma, and two patients had postoperative ileus. Mean operation time was 84 (57-124) minutes and mean hospitalization time was 5.5 (3-8) days. Stone-free status was achieved in 15 patients (83.3%). Conclusions Endourologic approaches are the first options for treatment of urinary stone disease. However, open stone surgery holds its indispensable position in complicated cases and in complex stone burden. Open stone surgery is also a valid alternative to endourologic techniques in all situations.

Amaç Bu çalışmada renal hücreli karsinom (RHK) nedeniyle radikal ve parsiyel nefrektomi yapılan hastaların evrelere göre onkolojik sonuçlarının karşılaştırılması amaçlanmıştır. Bu amaçla klinikopatolojik özelliklerin rekürrenssiz sağkalım ve kansere özgü sağkalım üzerine etkileri incelendi. ( Sakarya Tıp Dergisi 2019, 9(2):326-336 ) Gereç ve Yöntem 2004-2012 tarihleri arasında renal kitle nedeniyle kliniğimizde parsiyel/radikal nefrektomi uygulanan T3a ve altındaki 200 hastanın verilerini retrospektif olarak inceledik. Klinikopatolojik özelliklerin sağkalımlar üzerine istatistiksel etkileri olup olmadığı Log-Rank testi kullanılarak Kaplan Meier sağkalım analizi ile değerlendirildi. Her bir değişkene ilişkin 1- 3 ve 5 yıllık sağkalım hızları, ortalama yaşam süresi ve bu süreyle ilişkili %95 güven aralıkları hesaplandı. Bulgular Tüm olgular içerisinde 1- 3 ve 5 yıllık rekürrenssiz sağkalım % 95.5, 90.5 ve 85.5, kansere özgü sağkalım % 98.8, 96.4 ve 92.3 olarak tespit edildi. PN grubunda RN grubuna göre rekürrenssiz sağkalım istatistiksel olarak daha yüksekti (p=0,014) ama kansere özgü sağkalımda fark gözlenmedi. Evrelere göre T1a, T1b ve T3a’ da rekürrrenssiz sağkalım ve kansere özgü sağkalım T2a ve T2b’ den daha yüksekti (p=0,023 ve p

Introduction: The success of the robot assisted radical prostatectomy (RARP) procedures depend on a successful team, however the literature focuses on the performance of a console surgeon. The aim of this study was to evaluate surgical outcomes of the surgeons during the learning curve in relation to the bedside assistant's experience level during RARP. Materials and Methods: We retrospectively reviewed two non - laparoscopic, beginner robotic surgeon's cases, and we divided the patients into two groups. The first surgeon completed the operations on 20 patients with a beginner bedside assistant in February - May 2009 (Group-1). The second surgeon completed operations on 16 patients with an experienced (at least 150 cases) bedside assistant in February 2015 - December 2015 (Group-2). The collected data included age, prostate volume, prostate specific antigen (PSA), estimated blood loss, complications and percent of positive surgical margins. In addition, the elapsed time for trocar insertion, robot docking, console surgery, specimen extraction and total anesthesia time were measured separately. Results: There were no significant differences between the groups in terms of age, comorbidity, prostate volume, PSA value, preoperative Gleason score, number of positive cores, postoperative Gleason score, pathological grade, protection rate of neurovascular bundles, surgical margin positivity, postoperative complications, length of hospital stay, or estimated blood loss. The robot docking, trocar placement, console surgery, anesthesia and specimen extraction times were significantly shorter in group 2 than they were in group 1 (17.75 ± 3.53 min vs. 30.20 ± 7.54 min, p ≤ 0.001; 9.63 ± 2.71 min vs. 14.40 ± 4.52 min, p = 0.001; 189.06 ± 27.70 min vs. 244.95 ± 80.58 min, p = 0.01; 230.94 ± 30.83 min vs. 306.75 ± 87.96 min, p = 0.002; 10.19 ± 2.54 min vs. 17.55 ± 8.79 min, p = 0.002; respectively). Conclusion: Although the bedside assistant's experience in RARP does not appear to influence the robotic surgeon's oncological outcomes during the learning curve, it may reduce the potential complications by shortening the total operation time.

The elderly population is increasing in Turkey and across the world. With the frequent use of imaging modalities, the detection rate of coincidental small renal mass has also increased. Since small renal masses are generally not malignant, most of them can be followed up by active surveillance. In the current study, we examined the treatment options that can be offered to elderly patients with small renal masses. The optimum treatment method for patients of advanced age presenting with renal masses should be determined based on the presence of comorbidities such as age, renal function, and tumor characteristics.

