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Objective: To present a nation-wide analysis of the workload of urology departments in Turkey week-by-week during Covid-19 pandemic., Methodology: The centres participating in the study were divided into three groups as tertiary referral centres, state hospitals and private practice hospitals. The number of outpatients, inpatients, daily interventions and urological surgeries were recorded prospectively between 9-March-2020 and 31-May-2020. All these variables were recorded for the same time interval of 2019 as well. The weekly change of the workload of urology during pandemic period was evaluated, also the workload of urology and the distributions of certain urological surgeries were compared between the pandemic period and the same time interval of the year 2019., Results: A total of 51 centres participated in the study. The number of outpatients, inpatients, urological surgeries and daily interventions were found to be dramatically decreased by the 3rd week of pandemics in state hospitals and tertiary referral centres; however, the daily urological practice were similar in private practice hospitals throughout the pandemic period. When the workload of urology in pandemic period and the same time interval of the year 2019 were compared, a huge decrease was observed in all variables during pandemic period. However, temporary measures like ureteral stenting, nephrostomy placement and percutaneous cystostomy have been found to increase during Covid-19 pandemic compared with normal life., Conclusions: Covid-19 pandemic significantly affected the routine daily urological practice likewise other subspecialties and priority was given to emergent and non-deferrable surgeries by urologists in concordance with published clinical guidelines., (© 2020 John Wiley & Sons Ltd.)

To predict local invasive disease before retropubic radical prostatectomy (RRP), the correlation of perineural invasion (PNI) on prostate needle biopsy (PNB) and RRP pathology data and the effect of PNI on biochemical recurrence (BR) were researched. For patients with RRP performed between 2005 and 2014, predictive and pathologic prognostic factors were assessed. Initially all and D'Amico intermediate-risk group patients were comparatively assessed in terms of being T2 or T3 stage on RRP pathology, positive or negative for PNI presence on PNB and positive or negative BR situation. Additionally the effect of PNI presence on recurrence-free survival (RFS) rate was investigated. When all patients are investigated, multivariate analysis observed that in T3 patients PSA, PNB Gleason score (GS) and tumor percentage were significantly higher; in PNI positive patients PNB GS, core number and tumor percentage were significantly higher and in BR positive patients PNB PNI positivity and core number were significantly higher compared to T2, PNI negative and BR negative patients, separately (p < 0.05). When D'Amico intermediate-risk patients are evaluated, for T3 patients PSA and PNB tumor percentage; for PNI positive patients PNB core number and tumor percentage; and for BR positive patients PNB PNI positivity were significantly higher compared to T2, PNI negative and BR negative patients, separately (p < 0.05). Mean RFS in the whole patient group was 56.4 ± 4.2 months for PNI positive and 96.1 ± 5.7 months for negative groups. In the intermediate-risk group, mean RFS was 53.7 ± 5.1 months for PNI positive and 100.3 ± 7.7 months for negative groups (p < 0.001). PNI positivity on PNB was shown to be an important predictive factor for increased T3 disease and BR rates and reduced RFS., (Copyright © 2018 Kaohsiung Medical University. Published by Elsevier Taiwan LLC. All rights reserved.)

Objective: There is no sufficient evidence to demonstrate whether more challenging pelvic anatomy affects the functional and oncological outcomes of radical retropubic prostatectomy (RP). The aim of this study was to investigate the impact of pelvic biometric measurements, visceral and subcutaneous adipose tissue areas on trifecta outcome (cancer control, continence and potency) and surgical margin status after open RP., Materials and Methods: A retrospective study was performed on 270 patients who were diagnosed with clinically localized prostate cancer between 2005 and 2011 and underwent computed tomography imaging before RP. Pelvic bony and soft-tissue measurements, and visceral and subcutaneous adipose tissue area calculations were performed. Patients were evaluated for trifecta outcome and surgical margin status on univariate and multivariate analyses. Subgroup analysis was performed for prostate volume, body mass index (BMI) and D'Amico risk classification., Results: Univariate analysis revealed that patients with trifecta were younger, and had lower prostate-specific antigen (PSA) levels, wider symphysis angle, and narrower prostate width and soft-tissue width (p < 0.05). Patients with positive surgical margins were older, and had higher PSA levels, lower prostate volume and narrower prostate width (p < 0.05). Visceral adipose tissue area was lower in patients with trifecta when BMI was below 25 kg/cm² (p < 0.05). In multivariate analysis, PSA level and symphysis angle were statistically significant for trifecta while PSA level was the only statistically significant variable for positive surgical margins (p < 0.05). Interfemoral index was significant in the low-risk group of D'Amico classification for trifecta outcome., Conclusion: Pelvic biometric measurements and adipose tissue area calculations may help in preoperative planning and the management of RP.

