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Objective: This study aimed to investigate pathological lymph node involvement in selected patients and the relationship of prostate-specific antigen (PSA) progression-free survival rates between patients with and without lymph node involvement on preoperative conventional radiologic imaging. Limited data is available about local treatment outcomes in patients with prostate cancer (PCa) having clinical lymph node involvement.

Introduction: Functions attributed to androgens have increased, ranging from the role in hypothalamic-pituitary-gonadal axis and reproductive behaviors to modulation of cognition, mood and some other functions. Sex differences and changes in circulating sex hormones affect human sensory function. In the literature, authors reported this kind of influence for olfaction predominantly in females. Objective: To investigate the effects of low testosterone levels on olfactory functions in males, in this prospective clinical study. Methods: Male patients diagnosed with prostate cancer were included. Thirty-nine patients with prostate cancer whose testosterone levels were lower than 50 ng/dL due to castration, were the study group. Thirty-one patients with prostate cancer who were not castrated with testosterone levels higher than 50 ng/dL were selected as the control group. Acoustic rhinometry and peak nasal inspiratory flow tests were performed for all participants; and for evaluation of olfactory function, both groups completed the Connecticut chemosensory clinical research center olfactory test. Results: The mean ages of the patients and controls were 69.6 ± 7.2 (57-89) and 66.3 ± 5.8 (50-78) years, respectively (= 0.039). There was a significant difference between groups in terms of testosterone levels (p < 0.0001). The multivariate logistic regression revealed testosterone level as the only predictive factor determining the difference between the groups. In terms of olfactory parameters, all scores were lower in the emasculated group (butanol threshold test p = 0.019, identification p = 0.059, and Connecticut center score p = 0.029) There was a significant correlation between testosterone levels and olfactory parameters (p = 0.023; p = 0.025 for identification and Connecticut center scores, respectively). Conclusion: Low testosterone levels in males have negative effects on olfactory functions. Further molecular research is required to understand the connection between testosterone and olfaction. Resumo Introdução: As funções atribuídas aos andrógenos aumentaram, variam desde o papel no eixo hipotálamo-hipófise-gonadal e comportamentos reprodutivos até a modulação da cognição, humor e outras funções. As diferenças entre os sexos e as mudanças nos hormônios sexuais circulantes afetam a função sensorial humana. Na literatura, os autores relataram esse tipo de influência para o olfato, principalmente no sexo feminino. Objetivo: Investigar os efeitos dos baixos níveis de testosterona nas funções olfativas em homens, neste estudo clínico prospectivo. Método: Pacientes do sexo masculino com diagnóstico de câncer de próstata foram incluídos no estudo. Compreenderam o grupo de estudo 39 pacientes com câncer de próstata cujos níveis de testosterona eram inferiores a 50 ng/dL devido à castração. Foram determinados como grupo controle 31 pacientes com câncer de próstata que não foram emasculados, com níveis de testosterona superiores a 50 ng/dL. Testes de rinometria acústica e pico de fluxo inspiratório nasal foram feitos para todos os participantes; e para avaliação da função olfativa, ambos os grupos concluíram o teste olfativo do Connecticut chemosensory clinical research center. Resultados: A média da idade dos pacientes e controles foi de 69,6 ± 7,2 (57 ± 89) e 66,3 ± 5,8 (50 ± 78) anos, respectivamente (= 0,039). Houve uma diferença significante entre os grupos em relação a níveis de testosterona (p < 0,0001). A regressão logística multivariada revelou o nível de testosterona como o único fator preditivo que determinou a diferença entre os grupos. Em termos de parâmetros olfativos, todos os escores foram menores no grupo castrado (teste do limiar de butanol p = 0,019, identificação p = 0,059 e escore do Connecticut center p = 0,029). Houve uma correlação significante entre o nível de testosterona e os parâmetros olfativos (p = 0,023; p = 0,025 para identificação e escore do Connecticut center, respectivamente). Conclusão: Baixos níveis de testosterona em homens têm efeito negativo na função olfativa. Mais pesquisas moleculares são necessárias para entender a conexão entre testosterona e olfação.

Rare pathological variants may only be diagnosed after the surgical treatments applied. We aimed to determine the rare variant pathologies and their frequencies diagnosed in prostate surgeries performed in routine patient care. We retrospectively analyzed hospital pathology records for all prostate surgeries performed namely TUR-P, open prostatectomy, and radical prostatectomy between October 2014 and October 2019. A total of 1345 patients’ clinical data together with relevant prostate surgery pathologic diagnoses were evaluated from the database. Their mean age was 67.63±8.09. The most common comorbid diseases were hypertension (46%), diabetes mellitus (21%) and cerebrovascular disease (23%). Surgeries indicated and performed for prostate diseases were TUR-P (72%), open prostatectomy (9.7%) and radical prostatectomy (18.4%). The respective median PSA values for above mentioned surgery groups were 3.21, 7.34 and 8.13 ng/ml. Ninety-three patients (6.9%) had variant pathology associated with their primary pathologies including either BPH or prostate adenocarcinoma. 8.6% of patients with variant pathology had more than one variant types. Histopathological variant types generally considered rare can be seen up to 20% in oncological cases according to our database and their clinical importance and treatment differs for each variant type.