Objective: In this report, we determined the efficacy and the toxicity of low dose weekly gemcitabine with radiotherapy, in medically unfit or refused surgery muscle-invasive bladder cancer (BC) patients. Materials and Methods: From 2008 to 2012, 15 patients were included into the retrospective analysis. Weekly gemcitabine was administered at a rate of 50 mg/m 2 with a median dose of 63 Gy radiotherapy. Results: The median age was 69 (range, 55-86). Median follow-up was 15 months (range, 5-53 months). A complete response was achieved in 12 patients (80%). Median progression free survival and overall survival were 15 months (range, 7-23 months) and 18 months (range not calculated), respectively. Local recurrence was found in 3 patients (20%) and distant recurrence was found in 5 patients (33.3%) for the entire group. While salvage surgery was performed on 1 patient, salvage chemotherapy was delivered for 4 patients. Treatment was well tolerated, there was no treatment interruption or instances of toxic death. A serious toxicity (grade 3) cystitis was seen in only 1 patient. Conclusions: Multimodality treatment of muscle invasive BC proved a feasible and effective treatment option. Gemcitabine based chemoradiation is an active treatment option with a low toxicity profile for patients with muscle invasive BC, who are not suitable medically or refused to surgery.

Summary The aim of this study was to investigate the protective effects of trimetazidine (TMZ), as an antioxidant agent, on streptozotocin (STZ)-induced diabetic rats. A total of 50 male Sprague Dawley rats were randomly classified into five groups as follows: Group 1 (control), Group 2 (STZ-induced diabetic rats), Group 3 (STZ-induced diabetic rats treated orally with 1 cc/day isotonic saline), Group 4 (diabetic rats treated orally with 10 mg/kg/day TMZ) and Group 5 (diabetic rats treated orally with 20 mg/kg/day TMZ). After 8 weeks, orchiectomy was carried out. Histopathological and electron microscopic examinations were performed in all groups. In groups 1 and 5, the structural and ultra-structural findings of the testicular tissue and spermatogenesis were found normal. In groups 2, 3 and 4, similar results were obtained in terms of the impaired testicular architecture and degeneration of spermatogenesis. The administration of an optimal dose of TMZ protects against the harmful effects of diabetes mellitus on spermatogenesis in rats. TMZ therapy can be used to maintain normal spermatogenesis in diabetic rats.

Introduction We investigated the reliability and mapping of percutaneous needle core biopsies in the kidney in histopathological diagnosis of renal masses particularly for those with suspicious radiologic appearance in an attempt to prevent unnecessary nephrectomies.Material and methods Overall, 96 cases were included in our study that underwent radical nephrectomy or partial nephrectomy due to renal mass between November 2007-March 2010. Ex-vivo biopsies 1 cm apart were obtained from the peripheral region of the mass. Additionally, half of these peripheral biopsies were obtained from the central region of the mass. Diagnostic yield of the biopsy cores were correlated. Sensitivity and specificity of peripheral and central biopsies in differentiating benign and malignant tissues were calculated.Results Sensitivity and specificity in differentiating malignant lesions were 93% and 87%, and 90% and 93% for peripheral and central biopsies, respectively. Positive and negative predictive values were 97% and 68%, and 98% and 64% for peripheral biopsies and central biopsies, respectively. Hazard ratio for cigarette smoking and presence of necrosis on CT scans were 4.76 (CI 1, 6-14.3; p = 0.04) and 3.32 (CI 1,2-9.2; p = 0.017) and 3.71 (CI 1.3-10.7; p = 0.013) and 3,51 (CI 1.3-9.6; p = 0.012) for peripheral and central biopsies, respectively.Conclusions Kidney biopsies can be performed in suspicious renal masses of central and peripheral biopsies with similar efficacy. © 2014 Polish Urological Association. All rights reserved.

We compared the weight of the prostate specimen extracted after radical prostatectomy with preoperatively estimated weights of the prostate by different imaging techniques. Materials and methods: Prostate weights were estimated by transabdominal ultrasonography (TAUS), transrectal ultrasonography (TRUS), and computed tomography (CT) preoperatively before radical prostatectomy. Prostatectomy specimens were weighed postoperatively and the actual prostate weights were calculated. Statistical analyses were done using 95% confidence intervals with repeated measurement analysis of variance and intraclass correlation coefficients. Results: Of the 163 patients enrolled in the study, the mean age was 64.2 ± 6.4 (range: 45 to 76) years. The mean postoperative prostate weight was 54.7 ± 27.9 g. Preoperative mean prostate volumes calculated by TAUS, TRUS, and CT were 50.2 ± 24.1, 50.7 ± 24.6, and 62.7 ± 28.2 mL, respectively (P < 0.001). The actual prostate weight measured using an electronic scale was correlated with the estimated prostate weight in each of 3 methods, the best of which was that of TRUS. Conclusion: The actual prostate weight is best estimated by measurements done with TRUS. However, clinicians should consider that some errors and deviations may occur with these imaging techniques.