In this study, three kinds of electrohydrodynamic atomization (EHDA) processes (electrospraying, electrospinning, and coaxial electrospinning) are implemented to create hydroxypropyl methylcellulose (HPMC) based ultra‐thin products for providing the fast dissolution of a poorly water‐soluble drug ketoprofen (KET). An EHDA apparatus, characterized by a novel spinneret, is homemade for conducting the three processes. The three types of products are electrospun nanofibers E1, electrosprayed microparticles E2, and core‐shell nanofibers E3. SEM and TEM results indicate that they have the anticipated morphologies and inner structures. X‐ray diffraction and Fourier Transform Infrared results verify that KET is mainly amorphous in all the composites due to its fine compatibility with HPMC. In vitro dissolution tests demonstrate that the drug rapid release performances has an order of E3>E1>E2≫KET powders. The fast dissolution mechanisms are suggested and the advantages of the three products are compared. The super performance of E3 in furnishing the rapid release is attributed to a synergistic action of small size (of the shell thickness), high porosity, amorphous state of drug, and the solubility of HPMC. EHDA nanostructures can support the development of nano drug delivery systems (DDSs) through tailoring the spatial distribution of drug molecules within the nano products. [ABSTRACT FROM AUTHOR]

Background: Due to the deep location of the prostate within the pelvic cavity, procedures of robot-assisted radical prostatectomy (RARP) might be challenged by the prostate size and the limited pelvic cavity space. This study aimed to investigate the roles of bony pelvic and prostate dimensions in RARP procedures by an original study coupled with a meta-analysis., Methods: In the original study, patients undergoing multiport RARP between 2021 and 2022 were consecutively assessed. The associations of anatomic features with operative time (OT), estimated blood loss (EBL), and positive surgical margin (PSM) were evaluated using linear and logistic regression analyses as well as restricted cubic spline (RCS) analysis. Based on machine-learning algorithms, this study established predictive models for surgical difficulty and interpreted the model using SHapley Additive exPlanation (SHAP). In the meta-analysis, three databases were searched for eligible studies. Quantitative syntheses were subsequently performed., Results: Overall, 219 patients were enrolled in the original study. Prostate volume (PV) and the prostate volume-to-pelvic cavity index (PCI) ratio (PV-to-PCI ratio) were significantly associated with longer OT (P < 0.05). In the RCS models, U-shaped associations were observed between the prostate anteroposterior diameter (PAD) and OT, and between the prostate height (PH) and EBL, and an L-shaped association was observed between the anteroposterior diameter of the pelvic inlet (API) and EBL. The XGBoost model was superior to the logistic regression model in predicting prolonged OT. The meta-analysis demonstrated that greater PV was significantly associated with longer OT (β = 0.20; 95% confidence interval [CI] 0.12-0.27; odds ratio [OR] = 1.05; 95% CI 1.00-1.11), and a smaller PV could increase the risk of PSM (OR = 0.82; 95% CI 0.77-0.88)., Conclusions: A large prostate within a narrow and deep pelvis might suggest increased surgical difficulty of RARP. The size of the pelvic inlet also had a great impact on RARP. For PAD and PH, there seemed to be an optimal range with the lowest surgical difficulty. Machine-learning models based on the XGBoost algorithm could be successfully applied to predict the surgical difficulty of RARP., (© 2024. Society of Surgical Oncology.)