The aim of this study was to evaluate the diagnostic value of renal pelvis urine Gram staining (RPUGS) in predicting postoperative fever and renal stone culture (RSC) positivity in percutaneous nephrolithotomy (PCNL). Totally 141 consecutive patients undergoing PCNL for renal stone were included between January 2018 and December 2019. The RPUGS and renal pelvis urine culture (RPUC) were performed using urine sample from renal collecting system, while RSC was performed using stone fragments. Patients were divided into two groups as Group 1 (n = 119) without postoperative fever (

Objective: The applicability of cystoscopy follow-up protocol that is indicated for low-risk nonmuscle-invasive bladder cancer (NMIBC) in the guidelines was investigated for our population. Materials and Methods: Patients who underwent transurethral resection with a diagnosis of primary bladder tumor in our clinic within 10 years with low grade of pathology pTa and follow-up periods of at least 5 years were retrospectively reviewed. Fifty-one patients (39 males and 12 females) who were diagnosed with a low-risk NMIBC, had no recurrence at the 3-month control cystoscopy, and followed up for the first 2 years on 3-month basis with cystoscopy were included in the study. Results: The mean age of the patients was 57.37 ± 12.21 years (range: 29–80 years), and the mean duration of recurrence was 25.76 ± 32.45 months. In the cystoscopy follow-ups of 51 patients, up to the 6th month, a total of 12 (24%); up to the 9th month, a total of 21 (41%); up to the 12th month, a total of 30 (59%); up to the 15th month, a total of 36 (71%); up to the 18th month, a total of 36 (71%); up to the 21st month, a total of 39 (77%); and up to the 24th month, a total of 41 (80%) patients were reported to have recurrence. In the case of patients with no recurrence at the 9th month cystoscopy, it was determined that 50% of the patients had recurrence in the first 6 months and 67% in the first 2 years. Conclusion: The majority (80%) of recurrences in low-risk NMIBC occurred in the first 2 years. If the follow-up protocol described in the guidelines had been applied, patients with relapses would have a delay of at least 6 months of diagnosis. Therefore, even if there is no recurrence in the low-risk NMIBC at the 3rd and 9th months, it may be more appropriate to follow the cases in the first 2 years with follow-up cystoscopy every 3 months.

Mucinous adenocarcinoma of the prostate is one of the rare variants of the prostatic carcinoma, and its incidence among all prostatic carcinomas is reported to be 0.3% in the literature. If the tumor variant containing extracellular mucin in

Cystic nephroma is a rare benign tumour of the kidney. The symptoms are often non-specific and the diagnosis of the disease is usually made incidentally. Definitive diagnosis can be possible with histopathological evaluation. Surgical resection provides curative treatment. We report a successful removal of cystic nephroma in a 67-year-old female which was managed by laparoscopic nephron-sparing surgery. When a renal mass including multiple cystic formations is visualized on radiological imaging, the clinician should consider cystic nephroma for differential diagnosis, and these cases should be evaluated in terms of nephron-sparing surgery.

Prostate-specific membrane antigen (PSMA) ligand PET/CT is an emerging modality to detect the metastatic disease, especially in intermediate- and high-risk prostate cancer (PCa). In this study, we analyzed the contribution of Ga-PSMA-11 PET/CT in staging and therapy management of newly diagnosed PCa.A total of 78 patients with biopsy-proven PCa who were referred for Ga-PSMA-11 PET/CT for primary staging were retrospectively analyzed. The patients were divided into risk groups according to the D'Amico risk stratification criteria. All of the patients had undergone pelvic MRI, and 65 patients had bone scintigraphy also. The findings of Ga-PSMA-11 PET/CT were compared with these conventional imaging (CI) methods for staging of the disease. The relations between SUVmax of the primary tumors and Gleason scores (GSs), prostate-specific antigen (PSA) levels, and metastatic extent of the disease were analyzed.Of 78 patients, 5 patients were in low-risk group, 18 patients were in intermediate-risk group, and 55 patients were in high-risk group. Metastatic disease was found in 40 (51.2%) of 78 patients in Ga-PSMA-11 PET/CT. Ten patients had regional lymph node metastases, and 30 patients had distant metastases. Ga-PSMA-11 PET/CT changed the staging in 44 (56.4%) of 78 patients compared with CI. There was significant difference between the SUVmax of the tumors with GSs of 6 and 7 compared with GSs of 8, 9, and 10 (P = 0.003). The SUVmax were significantly different between the patients with no metastasis (n = 38) and patients with regional lymph node metastases or distant metastases (n = 40; 16.1 ± 10.9, 28.7 ± 25.8, P = 0.003, respectively). There was significant difference between the SUVmax of patients with PSA level less than 10 ng/mL compared with patients with PSA level of 10 or greater and less than 20 ng/mL and PSA 20 ng/mL or greater (P = 0.009). A weak correlation between PSA and primary tumor SUVmax was also found (r = 0.21).Ga-PSMA-11 PET/CT is an important imaging modality for primary evaluation of newly diagnosed PCa changing the disease stage substantially. Also the SUVmax of the primary tumor has a relation with GS, metastatic extent of disease, and PSA levels defining the prognosis.