To examine the effect of steep Trendelenburg position (ST) on intraocular pressure (IOP), resistive index of the central retinal artery, and venous impedance index of the central retinal vein during robotic prostatectomy and cystectomy. A total of fifty-three male patients were included into the study (prostatectomy: 43, cystectomy: 10). During robotic surgery, the effect of the ST on IOP, resistive index of the central retinal artery (CRA-RI), and venous impedance index of the central retinal vein (CRV-VI) was prospectively examined. The measurement times of IOP are as follows: T1: before anesthesia while supine and awake; T2: anesthetized and supine; T3: anesthetized and ST; T4: anesthetized, ST, and intraperitoneal insufflation; T5: anesthetized in ST at the end of the procedure with CO2; T6: anesthetized in ST after desufflation; and T7: anesthetized supine before awakening. There was no difference between the IOP values of the right and left eyes in both groups. The highest IOP values were reached at T4 and T5. CRA-RI values were different, while CRV-VI values were similar at T1 and T4. Despite staying in the ST for a long time provided that the ophthalmologic examination was normal, ocular complication risk is low in robotic prostatectomy and cystectomy.

WOS: 000393331000007 PubMed ID: 28081352 Background/aim: The aim of this study was to gauge whether removal of a specimen with traction during robot-assisted laparoscopic radical prostatectomy causes a positive surgical margin or not. Materials and methods: One hundred and sixty-nine patients with localized prostate cancer who underwent robot-assisted laparoscopic radical prostatectomy from 2009 to 2011 were included in the study. After dividing the patients into two groups, we recorded their characteristics and pre-op/post-op evaluations. Results: There were 111 and 58 patients in groups 1 (with traction) and 2 (without traction), respectively. We evaluated the patients' ages, follow-up time, body mass index (BMI), prostate-specific antigen (PSA) values, pre-op and post-op Gleason score values, pathological stage, positive surgical margin rates, and biochemical PSA recurrence rates. There was no statistically significant difference between the groups for age, pre-op PSA values, BMI, pre-op and post-op Gleason scores, positive surgical margin rates and biochemical recurrence rates. There was a significant difference between prostate weight, tumor volume, and clinical stage. Conclusion: Removing the specimen with traction during robot-assisted laparoscopic radical prostatectomy does not cause a positive surgical margin. The incision should be as small as possible for cosmetic appearance.

Robotic-assisted nephroureterectomy with distal ureterectomy using a LigaSure device is a safe alternative for upper tract transitional cell carcinoma., Background and Objectives: Our aim was to show that bladder cuff excision and distal ureterectomy can be safely performed by using the LigaSure device during robotic-assisted laparoscopic nephroureterectomy. Methods: A 60-year-old man presented with gross hematuria. He was diagnosed with upper urinary tract transitional cell carcinoma (TCC) on the left side and was scheduled for robot-assisted laparoscopic surgery. Without changing the patient's position, sealing with the LigaSure atlas for bladder cuff excision and distal ureterectomy was performed. Results: The operating time was 140 minutes from the initial incision to skin closure of all incisions. The estimated blood loss during the surgery was 120mL. There were no intraoperative or postoperative complications. The Foley drain was removed on day 3 after normal cystographic findings, and the patient was discharged from the hospital on the fourth postoperative day. Conclusion: Robot-assisted nephroureterectomy with distal ureterectomy in the same position using a LigaSure device is a safe alternative for upper tract transitional cell carcinoma.

Objective We determined the factors that can cause urethral stricture after radical retropubic prostatectomy. Materials and methods A total of 56 patients underwent radical retropubic prostatectomy for clinically localized prostate cancer between June 2004 and July 2006. The patients were invited for cystography and removal of the urethral catheter at the 7th postoperative day if no extravasation was seen. Otherwise, the same procedures were repeated at postoperative days 14 and 21 until complete healing at urethrovesical anastomosis was observed. The patients were followed up for the occurrence of urethral stricture with PSA blood levels, residual urine assessment and uroflowmetry at least for 1 year. The impact of age, preoperative PSA level, prostate weight, biopsy Gleason score, bladder neck reconstruction, neurovascular bundle preservation, presence of a water-tight anastomosis, amount of peroperative bleeding and catheter removal time on the development of urethral stricture was evaluated with logistic regression analysis. Results A statistically significant correlation was observed between catheter removal time, which reflects complete healing of the urethrovesical anastomosis, and development of urethral stricture (P = 0.004). Only 1 (4%) of 25 patients whose catheter was removed on postoperative day 7 developed urethral stricture, whereas 2 of 16 (12.5%) and 6 of 15 (40%) patients whose catheters were removed on postoperative days 14 and 21 developed urethral strictures. Additionally, patients with postoperative urethral strictures were found to be slightly older than those without (67.4 +/- 4.5 vs. 63.1 +/- 6.5, P = 0.048). Conclusion Our study showed that early healing of vesico-urethral anastomosis may allow early catheter removal and results in decreased rates of urethral stricture formation.

