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BACKGROUND: Robot-Assisted Radical Prostatectomy (RARP) is increasingly becoming the standard surgical treatment for prostate cancer. While some risk factors for postoperative complications of RARP have been identified, no scoring model that incorporates both preoperative physical status of the patient and intraoperative risk factors has been developed. The Estimation of Physiologic Ability and Surgical Stress (E-PASS) score was initially described to predict postoperative complications after gastrointestinal surgical procedures. This study aims to assess the effectiveness of the E-PASS score in predicting postoperative complications of RARP. METHODS: A retrospective evaluation was conducted on 204 patients who underwent RARP between 2019 and 2022. Demographic data, parameters indicating patients’ preoperative physical condition, and intraoperative risk factors were analyzed. The E-PASS score and subscores were calculated for each patient. RESULTS: Of the patients, 164 (80.4%) were discharged without any postoperative complications (Group 1), and 40 (19.6%) experienced various degrees of complications (Group 2). Patients in Group 2 had higher rates of previous abdominal surgery, elevated Eastern Cooperative Oncology Group (ECOG) performance scores, longer surgical durations, and higher E-PASS scores. To assess the effectiveness of the Comprehensive Risk Score (CRS) as a predictive factor for postoperative complications, a receiver operating characteristic (ROC) curve was constructed with a 95% confidence interval (CI), and a cut-off value was established. The cut-off value for CRS was determined to be -0.0345 (area under the curve [AUC]=0.783, CI: 0.713-0.853; p<0.001). Patients with a CRS higher than the cut-off value had a 16.4 times higher rate of postoperative complications after RARP (95% CI: 5.58-48.5). CONCLUSION: The E-PASS scoring model successfully predicts postoperative complications in patients undergoing RARP by using preoperative data about the physical status of the patient and surgical risk factors. The E-PASS score and its subscores could be utilized as objective criteria to determine the risk of postoperative complications before and immediately after surgery. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to determine whether the Mayo adhesive probability (MAP) score could predict perioperative outcomes in transperitoneal laparoscopic total adrenalectomy (LTA) and laparoscopic partial adrenalectomy (LPA). Materials and Methods: The clinical data of 139 patients who underwent transperitoneal LTA (n = 116) or LPA (n = 23) between March 2013 and September 2022 were retrospectively analyzed. According to the images obtained from preoperative contrast-enhanced computed tomography or magnetic resonance imaging, the patients were divided into two groups: the low MAP score group (0–1 points) and the high MAP score group (2–5 points). General clinical features and perioperative outcomes were compared between the groups. Results: In patients with a high MAP score, the mean body mass index (BMI) (p: 0.005), tumor size (p: 0.005), operative time (p: 0.002), estimated blood loss (EBL) (p: 0.001), and complication rate (p: 0.013) were significantly higher compared with those with a low MAP score. The comparison of the patients between the LTA and LPA subgroups revealed that operative time and EBL were significantly higher in both subgroups among the patients with a high MAP score. Moreover, the complication rate in the LTA subgroup was significantly higher in the high MAP score group compared with the other group. The Multivariate analyses revealed that a high MAP score was a risk factor for prolonged operative time (Odds Ratio [OR]: 3.081, 95% Confidence Interval [CI]: 1.284–7.398, p: 0.012), increased EBL (OR: 2.495, 95% CI: 1.114–5.588, p: 0.026), and complications (OR: 6.085, 95% CI: 1.532–24.171, p: 0.01) Conclusions: Patients with a high MAP score had a prolonged operative time, increased EBL, and a higher complication rate compared with those with a low MAP score. In addition, we found that a high MAP score was an independent risk factor for perioperative parameters and complications in patients who underwent LTA and LPA. [ABSTRACT FROM AUTHOR]

Aim: Differentiating granulomas from cancerous tissue poses a significant challenge in upper urinary tract surgery. We present the case of a 62-year-old male with a gelatin-based matrix (SurgifloTM) granuloma in the kidney following renal cyst decortication eight years earlier. Methods: Contrast-enhanced abdominal tomography revealed a Bosniak type-4 cyst at the previous operation site. The patient underwent laparoscopic partial nephrectomy with near-infrared imaging. Results: The lesion presented as hypofluorescent relative to normal kidney tissue. Histopathological examination revealed a foreign body granuloma due to unabsorbed Surgiflo. Conclusion: The fluorescence pattern could not distinguish a Surgiflo granuloma from a malignant lesion of the kidney. [ABSTRACT FROM AUTHOR]