This study aims to investigatel ongitudinal changes in sexual functions (SF), anxiety status, and health-related quality of life (HRQoL) after shock wave lithotripsy (SWL) in male urolithiasis patients. METHODS: Between February 2015 and April 2017, 85 consecutive male patients with kidney or ureter stones and treated with SWL were included. Patients were evaluated for SF, anxiety status, and HRQoL with questionnaire forms before and at the third month after SWL. Correlation between baseline and third-month scores of International Index of Erectile Function-15 (IIEF-15) subdomains and anxiety was evaluated. Uni- and multivariable linear regression analyses were used to identify changes in IIEF-15 subdomain scores at three months. RESULTS: Mean age was 42.80 ± 9.42 years. Significantly decreased IIEF-15 subdomain scores, increased anxiety and Short Form-36 (SF-36) subdomain scores were achieved at three months (p0.05, for each). The baseline median values of erectile function (IIEFEF), orgasmic function (IIEF-OF), sexual desire (IIEF-SD), intercourse satisfaction (IIEF-IS), and overall satisfaction (IIEF-OS) were 26, 9, 8, 12, and 8, respectively. The same scores were 26, 9, 6, 9, and 8 at month 3, respectively. According to multivariable analysis, the difference in Beck Anxiety Inventory (BAI) scores was an independent risk factor for both changing in IIEF-SD and IIEF-IS (b= -0.094, 95%CI: -0.179 - -0.009, p=0.030 and b= -0.197, 95%CI: -0.350 - -0.044, p=0.012, respectively). The difference in the State Anxiety (STAISA) scores was an independent risk factor for changing in IIEF-IS (b= -0.075, 95%CI: -0.146 - -0.004,p=0.039). CONCLUSIONS: SWL may lead to impaired SF related to treatment-driven anxiety and significantly improve HRQoL of male patients in short term.Este estudio tiene como objetivo investigar los cambios longitudinales en la función sexual, estado de ansiedad y calidad de vida después de la litotricia extracorpórea en pacientes varones conlitiasis. MÉTODOS: Entre febrero 2015 y abril 2017, 85 pacientes varones consecutivos con litiasis renales o ureterales tratados con litotricia extracorpórea fueron incluidos. Los pacientes fueron evaluados en relación a la función sexual, estado de ansiedad, y calidad de vida con cuestionarios de calidad de vida antes y a los 3 meses de la litotricia extracorpórea. Correlación entre los resultados de International Index of Erectile Function-15 (IIEF-15) iniciales y a los 3 meses en los dominios de ansiedad, fueron evaluados. Análisis de regresión univariada y multivariada fue utilizada para identificar cambios en IIEF-15 a los 3 meses. RESULTADOS: La edad media fue de 42,80 ± 9,42 años. Una caída significativa de los resultados de los subdominios de IIEF-15 con incremento de la ansiedad y Short Form-36 (SF-36) fueron conseguidos a los 3 meses (p0,05, para cada uno). Los resultados medios en función eréctil (IIEF-EF), función orgásmica (IIEF-OF), deseo sexual (IIEF-SD), satisfacción en las relaciones (IIEF-IS), y satisfacción general (IIEF-OS) fueron 26, 9, 8, 12, y 8, respectivamente. Los mismos resultados fueron 26, 9, 6, 9, y 8 a los 3 meses, respectivamente. En el análisis multivariado, la diferencia en Beck Anxiety Inventory (BAI) fue un factor de riesgo independiente para ambos, cambiando en IIEF-SD y IIEF-IS (b= -0,094, 95%CI: -0,179 – -0,009, p=0,030 y b= -0,197, 95%CI: -0,350 – -0,044, p=0,012, respectivamente). La diferencia en el State Anxiety (STAI-SA) fue un factor de riesgo independiente para cambio en IIEF-IS (b= -0,075, 95%CI: -0,146 –-0,004, p=0,039).La litotricia extracorpórea comporta cierto grado de disfunción sexual relacionada con la ansiedad del tratamiento y mejora significativamente la calidad de vida en los pacientes varones a corto plazo.

Purpose To evaluate the effect of second transurethral resection (TUR) on oncological outcomes, according to the presence or absence of detrusor muscle in the initial TUR of patients with pTa Grade 3 / high grade (G3/HG) tumors, who received at least 1 year of maintenance Bacillus Calmette-Guerin (BCG) therapy. Patients and methods In this retrospective study, we evaluated the effect of second TUR on oncological outcomes of 93 patients with pTa G3 / HG tumors, according to the presence or absence of muscle in the initial TUR. All patients received maintenance BCG therapy according to the SWOG protocol. Results Median follow-up was 36 months. If muscle is present in the initial TUR, a second TUR significantly increased median time to first recurrence, compared to those without a second TUR (77.6 vs. 36.9 mos, p = 0.0086). If muscle is missing in the initial TUR, a second TUR significantly decreased recurrence rate (20% vs. 66.7%, p=0.002), increased median time to first recurrence (78.9 vs. 42.7 mos, p = 0.0001) and median time to progression (22 vs. 7 mos, p = 0.05), compared to those without a second TUR. Conclusion In patients with pTa G3 / HG tumors, if the muscle is missing in the initial TUR, a second TUR should be performed in order to attain lower recurrence rates and longer median time to recurrence and progression. If the muscle is present in the initial TUR, a second TUR will only increase median time to first recurrence.

The aim of this study was to evaluate relationship between preoperative Prognostic Nutritional Index (PNI) values and tumor stage and to identify predictive value of PNI in patients with primary bladder cancer (BC). A total of 164 patients with primary bladder cancer were retrospectively analyzed using institutional bladder cancer database between January 2008 and January 2018. The PNI was calculated using preoperative blood sample results. According to pathological results, the patients were divided into groups as pTa (n=94), pT1 (n=54), and pT2 (n=16) and further into subgroups as Group 1 (pTa patients, n=94) and Group2 (pT1 + pT2 patients, n=70). Subgroups were compared statistically in terms of PNI values and independent risk factors were evaluated using Backward Step wise multivariate logistic regression analysis. Of patients, 145 (88.4%) were males and 19 (11.6%) were females with a mean age of 66.46±10.57 (range, 36 to 93) years. Mean total peripheral lymphocyte count was 2.11±0.71 (×109/L), mean serum albumin was 4.11±0.53 (gr/dL), and mean PNI score was 51.66±6.36. There was a statistically significant difference in serum albumin levels and PNI scores according to tumor stages (p=0.008 and p=0.003, respectively). There was a statistically significant difference in mean serum total protein, albumin, and PNI scores (p0.01, for all). Tumor size, tumor grade, PNI, carcinoma in situ,and atypical variant status were independent risk factors for predicting tumor stage. Our study results demonstrate that PNI is a potential preoperative predictor of tumor stage and is an independent risk factor for predicting tumor stage in patients with primary bladder cancer. Lower PNI levels are associated with high stage disease. El objetivo de este studio fue evaluar la relación entre el índice pronóstico nutricional (IPN) y el estadio tumor para identificar el valor predictivo de IPN en paciente con cáncer vesical primario.MÉTODOS: 164 pacientes fueron incluidos con cáncer vesical primario fueron retrospectivamente evaluados utilizando una base de datos institucional entre enero de 2008 y enero 2018. El IPN fue calculado utilizando la analítica preoperatoria. De acuerdo con los resultadosde la anatomía patológica, los pacientes se repartieron en varios grupos: pTa (n=94), pT1 (n=54) y pT2 (n=16) y después en subgrupos como Grupo 1 (pTa n=94),Grupo 2 (pT1+pT2, n=70). Los subgrupos se compararon en términos de IPN y factores independientes de riesgo se calcularon utilizando Regresión Logística. 145 pacientes (88%) fueron hombres y 19 (11%) fueron mujeres con una mediana de edad de 66+/- 11 años (rango 36-93). El recuento total de linfocitos fue de 2,1+/- 0,71 (x109/L, al albumina sérica fue de 4,1+/-0,53 (gr/dL), y la mediana IPN fuede 51. Se observaron diferencias estadísticamente significativas en los niveles de albumina sérica y proteína total y IPN scores (p0,01) tumoral, IPNm Cis, variantes atípicas fueron factores de riesgo independientes para la predicción del estadio tumoral. Nuestro estudio demuestra que IPN es un factor predictor potencial del estadio tumoral y un factor independiente de riesgo para la predicción del estadio tumoral en pacientes con cáncer de vejiga.Niveles bajos de IPN se asocian con estadios mas avanzados.