The objective of our study is to analyze the impact of patient age, education level, and household income on the understanding of the International Index of Erectile Function (IIEF) and to determine the patient characteristics that make this questionnaire less reliable. All men older than 18 years presenting to our clinic were asked to complete the Turkish translation of IIEF upon arrival. Self-reported information related to age, education level, and household income of the patients was also recorded from the questionnaire. The patients were requested to complete the questionnaires once again during their second visit, which was not earlier than 5 hours and no later than 5 days. The patients were requested to complete the questionnaire by themselves; however, those who were unable to do so themselves were allowed to receive the assistance of their companions. The answers of the questions that were replied to properly were defined as ''appropriate,'' and the unanswered questions or those replied to with more than one answer were defined as ''inappropriate.'' A total of 430 patients were included in this study. Only 289 patients (67.2%) were able to respond to all of the questions properly at first visit. The percentage of improper completion increased as age increased, whereas it decreased parallel to the increase in educational level and household income (respectively, P 5 .027, P , .001, P 5 .008). Of 430 patients, 68.4% did not need any help from their companions, and the remaining 31.6% needed some assistance during the completion of the questionnaire. A total of 131 patients who completed the questionnaire at their initial admittance to our clinic came for their second visit. Only 61.8% of the patients were capable of completion both at first and second visits. There was a low degree of consistency among the first and second administrations of IIEF (k 5 0.369, P , .001). Turkish translation of the IIEF needs further validations for the self-administered mode in order to improve its comprehension as well as its reliability, validity, and specificity, especially in older patients with lower educational levels and household income status, among whom the prevalence and the severity of erectile dysfunction is higher.

The purpose was to evaluate the efficacy of the addition of short-term desmopressin to enuretic alarm in patients with primary monosymptomatic nocturnal enuresis (PMNE). A total of 52 children with PMNE were included in this study. The patients were randomized into two groups. In group 1 (n = 30), the patients were given 6 weeks of additional oral desmopressin to 12 weeks of enuretic alarm therapy, as a single dose of 0.2 mg at the first 3 weeks and 0.4 mg at the following 3 weeks. In group 2 (n = 28), the patients were given 12 weeks of enuretic alarm therapy alone. According to the number of wet nights after 12 weeks of treatment, the patients were defined as complete responders (dry or more than 75% reduction in wet nights), partial responders (50 to 75% reduction) and non-responders (less than 50% reduction). Relapse was defined as the reappearance of >1 wet night per week for complete responders and >50% increase in pre-treatment wetting frequency for partial responders, and all these patients were called relapsers. The mean number of wet nights after 3 and 6 weeks treatment was significantly lower in group 1 compared to group 2. However, there was no significant difference between the groups regarding the mean number of wet nights after 12 and 24 weeks of treatment. There was no significant difference between the groups regarding the number of responders, partial responders, non-responders and relapsers. In the group with additional desmopressin therapy given, the number of patients who abandoned therapy was lower than the alarm therapy alone group, but it was not statistically significant. Our data showed that the addition of short-term desmopressin to alarm therapy was more effective only in the period when it was given, and it did not change the response to alarm therapy in the long term.

Abdullah Erdem Canda,1 Ali Fuat Atmaca,1 Ozer Ural Cakici,2 Bahri Gok,2 Muhammed Ersagun Arslan,2 Serkan Altinova,2 Ziya Akbulut,1 Mevlana Derya Balbay3 1School of Medicine, Yildirim Beyazit University, Department of Urology, Ankara Ataturk Training and Research Hospital, Ankara, Turkey; 2Department of Urology, Ankara Ataturk Training and Research Hospital, Ankara, Turkey; 3Department of Urology, Memorial Sisli Hospital, Istanbul, Turkey Introduction: In this retrospective study, we report outcomes of robot-assisted laparoscopic radical prostatectomy (RARP) in high-risk prostate cancer (HRPC) classified according to a D'Amico risk group with minimum 1-year follow-up. Methods: A total of 34 patients who had at least one preoperative HRPC feature and who underwent RARP were included. Mean patient age and preoperative serum prostate-specific antigen levels were 62.6±6.4 years and 12.2±9.1 ng/mL, respectively. Preoperatively, two (5.8%), one (2.9%), eleven (32.3%), three (8.8%), and 17 (50%) patients had prostate biopsy Gleason scores of 5+4, 4+5, 4+4, 3+5, and