Objective: Coronavirus disease-2019 (COVID-19) has caused many changes in the health services since its inception. The change in the functioning of the emergency services and the decrease in admissions have also changed the form of consultations requested from the urology clinic. This study aims to reveal how the consultations requested from the urology clinic of a large hospital were affected during the COVID-19 period. Materials and Methods: In our study, one year before and after March 10, 2020, was divided into two groups as "pre-covid" and "covid era". The gender, age, reason for consultation, result, date and time, hospitalization status of the patients were examined. Results: A total of 2018 consultations, 1242 in the pre-COVID period and 776 during the COVID period, were analyzed in the study. Although renal colic was the most common reason for consultation in both periods, its number and rate decreased significantly during the COVID period [384 (30.9%) vs. 165 (21.3%), p<0.0001]. Proportionally, more patients were hospitalized during the COVID period [196 (15.8%) vs. 161 (20.7%), p=0.02]. In both periods, the most common reason for hospitalization was hematuria, but the difference was not statistically significant [26 (29.5%) vs. 20 (27.8%), p=0.261]. Conclusion: COVID-19 has turned all health parameters upside down and has been one of the biggest factors affecting public health since the day it started. While the density and form of consultation requested from the urology clinic changed during the pandemic period, the hospitalization rates increased, so urology clinics should adapt accordingly for possible pandemic waves or epidemics in the future. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of coronavirus disease-2019 (COVID-19) phobia in patients with ureteral stones. Materials and Methods: Between August 2020 and March 2021, patients over the age of 18 who were diagnosed with ureteral stones were included in this study. The COVID-19 Phobia scale (C19P-S) was used to measure the COVID-19 phobia levels of the patients. Demographic and patients' characteristics were recorded. The time between the onset of the patient's complaint and the time of admission to the hospital was recorded and grouped as group 1 (≤7 days), group 2 (7-21 days), group 3 (>21 days). Results: A total of 77 patients with a mean age of 45.8±14.8 years were eligible for analysis. Among these, 55 (71.4%) were male. According to the time between the onset of the patient's complaint and the time of admission to the hospital, there were 39 (50.6%) patients in group 1 (≤7 days), 17 (22.1%) patients in group 2 (7-21 days) and 21 (27.3%) patients group 3 (>21 days). The median C19P-S scores in these groups were 32.0 (15.0- 46.0), 37.0 (26.0-62.0) and 56.0 (37.0-80.0), respectively. There were significant differences in terms of C19P-S between groups of the time between the onset of the patient's complaint and the time of admission to the hospital (p≤0.001). Conclusion: COVID-19 phobia caused a delay in the hospital admission of patients with ureter stones. When patients have complaints, it is necessary to raise the awareness of society about applying to the hospital and to increase awareness of this issue. [ABSTRACT FROM AUTHOR]

Simple Summary: Prostate cancer is one of the most frequently diagnosed cancers in men worldwide. Perineural invasion (PNI), the movement of cancer cells along nerves, is a commonly observed approach to tumor spread and is important in both research and clinical practice of prostate cancer. However, despite many studies reporting on molecules and pathways involved in PNI, understanding its clinical relevance remains insufficient. In this review, we aim to summarize the current knowledge of mechanisms and prognostic significance of PNI in prostate cancer, which may provide new perspectives for future studies and improved treatment. Perineural invasion (PNI) is a common indication of tumor metastasis that can be detected in multiple malignancies, including prostate cancer. In the development of PNI, tumor cells closely interact with the nerve components in the tumor microenvironment and create the perineural niche, which provides a supportive surrounding for their survival and invasion and benefits the nerve cells. Various transcription factors, cytokines, chemokines, and their related signaling pathways have been reported to be important in the progress of PNI. Nevertheless, the current understanding of the molecular mechanism of PNI is still very limited. Clinically, PNI is commonly associated with adverse clinicopathological parameters and poor outcomes for prostate cancer patients. However, whether PNI could act as an independent prognostic predictor remains controversial among studies due to inconsistent research aim and endpoint, sample type, statistical methods, and, most importantly, the definition and inclusion criteria. In this review, we provide a summary and comparison of the prognostic significance of PNI in prostate cancer based on existing literature and propose that a more standardized description of PNI would be helpful for a better understanding of its clinical relevance. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the study was to investigate whether a novel simple measurement of pelvic anatomy, the pelvic anatomical index (PAI), which is obtained from simple physical examination, was predictive for potential difficulty and adverse outcome in radical prostatectomy. Materials and methods: Available data from 73 consecutive radical prostatectomy patients were analyzed. The distances between umbilicus and cranial edge of the symphysis pubis (USPD) and between root of the penis and umbilicus (PUD) were measured. PAI was obtained using the formula (PUD/USPD) × body mass index (BMI). Indicators of surgical difficulty assessed were operation time (OT), dorsal vein bleeding (DVB), total blood loss (TBL), and surgical margin (SM) status. Patients with below-median values of the OT, DVB, TBL, and had negative SM were grouped as favorable surgery (n = 18). Results: Median OT, DVB, and TBL were 215 (IQR: 187.5–240) min, 380 (IQR: 200–500) cc, and 1000 (IQR: 700–1300) cc, respectively. Both PAI and BMI were significantly correlated with TBL, DVB, and OT (p < 0.05, for all). PAI and BMI significantly associated with favorable surgery (p = 0,006 and p = 0.048, respectively). However, only PAI was an independent predictor of favorable surgery in multivariable logistic regression analysis. A PAI 36 kg/m2 was determined as the threshold value for favorable surgery with 83.3% sensitivity and 60% specificity. Conclusion: PAI significantly correlated with almost all surgical parameters and was a significant independent predictor of favorable surgery. PAI can enable the physician to select and discuss individualized treatment options for patients during preoperative planning. [ABSTRACT FROM AUTHOR]