Objective: Micropapillary urothelial carcinoma is an aggressive variant of urothelial carcinoma. Evidence suggests that the relationship between the tumor and inflammatory cells is important in tumor progression and the treatment response. We evaluated the stromal lymphoid response in micropapillary urothelial carcinomas and compared it with conventional urothelial carcinomas. Material and Method: Among bladder transurethral resection materials diagnosed as 'invasive urothelial carcinoma' between January 2010-March 2017, cases with at least 5% micropapillary urothelial carcinoma were evaluated for age, gender, grade, stage, micropapillary urothelial carcinoma percentage, presence/percentage of accompanying conventional urothelial carcinoma/urothelial carcinoma variants, in situ urothelial carcinoma/micropapillary urothelial carcinoma, lymphovascular invasion, necrosis, and stromal lymphoid response. Stromal lymphoid response was scored as 0-1-2-3. All parameters were evaluated in 50 pure conventional urothelial carcinomas. Results: Among 47 micropapillary urothelial carcinomas, 41 were male. The mean age was 69 years. pT1/pT2 was 23/24. Six cases were pure MPUC. Lymphovascular invasion was present in 8, necrosis in 9 cases. Stromal lymphoid response was present and scored as 1-2-3 in 32 micropapillary urothelial carcinomas (68.1%) and 48 conventional urothelial carcinomas (96%). Micropapillary urothelial carcinomas had significantly higher lymphovascular invasion and pT2 rates and lower stromal lymphoid response. Conclusion: Low stromal lymphoid response in micropapillary urothelial carcinomas can be responsible for the poor clinical outcome and impaired response to treatment of these tumors. This is the first study in the English literature to demonstrate a lower stromal lymphoid response rate in micropapillary urothelial carcinomas compared to conventional urothelial carcinomas.

Aim: In this case-control study, we examined the association between two types of eNOS gene polymorphisms (intron 4 a/b and Glu298Asp) and transitional cell carcinoma (TCC) of the bladder.Nitric Oxide (NO) is a free radical that plays a key role in various physiological and pathophysiological processes, particularly in the circulatory system. Endothelial Nitric Oxide Synthase (eNOS), as a member of NOS family, is the enzyme, responsible for the physiological production of nitric oxide in the endothelium. Polymorphisms of eNOS have been related to increased risk for different types of cancers. Material and Methods: A total of 64 patients with bladder TCC and 80 controls with similar epidemiological characteristics of patients group were evaluated and compared in terms of eNOS gene polymorphisms of two different types ((intron 4 a/b and Glu298Asp). Following DNA isolation from the blood samples, eNOS gene was replicated via PCR. The genomic distribution of two types of eNOS polymorphism was determined by gel electrophoresis following the process of restriction, for both groups. Results: The alleles most commonly observed in patient group were “ab” for intron 4 (OR= 1.80, 95% CI: 0.71-4.64; P=0.20) and “GT” for Glu298Asp polymorphisms (OR= 1.65, 95% CI: 0.85-3.22; P=0.14). Neither bladder cancer risk nor disease grade was associated with these polymorphisms. Conclusions: This study suggests that the intron 4 a/b and Glu298Asp eNOS gene polymorphisms are not associated with bladder cancer susceptibility. However, it is mandatory to conduct further trials with more patients to confirm these findings and to evaluate the association between bladder cancer and eNOS gene polymorphisms.

To evaluate the performance of quantitative computed tomography (CT) texture analysis using different machine learning (ML) classifiers for discriminating low and high nuclear grade clear cell renal cell carcinomas (cc-RCCs). This retrospective study included 53 patients with pathologically proven 54 cc-RCCs (31 low-grade [grade 1 or 2]; 23 high-grade [grade 3 or 4]). In one patient, two synchronous cc-RCCs were included in the analysis. Mean age was 57.5 years. Thirty-four (64.1%) patients were male and 19 were female (35.9%). Mean tumour size based on the maximum diameter was 57.4 mm (range, 16–145 mm). Forty patients underwent radical nephrectomy and 13 underwent partial nephrectomy. Following pre-processing steps, two-dimensional CT texture features were extracted using portal-phase contrast-enhanced CT. Reproducibility of texture features was assessed with the intra-class correlation coefficient (ICC). Nested cross-validation with a wrapper-based algorithm was used in feature selection and model optimisation. The ML classifiers were support vector machine (SVM), multilayer perceptron (MLP, a sort of neural network), naive Bayes, k-nearest neighbours, and random forest. The performance of the classifiers was compared by certain metrics. Among 279 texture features, 241 features with an ICC equal to or higher than 0.80 (excellent reproducibility) were included in the further feature selection process. The best model was created using SVM. The selected subset of features for SVM included five co-occurrence matrix (ICC range, 0.885–0.998), three run-length matrix (ICC range, 0.889–0.992), one gradient (ICC = 0.998), and four Haar wavelet features (ICC range, 0.941–0.997). The overall accuracy, sensitivity (for detecting high-grade cc-RCCs), specificity (for detecting high-grade cc-RCCs), and overall area under the curve of the best model were 85.1%, 91.3%, 80.6%, and 0.860, respectively. The ML-based CT texture analysis can be a useful and promising non-invasive method for prediction of low and high Fuhrman nuclear grade cc-RCCs. • Based on the percutaneous biopsy literature, ML-based CT texture analysis has a comparable predictive performance with percutaneous biopsy. • Highest predictive performance was obtained with use of the SVM. • SVM correctly classified 85.1% of cc-RCCs in terms of nuclear grade, with an AUC of 0.860.