Background and Objectives: To compare open versus totally intracorporeal robotic-assisted radical cystectomy, bilateral extended pelvic lymph node dissection, and Studer urinary diversion in bladder cancer patients. Methods: A retrospective comparison of open (n = 42) versus totally intracorporeal (n = 32) robotic-assisted radical cystectomy, bilateral extended pelvic lymph node dissection, and Studer urinary diversion was performed concerning patient demographic data, operative and postoperative parameters, pathologic parameters, complications, and functional outcomes. Results: Patient demographic data and the percentages of patients with pT2 disease or lower and pT3–pT4 disease were similar between groups (P > .05). Positive surgical margin rates were similar between the open (n = 1, 2.4%) and robotic (n = 2, 6.3%) groups (P > .05). Minor and major complication rates were similar between groups (P > .05). Mean estimated blood loss was significantly lower in the robotic group (412.5 ± 208.3 mL vs 1314.3 ± 987.1 mL, P < .001). Significantly higher percentages of patients were detected in the robotic group regarding bilateral neurovascular bundle–sparing surgery (93.7% vs 64.3%, P = .004) and bilateral extended pelvic lymph node dissection (100% vs 71.4%, P = .001). The mean lymph node yield was significantly higher in the robotic group (25.4 ± 9.7 vs 17.2 ± 13.5, P = .005). The number of postoperative readmissions for minor complications was significantly lower in the robotic group (0 vs 7, P = .017). Better trends were detected in the robotic group concerning daytime continence with no pad use (84.6% vs 75%, P > .05) and severe daytime incontinence (8.3% vs 16.6%, P > .05). No significant differences were detected regarding postoperative mean International Index of Erectile Function scores between groups (P > .05). Conclusions: Robotic surgery has the advantages of decreased blood loss, better preservation of neurovascular bundles, an increased lymph node yield, a decreased rate of hospital readmissions for minor complications, and a better trend for improved daytime continence when compared with the open approach.

Objective: We evaluated outcomes of our robot-assisted laparoscopic transperitoneal pyeloplasty (RALP) procedures. Material and methods: Between July 2011 and March 2014, 18 RALP procedures were performed at our instutition. Ureteropelvic junction obstruction (UPJO) diagnosis was made based on clinical presentation and intravenous urography. All patients underwent basal and diuretic isotopic renography to evaluate the degree of obstruction and impaired renal function. Anderson-Hynes dismembered pyeloplasty technique was used with a transperitoneal approach by using the da Vinci-S 4-arm surgical robot. Outcomes were assessed retrospectively. Results: Mean patient age was 31.3±11.7 (13-62) years. Male: female ratio was 9: 9. All procedures were primary surgeries. Of 18 patients, 10 (55.5%) had a crossing vessel and 8 (44.5%) had intrinsic obstruction. Mean operative time was 150.4±17.2 (115-185) minutes. Mean anastomosis time was 21.4±5.5 (10-33) minutes. Mean blood loss during the operation was 33.6±17.3 (10-60) cc. Mean hospital stay was 2.6±1.0 (1-6) days. No conversion to open surgery was required. No intraoperative and perioperative (0-30 days) complication occurred. Readmission rate during perioperative period was 0%. Median follow-up was 16.6±10.3 (3-35) months. Postoperative intravenous urography and renography showed improved results in all cases. Conclusion: Due to our experience, RALP is a safe and feasible minimally invasive approach in patients with UPJO with excellent surgical and functional outcomes.

To evaluate the necessity of leaving a pelvic drain after open radical cystectomy. Materials and methods: Between January 2007 and January 2010, 58 patients with muscle-invasive bladder carcinoma were included. All patients underwent radical cystectomy, extended lymph node dissection, and orthotopic bladder (Studer pouch) substitution. Patients were randomized to have a pelvic drain catheter (Group 1, n = 22) or not (Group 2, n = 36). Ureteral catheters were removed at postoperative days 7 and 8. The pelvic drain catheters in Group 1 were removed when daily production was

Aim: To evaluate the effect of neoadjuvant chemotherapy on tumor pathology and patient survival in patients with muscle-invasive bladder cancer undergoing radical cystectomy. Neoadjuvant chemotherapy is believed to prevent micrometastasis and provide pathological downstaging. Materials and methods: Between June 2004 and March 2009, 74 patients with muscle-invasive bladder cancer were treated with radical cystectomy. Patients fit to receive chemotherapy were administered systemic chemotherapy of methotrexate, vinblastine, Adriamycin, and cisplatin (MVAC); gemcitabine and cisplatin (GC); or carboplatin and gemcitabine (CG). Patients in Group 1 (n = 36) did not receive any chemotherapy, while the remaining 38 patients in Group 2 did so, before radical cystectomy. Patient characteristics, pathological staging, and survival analysis were compared statistically between groups. Results: The mean follow-up time was 16.12 ± 12.13 months. There was no significant difference between the groups regarding patient age, sex, preoperative clinical staging, lymph node invasion, comorbidity, type of urinary diversions done, postoperative early complications, progression-free survival (21.96 ± 3.5 and 23.44 ± 2.5 months; P = 0.275), and overall survival rates (25.76 ± 3.5 and 23.57 ± 2.4 months; P = 0.646). However, differences in pathological downstaging (pT3-pT4, 21.58% and 16.42% for groups 1 and 2, respectively; P < 0.001) and perioperative mortality (6 vs. 0 deaths in groups 1 and 2; respectively) were significant between groups. Conclusion: Neoadjuvant chemotherapy may result in pathological downstaging while having no effects on progression-free or overall survival rates.