The role of perineural invasion detected by puncture biopsy of prostate cancer remains controversial. We performed a meta‐analysis to assess the relationship between positive perineural invasion at prostate biopsy and positive surgical margins (PSM) after radical prostatectomy. We searched a number of relevant electronic databases including Web of Science, Medline, PubMed, Embase, and the Cochrane Library until 31 March 2021. STATA 15.1 software was used to analyse all data for this article. The quality of these studies was assessed by the Newcastle‐Ottawa Scale (ranged from 0 to 9 stars). Finally, we selected 13 high‐quality studies in our meta‐analysis, which contain 8283 patients. Overall pooled analysis proposed that biopsy perineural invasion was related to a higher risk of the positive surgical margins after radical prostatectomy in prostate cancer (RR: 1.73; 95% CI: 1.56–1.92; z = 10.30, p = 0.000). Moreover, the outcomes of the publication bias checkout testified that without significant bias arose (Egger's test: 0.086 > 0.05; Begg's test: 0.59 > 0.05). The existing evidence indicates that higher incidence of positive surgical margins in patients who had perineural invasion was detected in prostate biopsy. [ABSTRACT FROM AUTHOR]

Background. The amount of visceral adipose tissue (VAT) tends to increase with age and is associated with several health problems, such as cardiometabolic diseases, increased infections, and overall mortality. Objectives. This review provides a general assessment of how visceral adiposity correlates with the development of health problems and changes in serum biochemical parameters in middle-aged and older adults. Methods. We searched specific terms in the Virtual Health Library (VHL) databases for VAT articles published in the English language between 2009 and 2019 related to older adults. Results. The search found twenty-three publications in this period, of which nine were excluded. The publications had a population aged between 42 and 83 years and correlated the VAT area ratio with several comorbidities (such as pancreatitis, depression, cancer, and coronary heart disease) and serum biochemical parameters. Conclusion. Further research on the association between visceral obesity and the emergence of health problems and the relationship between VAT and changes in serum biochemical parameters in older individuals should deepen the understanding of this connection and develop preventive actions. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to present the impact of coronavirus disease-2019 pandemic on seeking treatment in patients with erectile dysfunction (ED) and compare the clinical characteristics, demographics, and laboratory analysis of patients with ED during and before the pandemic period. Materials and Methods: The clinical and demographic characteristics and laboratory analysis of patients with ED were compared between the time interval of March 9, 2020, to June 1, 2020, and the previous 3 months from the pandemics. The International Index of Erectile Function-5 questionnaire was used to assess ED and the results from two groups were compared. Results: A 76.4% decreased total number of outpatient clinics and a 70.9% decreased number of patients with ED was observed; however a significant increase was detected in the ratio of patients with ED to the total number of patients during the pandemic period (1.7% vs. 2.1%, p=0.008). The median age of patients was smaller in the pandemic period. Mild ED was significantly higher in the pandemic period and moderate ED was detected higher in the period before the pandemic. Conclusion: The admission rate of patients with ED has increased in the pandemic period. The patients presenting with ED during the pandemic period were younger, with milder ED symptoms. [ABSTRACT FROM AUTHOR]

Background: Epstein criteria based on sextant biopsy are assumed to be valid for 12-core biopsies. However, very scarce information is present in the current literature to support this view. Objectives: To investigate the validity of Epstein criteria for clinically insignificant prostate cancer (PCa) in a cohort of the currently utilized 12-core prostate biopsy (TRUS-Bx) scheme in patients with low-risk and intermediate-risk PCa. Method: Pathological findings were separately evaluated in the areas matching the sextant biopsy (6-core paramedian) scheme and in all 12-core schemes. Patients were divided into 2 groups according to the final pathology report of RP as true clinically significant PCa (sPCa) and insignificant PCa (insPCa) groups. Predictive factors (including Epstein criteria) and cutoff values for the presence of insPCa were separately evaluated for 6- and 12-core TRUS-Bx schemes. Then, different predictive models based on Epstein criteria with or without additional biopsy findings were created. Results: A total of 442 patients were evaluated. PSA density, biopsy GS, percentage of tumor and number of positive cores, PNI, and HG-PIN were independent predictive factors for insPCa in both TRUS-Bx schemes. For the 12-core scheme, the best cutoff values of tumor percentage and number of positive cores were found to be ≤50% (OR: 3.662) and 1.5 cores (OR: 2.194), respectively. The best predictive model was found to be that which added 3 additional factors (PNI and HG-PIN absence and number of positive cores) to Epstein criteria (OR: 6.041). Conclusions: Using a cutoff value of "1" for the number of positive biopsy cores and absence of biopsy PNI and HG-PIN findings can be more useful for improving the prediction model of the Epstein criteria in the 12-core biopsy scheme. [ABSTRACT FROM AUTHOR]