Introduction: We investigated the clinical characteristics of patients who underwent penile fracture surgery.Methods:Between December 2005 and February 2015, a total of 45 patients underwent surgery for repair of penile fracture at our institution. The age and body mass index (BMI) of these patients were recorded along with their medical history and physical examination findings. Moreover, the duration of the operation was noted, and the preoperative International Index of Erectile Function-Erectile Function (IIEF-EF) scores were compared with postoperative scores.Results:Average age of patients was 41.25±11.78 (20-65) years, and average BMI was 26.36±3.17 (23.67-29.72) kg/m2. Of the patients, 18 (40%), 16 (35.5%), 5 (11.1%), 3 (6.7%), and 3 (6.7%) cases had the fracture during sexual intercourse, during sleep, with sudden penile maneuvers, during masturbation, and with trauma, respectively. Mean operation time was 38.32±19.74 (20-90) min, and mean hospital stay was 1.28±0.61 (1-3) days. Most of the cases (26/45) were performed under spinal anesthesia. There was only one patient with urethral injury. Mean preoperative IIEFEF score was 26.12±3.21 (19-30), and mean IIEF-EF score at postoperative 3rd month was 23.37±3.87 (10-27). We found significant differences between preoperative and postoperative scores (p=0.011). Postoperative penile curvature was observed in 2 (4.4%) cases, and painful erection was seen in 2 (4.4%) cases.Conclusion:Penile fracture requires urgent intervention in the urological practice. The majority of the cases occur during sexual intercourse. Although the management of penile fracture is not complicated, postoperative erectile problems are not rare.

Background: We investigated the correlation between the sampled number of cores in rebiopsy and the cancer detection rate (CDR). Materials and Methods: Two hundred and twelve patients with normal rectal examination who had undergone rebiopsy in the past 5 years were examined retrospectively. Moreover, 68% of them had undergone 12 cores (Group 1) while 32% had undergone 20 cores (Group 2). Both groups were compared with respect to the CDR. Results: There was no difference between groups in terms of age, total prostate-specific antigen, and prostate volume (P > 0.05). Forty-one (19%) of 212 patients were diagnosed with cancer, and the CDR was significantly higher in Group 2 (30.9% vs. 13.9%, P = 0.004). This rate increased from 6.5% to 20% (P = 0.025) and from 0% to 33.3% (P = 0.023), respectively, with 12-core and 20-core rebiopsies in patients whose initial pathology indicated benign and high-grade prostatic intraepithelial neoplasia (HGPIN). Furthermore, cancer was detected in 24 (40%) of 60 patients who were diagnosed with atypical small acinar proliferation (ASAP) in the initial biopsy. However, despite being higher in 20-core biopsy group (47.6% vs. 35.9%), this was not statistically significant (P = 0.377). Conclusions: At least 20 cores should be sampled in rebiopsy, especially in the patients diagnosed with benign and HGPIN. However, we believe that standard systematic sampling will be sufficient for the patients diagnosed with ASAP.

Objective We aimed to evaluate the results of laparoscopic pyeloplasty with concomitant pyelolithotomy and compare results with a cohort of patients undergoing laparoscopic pyeloplasty without pyelolithotomy. Materials and Methods We retrospectively reviewed records of 43 patients undergoing transperitoneal laparoscopic Anderson-Hynes dismembered pyeloplasty between December 2012 and July 2018 at our department. Eighteen patients (42%) underwent laparoscopic pyeloplasty with concomitant pyelolithotomy. The results of patients with renal stones were compared with 25 matched patients undergoing laparoscopic pyeloplasty without concomitant renal stones. Demographic data, operative and stone parameters were compared between the groups. Results The groups were similar regarding to demographic characteristics. All operations were completed laparoscopically with no conversions to open surgery. In 3 cases without renal stones and 15 cases with renal stones, transposition of the ureter due to crossing vessels was performed. The mean stone size was 13±5.24 mm, and the median number of stones was 1 (1-18). The success of laparoscopic pyeloplasty with and without pyelolithotomy was 93.3% and 92.9%, respectively, as confirmed by negative diuretic renogram at postoperative 3rd months. Overall stone-free rate after laparoscopic pyelolithotomy was 93.3%. Mean operative time was 222.6765.71 minutes vs. 219.11±75.63 minutes for the pyeloplasty with concomitant pyelolithotomy vs. pyeloplasty, respectively (p=0.88). Conclusions Laparoscopic pyeloplasty with concomitant pyelolithotomy is a safe and effective intervention with associated good cosmetic results and high stone-free rates without significant increase in operative time or complications.

Micropercutaneous nephrolithotomy (microperc) is a new minimal-invasive technique.We aimed to investigate whether preoperative hydronephrosis has an impact on the stone-free rate of microperc.In this study, 66 consecutive patients were included and divided into 2 groups:patients without preoperative hydronephrosis (group-1) and patients with preoperative hydronephrosis (group-2).Both groups were compared for age, gender, body mass index (BMI), stone burden, stone location, fluoroscopy and operative time, blood loss, stone-free rate and perioperative and postoperative complication rates. Parameters were analyzed using univariate and multivariate analyses for the stone-free rate.The mean age, gender, BMI, stone location, and blood loss were similar in both groups (p0.05). Stone burden in group-2 was greater than group-1 (p=0.011). In addition, mean fluoroscopy time in group-1 was found to be significantly lower (p0.05). However, operative time was comparable among the groups (p=0.169). Lastly, group-2 had a higher rate of perioperative and postoperative complication rates and lower success rate (p=0.023, p=0.027 and p=0.001, respectively). The success was significantly affected by hydronephrosis, stone burden and location (p0.05). Logistic regression analysis revealed that unsuccessful outcome was significantly associated only with the presence of hydronephrosis (OR 0.225,p=0.033).This study seems to suggest that presence of hydronephrosis is a major factor on the stone free rate of microperc procedures.La nefrolitotomíamicropercutanea (microperc) es una nueva técnica mínimamente invasiva. Investigamos si la hidronefrosis preoperatoria tiene un impacto sobre la tasa de pacientes libres delitiasis de la microperc.MÉTODOS: En este estudio, 66 pacientes consecutivos fueron incluidos y divididos en 2 grupos: pacientes sin hidronefrosis preoperatoria (grupo 1) y pacientes con hidronefrosis preoperatoria (grupo 2). Se compararon ambos grupos por edad, género, índice de masa corporal (IMC), carga litiásica, localización de la litiasis, fluoroscopia y tiempo operatorio, sangrado, tasa de pacientes libres de litiasis, y tasas de complicaciones peri y postoperatorias. Las variables fueron analizadas utilizando análisis uni y multivariado para la tasa de pacientes libres de litiasis.Edad media, género, localización de la litiasis y sangrado fueron similares en ambos grupos (p0,05). La carga litiásica en el grupo 2 era mayor que en grupo 1 (p=0,011). Además, el tiempo medio de fluoroscopia en el grupo 1 era significativamente menor (pera comparable en los dos grupos (p=0,169). Finalmente, el grupo 2 tenía una tasa de complicaciones peri y postoperatorias mayor y una tasa de éxitos menor (p=0,023, éxito estaba significativamente influido por la hidronefrosis, la carga litiásica y la localización de la litiasis (p0,05). El análisis de regresión logística reveló que los resultados sin éxito se asociaban significativamente sólo con la presencia de hidronefrosis (OR 0,225,p=0,033).CONCLUSIÓN: Este estudio parece sugerir que la presencia de hidronefrosis es un factor principal en la tasa de pacientes libres de litiasis de los procedimientos de microperc.