Aim: The purpose of this study was to compare the effectiveness of handmade transobturator tape (TOT) devices (tailored polypropylene mesh by the surgeon during the operation) with commercially available ones. Materials and methods: We included 78 consecutive women with the complaint of pure stress urinary incontinence recalcitrant to lifestyle modifications, pelvic floor muscle training, and medical treatment. The patients underwent TOT procedures either with a commercially available product (I-Stop, CL Medical, Lyon, France) (group 1) or with a device prepared during the operation with polypropylene mesh of 35 × 2 cm in size (Prolen®, Ethicon Inc., Somerville, New Jersey, USA) (group 2). The patients were followed for at least 18 months and cure was defined as the absence of any episodes of involuntary urine leakage during stressful activities and/or the stress cough test. Results: Thirty-two (group 1) and 46 (group 2) patients underwent TOT surgery. Mean operation time was slightly shorter in group 1 compared to group 2 (20.53 ± 4.88 vs. 22.93 ± 4.84, P = 0.035); however, mean duration of the indwelling catheter was less than 1 day in both groups (P = 0.444). None of the patients had incontinence or urinary retention postoperatively. The cure rates in groups 1 and 2 were not significantly different at the end of the 1st (87.5% vs. 87%, P = 0.944) and 2nd (78.1% vs. 80.4%, P = 0.804) postoperative years. Conclusion: TOT procedures performed with polypropylene mesh and No. 1 silk line are as effective and safe as commercially available TOT devices.

Amaç: Bu çalışmada sistoskopi esnasında hastanın konforunu artıran ve ağrı duyusunu azaltan hasta özellikleri ve yöntemler arasındaki etkinlik farkı araştırıldı. Gereç ve Yöntem: Hem kanser hem de benign endikasyonlar nedeni ile sistoskopi yapılan hastalar çalışmaya dahil edildi. İşlemler, sistoskopi esnasındaki ağrı ve rahatsızlık üzerindeki tecrübenin önemini belirtmek için, asistan ve diğer sağlık personellerine anlatılarak yapıldı. Hastalar sözlü anlatım yapılan ve sistoskopi görüntülerini yapan ürologla beraber ekrandan izlemek isteyip istemediklerine göre gruplara ayrıldı. Hastaların ağrıları 10 mm VAS skoruna göre değerlendirildi ve ağrı noktası lokalize edildi. Bulgular: Sistoskopi yapılan 146 hasta (99 rijid, 47 esnek) değerledirildi. Yaş ve VAS skorları arasında farklılık yoktu. Esnek sistoskopi esnasında ortalama VAS skoru rijide göre düşüktü. Univariate analizler gösterdi ki; düşük vücut kitle indeksi, klinisyen tarafından aynı anda hastaya detaylı anlatım yapılması, düşük klnisyen tecrübesi ve ilk sistoskopiler ağrı ile anlamlı derece ilişkili idi. En ağrılı durumlar, esnek sistoskopi esnasında lidokain instilasyonu ve rijid sistoskopi esnasında mesane yan duvarlarının görüntülenmesiydi. Tartışma: Teknik, esnek veya rijid sistoskopi, tecrübe ve ilk sistoskopi ağrıda önemli role sahiptir. Aim: To determine the patient characteristics and surgical conditions which is associated with patient pain and discomfort during cystoscopic procedures. Material and Method: Consecutive patients who had a cystoscopy for cancer- related and benign indications were included. Patients were randomized to undergo either rigid or flexible cystoscopy. Procedures were performed in a teaching setting that included residents and attending physicians to assess the impact of experience on pain/discomfort. Patients were further subdivided into the groups that were received detailed verbal explanation during the cystoscopy and allowed to watch the video screen together with the urologist during the procedure or not. Patients were asked to assess their pain on a 10-mm VAS after the procedure the location of the pain was noted. Results: A total of 146 outpatient cystoscopies (99 rigid, 47 flexible) were evaluated. There was no correlation between patients age and VAS scores. Mean VAS during flexible cystoscopy was lesser than rigid one. Univariate analysis showed that lower BMI, real time detailed verbal explanation by the physician, lesser physician experience and initial cystoscopies were significantly associated with painful cystoscopies. Lineer regression analysis confirmed that type of instrument, detailed verbal information, physicians experience-more than 3 years and history of previous cystoscopy were independent factors related to VAS scores. The most painful localizations were lidocaine injections during flexible cystoscopy whereas visualization of the side wall of the bladder for rigid technique. Discussion: Instrument type (flexible or rigid), explaining the procedure, experience of the physician, number of previos cystoscopies may have an effect on the amount of pain and discomfort during cystoscopy.