Introduction: We aimed to compare the postoperative continence rates in prostate cancer patients who had robot-assisted radical prostatectomy (RARP) when bladder necks were "unpreserved", "preserved" and "extremely preserved". Methods: In this study, the data of 184 patients who underwent RARP for localized prostate cancer in our clinic between August 2019 and January 2023 were analyzed. The patients were divided into three groups as the bladder neck was not preserved (Group 1), the bladder neck was preserved (Group 2), and the bladder neck was extremely preserved (Group 3). Incontinence status was evaluated with the 24-hour pad test postoperatively at the 1st, 3rd 6th month and 12th months. Results: One month after surgery, the rate of fully continent patients was higher in Group 3 (39.1%) than Groups 1 and 2 (27.5% and 32.7%, respectively), however the difference was not statistically significant (p=0.483). At the postoperative 3rd month, the rate of fully continent patients was 56.5% in Group 3, 51.9% in Group 2 and 43.1% in Group 1 (p=0.361). The rate of patients with moderate incontinence was higher in Group 1 compared to other study groups (p=0.019). The rate of fully continent patients was 82.6% in Group 3, 73.1% in Group 2 and 61.5% in Group 1 at 6th postoperative month (p=0.079). At postoperative 6 month a significant difference was observed for moderate incontinence rates (15.6%, 5.8% and 0 for Groups 1, 2 and 3, respectively) (p=0.034). At the postoperative 12th month, the rate of fully continent patients was 91.3% in Group 3, 80.8% in Group 2 and 72.5% in Group 1 (p=0.118). Conclusion: Our results indicated that the approaches for preserving the bladder neck during RARP did not have a statistically significant effect on the prevalence of incontinence, however reduced the severity of incontinence. [ABSTRACT FROM AUTHOR]

Objective: Urethral stricture is characterized by fibrosis that decreases urine flow. Metabolic syndrome is a complex disorder that causes fibrosis in many organs. This study aimed to evaluate the relationship between metabolic syndrome and appearance of urethral stricture and effects of metabolic syndrome on the recurrence of urethral stricture in patients with primary urethral stricture who underwent direct visual internal urethrotomy. Materials and methods: One hundred thirty-two male patients who underwent direct visual internal urethrotomy between 2014 and 2021 because of primary urethral stricture were included. Location, length, and type of urethral stricture, time from diagnosis to surgery, postoperative follow-up, time from surgery to recurrence, and postoperative follow-up duration with a urethral catheter were retrospectively analyzed and association with metabolic syndrome was evaluated. Results: The mean age was 50.48 ± 17.94 years. Recurrence was found in 34.1% and metabolic syndrome in 27.3%. Postoperative follow-up duration was significantly longer in patients with recurrence than in those without (P = .033). There was no statistically significant difference in terms of metabolic syndrome and postoperative urethral catheterization between patients with and without recurrence (P = .126, P = .714, respectively). Postoperative clean intermittent self-catheterization use was found to be statistically higher in patients with recurrence than in patients without recurrence (P = .018). Postoperative urinary tract infection rate was found to be significantly higher in patients with metabolic syndrome compared to patients without metabolic syndrome (P = .001). Conclusion: Metabolic syndrome was not associated with recurrence. However, postoperative urinary tract infections were more common in patients with metabolic syndrome than in patients without. Clean intermittent self-catheterization used postoperatively may increase the risk of stricture. [ABSTRACT FROM AUTHOR]

Introduction: It was aimed to show the relationship between benign prostatic hyperplasia and inflammation by measuring urinary C-reactive protein values before and after alpha-blocker treatment. Methods: A total of 71 patients with a total prostate-specific antigen <3.5 ng/mL, International Prostate Symptom Score >7, and maximum urinary flow rate <15 mL/s were included in the study. Doxazosin 4 mg p.o. once daily was started orally as an alpha-blocker treatment. Serum and urine C-reactive protein values, International Prostate Symptom Score, maximum urinary flow rate, and the post-void residual volume of patients were recorded at the first admission and in the first month of alpha-blocker treatment. Results: The mean age of the patients was 59.2 ± 7.5 years. The mean serum C-reactive protein values of the patients at the first admission and follow-up were 2.62 ± 1.8 (range, 0–5) mg/L and 2.83 ± 1.6 (0–6) mg/L, respectively. The mean urine C-reactive protein values of the patients at the first admission and follow-up were 0.45 ± 0.11 (range, 0.28–0.99) mg/L and 0.14 ± 0.04 (range, 0.79–0.328) mg/L, respectively, which was statistically significantly different. In the subgroup analysis, the urine C-reactive protein level change was more prominent in severely symptomatic patients than in moderately symptomatic patients. Conclusion: Our results showed that C-reactive protein was detectable in urine, alpha-blocker treatment significantly reduced urine C-reactive protein levels, and the decrease was more prominent in severely symptomatic patients. [ABSTRACT FROM AUTHOR]