Objectives: The aim of the study is to investigate the predictive value of ischemia-modified albumin (IMA) as an oxidative stress indicator in renal ischemia-reperfusion (I/R) injury. Methods: Forty female Wistar Albino rats were divided into 5 groups: Group-1, sham; group-2, 20 min I/R, group-3, 30 min I/R; group-4, 40 min I/R; and group-5, 60 min I/R. Blood samples were taken, and nephrectomy was performed in the sham group before ischemia was induced. At the end of the defined periods for each group, reperfusion was achieved and a blood sample was taken and nephrectomy was performed. At the end of the 6-hour reperfusion period, the blood sample was taken again and the other kidney is removed. IMA in serum and total anti-oxidant status (TAS), total oxidant status (TOS), and oxidative stress index in both serum and tissue were examined. Results: Serum IMA values were significantly different between the groups (p = 0.009), and there was a significantly difference in TOS values between ischemic serum (p = 0.024) and tissue samples (p = 0.02). However, there was no significant difference in serum and tissue TAS values after ischemia (p = 0.9). Serum IMA, TOS and TAS and tissue TOS and TAS values after reperfusion were not significantly different. There was a significant correlation between tubular damage and ischemia duration in histopathological examination of renal tissue after I/R (p < 0.0001). Conclusion: Serum IMA values increased in parallel with the duration of ischemia, and this increase was supported by histopathological damage findings.

Infection is one of the most devastating complications of penile prosthesis implantation. Although the infection prevalence have decreased owing to new technologies and growing surgical experience, it is still a troublesome situation. We present a 50-year-old male patient who had necrotizing fungal infection after penile prosthesis implantation caused by Trichosporon asahii.

toktas, mahmut gokhan/0000-0001-9845-5481; Kadihasanoglu, Mustafa/0000-0001-5109-5319; WOS:000390100700002 Objective: To present the initial experience with micro-percutaneous nephrolithotomy (micro-PNL) in patients with kidney stones. Methods: Medical records of 66 patients with kidney stones who underwent micro-PNL between December 2012 and March 2015 were retrospectively reviewed. The demographic data; stone side, location and size; operation and fluoroscopy time; intraoperative and postoperative complications; preoperative and postoperative hemoglobin levels and hematocrit; and operation success of the patient were evaluated. Results: The mean age of the patients was 46.62 +/- 13.94 years, and their mean body mass index was 25.77 +/- 2.62 kg/m(2). The mean stone size was 186.7 +/- 34.23 mm(2). The mean operation and fluoroscopy times were 80.46 +/- 43.67 min and 10.78 +/- 7.14 min, respectively. The mean hemoglobin drop was 0.86 g/dL. Twenty-four intraoperative and 17 postoperative complications were observed. An overall success rate of 95% (including clinically insignificant residual fragments) was achieved. Conclusion: Micro-PNL is a feasible, safe, and effective minimally invasive treatment modality for patients with small kidney stones.

Worldwide, bladder carcinoma is the most diagnosed cancer, and it is the most common urologic malignancy among men in Turkey. Although bladder carcinoma is diagnosed at an early stage of the disease, 100,000 patients are diagnosed with the muscle-invasive or advanced stage each year. Radical cystectomy (RC) and bilateral lymph node dissection are the gold standard treatments for muscle-invasive bladder cancer. Partial cystectomy, chemotherapy, radiotherapy, transurethral resection, and combined treatment modalities are other treatment options when RC is not suitable for patients. Oncologic outcomes, complications, effects on the quality of life, and cost of treatment change in each treatment modality. In this article, we aimed to review the treatment modalities for urinary bladder cancer such as radical surgical method and bladder-sparing modalities in light of the current literature.

Introduction: This study aimed to evaluate the clinical results of penile prosthesis implantation for treating patients with organic erectile dysfunction (ED).Methods: Between January 2006 and December 2015, medical records of penile prosthesis implantation for treating 47 patients with organic ED were retrospectively reviewed. The demographic data of patients, causes and duration of ED, operation time, hospitalization time, types of prosthesis, and intra- and postoperative complications were evaluated.Results: The mean age of patients was 54.63±9.69 years, and the mean body mass index of the patients was 26.71±6.57 kg/m2. The mean duration of ED was 45.36±24.82 months. Etiological factors were diabetes mellitus in 30 patients (%64), cardiovascular diseases in eight (%17), radical pelvic surgery in four (9%), radiotherapy in two (4%), spinal surgery in two (4%), and genital trauma in one (2%). Thirty-three patients (70.2%) were smokers. The mean operation time was 109.6±28.41 min, and the mean hospitalization time was 2.64±1.57 days. In 42 patients (88.8%) who were implanted with malleable penile prosthesis, malleable penile prostheses of two different trademarks were used. Five (11.2%) inflatable penile prostheses were implanted in the remaining patients. The penile prosthesis implantation was performed under general anesthesia with antibiotic prophylaxis using vancomycin and gentamicin. No preoperative complications were observed. Postoperative complications were acute urinary retention in one patient, penile pain in one, and re-implantation because of mechanical failure in one. Two prostheses were completely removed because of an infection. The patients were followed up for 21.04±28.72 months. The satisfaction rate of the patients was 67%.Conclusion: Although penile prosthesis implantation is an invasive treatment option for patients with organic ED, it can be safely and effectively performed in these patients. Despite appropriate surgical techniques, infection is the most common complication of this operation, although it provides patient and their partner’s satisfaction.