Although foci of calcification in renal cell carcinoma is frequently observed, ossification is extremely rare and may be a marker for favorable prognosis. We report a case of renal cell carcinoma with a focus of ossification; this case was not detected with imaging techniques prior to surgery and diagnosed initially on pathologic examination, unlike other cases. If the radiographic evaluation for ossification is inconclusive but the mass is extremely hard to palpate or difficult to cut, the surgeon should remember the favorable prognosis of such lesions and might consider a limited procedure such as partial nephrectomy while waiting for pathological analysis.

We are presenting a patient with two calculi in a right pelvic kidney managed by percutaneous nephrolithotomy with an access just above the iliac crest in the prone position.

Introduction Our aim was to examine the incidence and risk factors of postoperative ileus among pa tients who underwent robot–assisted radical prostatectomy (RARP). Material and methods We retrospectively reviewed 239 patients who underwent RARP transperitoneally between February 2009 and December 2011. Patients switched to open surgery were excluded. We defined postoperative ileus as intolerance of a solid diet continued until the third postoperative day and beyond. By Clavien classification, we evaluated the perioperative complications that cause or contribute to postoperative ileus. Similarly, we analyzed the impact of anesthesia risk score on the incidence of postoperative ileus. Results The study included 228 patients. The mean period to tolerate solid food was 1.24 days. Only 6 patients experienced postoperative ileus, all of whom were treated with a conservative approach. The two groups differed significantly in the duration of abdominal drainage, hospital stay, modified Clavien classification, and the presence of comorbidity diabetes mellitus (P

DOI: 10.4328/JCAM.1094 Received: 11.05.2012 Accepted: 31.05.2012 Printed: 01.09.2013 J Clin Anal Med 2013;4(5): 360-2 Corresponding Author: Muhammet Fuat Ozcan, Iscibloklari Mah. 1489. Cad. 6/43 06530 Cankaya, Ankara, Turkiye. GSM: +905056407025 T.: +90 3122912740 E-Mail: mfuatozcan@hotmail.com Ozet Amac: Parsiyel orsiektomi endikasyonlari ve sonuclarinin gozden gecirilmesi amaclanmistir. Gerec ve Yontem: Subat 2005 –Aralik 2011 tarihleri arasinda parsiyel orsiektomi yapilan hastalarin demografik ve patolojik ozellikleri retrospektif olarak incelendi. Bulgular: Yaslari 2 ile 30 arasinda degisen 7 hastaya parsiyel orsiektomi yapildi. Parsiyel orsiektomi endikasyonlari: 3 hastada soliter testiste kitle, 2 hastada bilateral testikuler kitle, 1 hastada ise travma idi. Travma nedeniyle parsiyel orsiektomi yapilan hastada insidental olarak miks germ hucreli tumor saptandi. Tartisma: Fertilitenin korunmasi, uzun donemde hormon replasman tedavisi gereksinimini ortadan kaldirabilmesi ile testis koruyucu cerrahi secilmis vakalarda tercih edilebilecek tedavi secenegidir.

Secondary injuries especially extremity fractures may be seen concurrently with traumatic brain injury (TBI). Peripheral nerve damages may accompany to these fractures and may be missed out, especially in acute stage. In this case report; damage of radial, ulnar and median nerves which was developed secondarily to distal humerus fracture that could not be detected in acute stage, in a patient who had motor vehicle accident (MVA). 29-year-old male patient was admitted with weakness in the right upper extremity. 9 months ago, he had traumatic brain injury because of MVA, and fracture of distal humerus was detected in follow-ups. Upon the suspect of the peripheral nerve injury, the diagnosis was confirmed with ENMG. The patient responded well to the rehabilitation program treatment. In a TBI patient, it must be kept in mind that there might be a secondary trauma and therefore peripheral nerve lesions may accompany to TBI.