Objective: This study describes the research regarding injuries by surgical tools and the precautions to be undertaken in the event of such an injury. The study was conducted at the Ministry of Health of the Republic of Turkey, Istanbul (Fatih) Institution of Public Hospitals Province of Istanbul Association of Public Hospitals General Secretary, Istanbul Research and Education Hospital. The study aims to enhance professional safety programs in this regard.Methods: From March to April 2014, 200 nurses from different clinics were personally met. These volunteers answered 19 questions from the data collection form. The survey responses were analyzed. Proportional data was statistically analyzed using a chi-square test.Results: It was determined that 59% of volunteers (118 volunteers) experienced injuries from contaminated surgical or medical tools, and in 54% of these cases (64 volunteers), the injury occurred while putting the cap on a syringe needle. Only 6% (7 volunteers) of those injured by surgical or medical tools were reported. Moreover, 91% of volunteers (182 volunteers) answered that they had been vaccinated against hepatitis B. To prevent such injuries, 36% of volunteers recommended that workers should be given periodic and in-depth educational programs.Conclusion: We conclude that majority of nurses are vaccinated against hepatitis B. Moreover, although there are a high number of injury cases, a very small number of these cases are reported. In light of the information obtained in this study, it is probable that the use of safe medical tools and periodic educational programs that teach precautionary measures can reduce the number of injuries.

Intrauterine contraceptive devices (IUDs) are frequently used for birth control. Side-effects such as vaginal bleeding and localized pelvic pain are most common, and uterine perforation and migration of the adjacent organs are rare, but serious, complications. Herein we present the case of a 46-year-old woman who had a bladder stone because of an IUD that had migrated to the bladder and encrusted.

Objective To develop externally validated, reproducible, and generalizable models for distinguishing three major subtypes of renal cell carcinomas (RCCs) using machine learning-based quantitative computed tomography (CT) texture analysis (qCT-TA). Materials and methods Sixty-eight RCCs were included in this retrospective study for model development and internal validation. Another 26 RCCs were included from public databases (The Cancer Genome Atlas-TCGA) for independent external validation. Following image preparation steps (reconstruction, resampling, normalization, and discretization), 275 texture features were extracted from unenhanced and corticomedullary phase CT images. Feature selection was firstly done with reproducibility analysis by three radiologists, and; then, with a wrapper-based classifier-specific algorithm. A nested cross-validation was performed for feature selection and model optimization. Base classifiers were the artificial neural network (ANN) and support vector machine (SVM). Base classifiers were also combined with three additional algorithms to improve generalizability performance. Classifications were done with the following groups: (i), non-clear cell RCC (non-cc-RCC) versus clear cell RCC (cc-RCC) and (ii), cc-RCC versus papillary cell RCC (pc-RCC) versus chromophobe cell RCC (chc-RCC). Main performance metric for comparisons was the Matthews correlation coefficient (MCC). Results Number of the reproducible features is smaller for the unenhanced images (93 out of 275) compared to the corticomedullary phase images (232 out of 275). Overall performance metrics of the machine learning-based qCT-TA derived from corticomedullary phase images were better than those of unenhanced images. Using corticomedullary phase images, ANN with adaptive boosting algorithm performed best for discrimination of non-cc-RCCs from cc-RCCs (MCC = 0.728) with an external validation accuracy, sensitivity, and specificity of 84.6%, 69.2%, and 100%, respectively. On the other hand, the performance of the machine learning-based qCT-TA is rather poor for distinguishing three major subtypes. The SVM with bagging algorithm performed best for discrimination of pc-RCC from other RCC subtypes (MCC = 0.804) with an external validation accuracy, sensitivity, and specificity of 69.2%, 71.4%, and 100%, respectively. Conclusions Machine learning-based qCT-TA can distinguish non-cc-RCCs from cc-RCCs with a satisfying performance. On the other hand, the performance of the method for distinguishing three major subtypes is rather poor. Corticomedullary phase CT images provide much more valuable texture parameters than unenhanced images.

Purpose: The objective of this study was to evaluate the effects of intratunical injection of platelet rich plasma (PRP) for the treatment of Peyronie’s disease (PD) in a rat model. Materials and Methods: Twenty male Sprague-Dawley rats (300–350 g) were randomly divided into 4 groups: sham, PD, PD + PRP, and PRP. The PD + PRP groups received intratunical injections with 0.1 mL PRP on day 15 (treatment) or day 0 (PRP effect). Forty-five days following transforming growth factor-beta 1 injection, rats underwent pathological examination. Tissues were evaluated histologically for fibrosis grade (Haematoxylin & Eosin staining), collagen/smooth muscle ratio (Masson Trichrome staining) and type III/type I collagen ratio (Picro-sirius red staining). Statistical analysis was performed by Kruskal-Wallis and chi-square followed by the Mann-Whitney U test for post hoc comparisons. Results: Significant changes were found in all 3 groups compared to the sham group (p < 0.0001 for fibrosis, p = 0.001 for collagen/smooth muscle ratio and p = 0.003 for type III/type I collagen ratio). The values in the PRP group and the findings in the PD group are similar (p = 0.122 for fibrosis, p = 0.221 for collagen/smooth muscle ratio and p = 1.0 for type III/type I collagen ratio). Conclusion: This is the first study of PRP on PD. As a result of pathological examinations, PRP shows PD-like effects in rats. PRP may be a cheap, easily accessible, and an effective disease model for PD treatment research.