Introduction: Prostate biopsies incur the risk of being false-negativeand this risk has not yet been evaluated for 12-core prostatebiopsy. We calculated the false-negative rate of 12-core prostatebiopsy and determined the patient characteristics which mightaffect detection rate.Methods: We included 90 prostate cancer patients (mean age of64, range: 49-77) diagnosed with transrectal ultrasound guided12-core prostate biopsy between December 2005 and April 2008.All patients underwent radical retropubic prostatectomy and the12-core prostate biopsy procedure was repeated on surgical specimenex-vivo.Results of preoperative and postoperative prostatebiopsies were compared. We analyzed the influence of patient age,prostate weight, serum prostate-specific antigen (PSA) level, free/total PSA ratio, PSA density and Gleason score on detection rate.Results: In 67.8% of patients, prostate cancer was detected withrepeated ex-vivo biopsies using the same mapping postoperatively.We found an increase in PSA level, PSA density and biopsyGleason score; patient age, decreases in prostate weight and free/total PSA ratio yielded higher detection rates. All cores, exceptthe left-lateral cores, showed mild-moderate or moderate internalconsistency. Preoperative in-vivo biopsy Gleason scores remainedthe same, decreased and increased in 43.3%, 8.9% and 47.8% ofpatients, respectively, on final specimen pathology.Conclusions: The detection rate of prostate cancer with 12-corebiopsy in patients (all of whom had prostate cancer) was considerablylow. Effectively, repeat biopsies can still be negative despitethe patient’s reality of having prostate cancer. The detection rate ishigher if 12-core biopsies are repeated in younger patients, patientswith high PSA levels, PSA density and Gleason scores, in additionin patients with smaller prostates, lower free/total PSA ratios.

Aim: The initial therapy for superficial bladder carcinoma is the transurethral resection of the tumor. In spite of successful resections, there are 60-79% recurrence and 15% progression rates. Additional therapies are suggested for the treatment of superficial bladder carcinoma. We compared the efficacy of interferon alfa-2b monotherapy with interferon alfa-2b plus Bacillus Calmette Guerin (BCG) combination therapy with urine interleukin (IL) 2, 6 and 10 levels of patients with superficial bladder carcinoma. Material and Method: The patients who underwent TUR-BT for superficial bladder tumor (pathological staging Ta-T1) between 2004 and 2007 at our hospital included in this prospective study. Intravesical immunotherapy was administered once a week for 6 weeks and there after a month for 6 months, starting 4 weeks after TUR-BT. IL levels were measured. Results: IL-2, IL-6 and IL- 10 levels in urine samples were taken at 2nd and 4th hours of intravesical therapy. A statistically significant difference was observed between mean urine IL-2 levels of patients treated with IFN%u03B1-2b monotherapy and IFN%u03B1- 2b plus BCG combination both at 2nd and 4th hours. (p=0.05) In IFN%u03B1-2b plus BCG combination group, there was a statistical significant difference between stages regarding IL-2 and IL-6 levels (p=0.05). Among patients with G3 tumors, IL-2 levels were higher at 2 and 4 hours (p=0.05) but there was no significant difference in IL-6 and IL-10 levels in this group of patients regardless of intravesical therapy received (p=0.05). Discussion: IFN%u03B1-2b and BCG combination therapy is a reliable and effective therapy in the management of superficial bladder tumors.

• To report the outcomes of 27 patients whom we performed robot-assisted radical cystoprostatectomy and cystectomy (RARC) with intracorporeal urinary diversion (Studer pouch and ileal conduit) for bladder cancer.• Between December 2009 and December 2010, we performed RARC in 25 men (intrafascial bilateral [22], unilateral [one], non-neurovascular bundle [NVB] sparing [two]), NVB-sparing RARC with anterior pelvic exenteration in two women, bilateral extended robot-assisted pelvic lymph node dissection (RAPLND) (25), intracorporeal Studer pouch (23), ileal conduit (two), and extracorporeal Studer pouch (two) construction. • Patient demographics, operative and postoperative variables, pathological variables, complications (according to modified Clavien system) and functional outcomes were evaluated.• The mean (sd, range) operative duration, intraoperative estimated blood loss and mean lymph node (LN) yield were 9.9 (1.4, 7.1-12.4) h, 429 (257, 100-1200) mL and 24.8 (9.2, 8-46), respectively. • The mean (sd, range) hospital stay was 10.5 (6.8, 7-36) days, there was one perioperative death (3.7%), lodge drains were removed at a mean of 11.3 (5.6, 9-35) days and surgical margins were negative in all but one patient who had pT4b disease. • The postoperative pathological stages were: pT0 (five), pTis (one), pT1 (one), pT2a (five), pT2b (three), pT3a (six), pT3b (two), pT4a (three) and pT4b (one). • Positive LNs and incidental prostate cancer were detected in six and nine patients, respectively and at a mean follow-up of 6.3 (2.9, 1.8-11.3) months, three patients died from metastatic disease and one from cardiac disease. • According to the modified Clavien system, there were nine minor (Grade 1 and 2) and four major (Grade 3-5) complications in the perioperative (0-30 days) period; four minor and three major complications in the postoperative (31-90 days) period. Of the available 18 patients, 11 were fully continent, four had mild and two had severe day-time incontinence.• Bilateral NVB-sparing RARC with RAPLND and intracorporeal Studer pouch or ileal conduit reconstruction are complex procedures with acceptable morbidity, excellent short-term surgical and pathological outcomes and satisfactory functional results. • Studies with more patients and longer follow-ups are required to evaluate the feasibility of these RA totally intracorporeal complex procedures.