Previous studies have evidenced that inflammation and endothelial dysfunction have a crucial role in erectile dysfunction (ED). Increased monocyte count or activity and lower high-density lipoprotein cholesterol (HDL-C) levels have been associated with inflammation. The monocyte to HDL-C ratio (MHR) is a recently emerged indicator of inflammation. We aimed to investigate the relationship between MHR and ED. In this retrospective study, a total of 120 patients were enrolled, 60 of them having ED and 60 having a normal erectile function. The presence of ED was evaluated with the International Index of Erectile Function (IIEF-5). Patients with ED were compared with the control group for IIEF-5 and MHR. The mean ages of patients and controls were 55.6±5.53 and 56.42±6.63 years, respectively (p = 0.47). The risk factors for ED were similar between cases and controls. The total testosterone, glucose and creatinine levels did not differ between groups. While the HDL-C, LDL-C and triglyceride levels were similar between groups, the monocyte count (0.55±0.20 vs. 0.73±0.18, p

Introduction This study sought to evaluate the correlation of ischemia-modified albumin (IMA) with time-dependent renal ischemic injury. Methods We established 5 groups of 8 Wistar albino rats as follows: sham, 10 minutes of renal ischemia, 20 minutes of renal ischemia, 30 minutes of renal ischemia, and 40 minutes of renal ischemia. Renal ischemia was established by occlusion of the right renal pedicle. Blood samples were obtained after exploration of the renal pedicle in the sham group and after thoracotomy and directly from the cardiac chambers at the end of the ischemic period in the other groups. The ischemic kidneys were removed for histopathological evaluation, and the rats were killed. Results There were significant differences among the IMA levels of the 5 groups ( P = .0013). Pathological examination showed that renal ischemic injury corresponded to the duration of ischemia. In the group analysis, the pathological evaluation scores were significantly different among the groups ( P Conclusions This study shows that IMA levels can be used as a nonselective biomarker for renal ischemic injury. However, further studies are needed to support our findings.

WOS:000346638300057 PubMed: 25435981 Primary tumors of the paratesticular region are rare, with paratesticular sarcomas constituting a major proportion of these tumors, particularly in the elderly. The paratesticular region consists of mesothelial, various epithelial and mesenchymal cells and may therefore give rise to a number of tumors with various behaviors. Defining the association between the paratesticular mass and the testicle, and differentiation between benign and malignant masses using radiology is challenging, therefore the mass is usually considered to be malignant and radical orchiectomy with high ligation is performed. The present study reports the cases of seven patients with tumors of the paratesticular region and presents the clinical and significant histological features of the tumors. In total, two patients suffered from dedifferentiated liposarcoma (DDLS), two exhibited leiomyosarcoma, two exhibited low-grade fibromyxoid sarcoma and one case of undifferentiated pleomorphic sarcoma was identified. Radical orchiectomy with high ligation was performed in five cases; simple orchiectomy was performed in one case and excisional biopsy was performed in the remaining case. A leiomyosarcomatous and epithelial membrane antigen (EMA) positive whorl pattern was observed during microscopy in the two DDLS cases. Additionally, one of the low-grade fibromyxoid sarcoma patients exhibited pleomorphism and mitosis in focal areas. To the best of our knowledge, the present study is the second time low-grade fibromyxoid sarcoma cases with paratesticular localization have been reported in the literature. Of the seven cases, four patients succumbed to the disease, one patient is living with the disorder and the two cases of DDLS are living without the disease. Paratesticular sarcomas are often aggressive and a multidisciplinary approach is required for the diagnosis and treatment of these tumors.

Material and methods: Fifty-eight patients (33 females and 25 males) with multiple sclerosis were included in the study. All of the patients underwent a detailed neurological examination, according to the clinical course of multiple sclerosis. For the assessment of quality of life, the Expanded Disability Status Scale (EDSS), Barthel Index (BI) for daily-life activities, and the Multiple Sclerosis Quality of Life-54 Instrument (MSQOL-54) were used. To determine sexual dysfunction, the Female Sexual Function Index (FSFI) and International Index of Erectile Function Questionnaire (IIEF) were used for females and males, respectively. The relationship between the scores of FSFI, IIEF and MSQOL-54, EDSS, BI was investigated.

Aims To evaluate the prevalence of Overactive Bladder (OAB) and Urgency Urinary Incontinence (UUI) in males with Obstructive Sleep Apnea Syndrome (OSAS) using the OSAS grading system. Methods A total of 194 patients who underwent Polysomnography (PSG) were included in our prospective cross sectional study. Patients were divided into four groups according to Apnea-Hypopnea Index (AHI). Group 1, 35 patients with normal AHI (

Clear cell renal cell carcinoma with mucin secretion is an unexpected situation. Primary renal adenocarcinoma and various metastatic carcinomas should be considered in the differential diagnosis. Prognostic significance is not yet fully known due to the limited number of reported cases, and these lesions have been grouped under unclassified renal cell carcinoma. In our study, clear cell renal cell carcinoma with significant luminal mucin secretion is discussed with its histological, histochemical and immunohistochemical features.

Objectives: To evaluate PSA-age volume (AV) scores in predicting positive prostate biopsy findings in Turkey. Materials and Methods: PSA-AV was calculated by multiplying the patient's age by the prostate volume and dividing it by the PSA level. Sensitivities and specificities of the PSA-AV were assessed by retrospective analysis of findings from 4,717 prostate biopsies. Results: The population's average age was 63.71±7.63 years, the mean PSA level was 9.73±17.01ng/mL, the mean prostate volume was 44.46±23.88 cm3. Of the 4,717 prostate biopsies, 1,171 biopsy specimens (24.8%) were positive for prostate cancer. A PSA-AV score of 700 had a sensitivity and specificity of 95% and 15%, respectively. These values were similar to the sensitivity and specificity for a PSA cut-off of 4ng/mL (94% and 13%, respectively). Although the sensitivity of a PSA-AV cut-off of 700 in patients over 60 years was similar to the PSA cut-off of 4ng/mL and the age-adjusted PSA, in patients