Assessment of the results of a three-year program for National Standardization and Quality Improvement of Medical Laboratories on Drug of Abuse Testing by the Ministry of Health in Turkey.

The aim of this study is to assess the results of inspections in the last three years of drug abuse testing in medical laboratories according to the latest regulations in Turkey. The on-site inspections of medical laboratories for drugs abuse testing performed in Alcohol and Drug Addiction Treatment Centers during 2014-2016 are described, and laboratory processes and performance evaluated. The performance of 35 laboratories in 2014, 62 laboratories in 2015, and 94 laboratories in 2016 were scored as the sum of the scores for all answers on the inspection form. An inspected laboratory was considered to have an unconformity if the total score was less than 2/3 of maximum score. The total scores of inspections and the number of laboratories with between years were compared using one-way analysis of variance and slope Chi-square for trend test, respectively. Total scores increased statistically significantly from 35.9 ± 16.2 in 2014, to 43.5 ± 16.3 in 2015 and 49.1 ± 1.3 in 2016 (p < 0.001). The laboratories with unconformities decreased statistically significantly from 57% in 2014 to 37% in 2015 and 22% in 2016 (p < 0.001). The published legislation and the inspections contributed to national standardization and improved quality of service in medical laboratories for drug abuse testing.

Robot-assisted radical prostatectomy in low- and high-risk prostate cancer patients.

OBJECTIVE: To evaluate the benefit of robot-assisted radical prostatectomy (RARP) in the low-risk prostate cancer (PCa) patients suitable for active surveillance and in the high-risk PCa patients who would be considered for alternative treatments such as radiotherapy (RT) and androgen deprivation therapy (ADT) instead of radical prostatectomy. MATERIAL AND METHODS: Of 548 patients, who underwent RARP, 298 PCa patients (258 low-risk and 40 high-risk) with a mean of 3.6 years follow-up, were included into this study. Oncological outcomes were compared separately in low- and high-risk PCa patients. RESULTS: The pathologic Gleason scores were ≥7 in 73 (28%), and 68 (26%) patients had a pathologic stage of T3, 29 (11%) patients had a positive surgical margin (PSM), and 20 (7%) patients had biochemical recurrence (BCR) in the first year follow-up in the low-risk group. Of 258 low-risk PCa patients, a total of 93 (36%) patients had not either BCR, pathologic Gleason score ≥7, or ≥pT3 disease with PSM. In the high-risk group, the pathologic stage was pT2 in 14 (35%) patients and 29 (72%) patients had no biochemical recurrence in the follow-up of these high-risk PCa patients. Of 40 high-risk PCa patients, in a total of 25 (62.5%) patients ≥pT3b disease, BCR, pT3a disease with PSM were not detected. CONCLUSION: Approximately two thirds of high-risk PCa patients benefit from RARP without additional RT or ADT. Besides, more than one third of low-risk PCa patients who fit active surveillance criteria would have unfavorable results.

Is rhabdomyolysis an anaesthetic complication in patients undergoing robot-assisted radical prostatectomy?

BACKGROUND: In patients undergoing robot-assisted radical prostatectomy (RARP), pneumoperitoneum, intraoperative fluid restriction and prolonged Trendelenburg position may cause rhabdomyolysis (RM) due to hypoperfusion in gluteal muscles and lower extremities. In this study, it was aimed to assess effects of body mass index (BMI), comorbidities, intra-operative positioning, fluid restriction and length of surgery on the development of RM in RARP patients during the perioperative period. SUBJECTS AND METHODS: The study included 52 American Society of Anesthesiologists I-II patients aged 50-80 years with BMI >25 kg/m2, who underwent RARP. Fluid therapy with normal saline (1 ml/kg/h) and 6% hydroxyethyl starch 200/05 (1 ml/kg/h) was given during the surgery. Charlson comorbidity index (CCI), operation time (OT) and Trendelenburg time (TT) were recorded. Blood samples for creatine phosphokinase (CPK), blood urea nitrogen, creatinine (Cr), aspartate aminotransferase (AST), alanine transferase (ALT), lactate dehydrogenase (LDH), creatinine kinase-MB, cardiac troponin I and arterial blood gases were drawn at baseline and on 6, 12, 24 and 48 h. RM was defined by serum CPK level exceeding 5000 IU/L. RESULTS: Seven patients met predefined criteria for RM. There were positive correlations among serum CPK and Cr, AST, ALT and LDH levels. However, there was no significant difference in BMI, OT and TT between patients with or without RM (P > 0.05). CCI scores were higher in patients with RM than those without (3.00 ± 0.58 vs. 2.07 ± 0.62; P< 0.01). No renal impairment was detected among patients with RM at the post-operative period. CONCLUSIONS: It was found that comorbid conditions are more important in the development of RM during RARP rather than BMI, OT or TT. Patients with higher comorbidity are at risk for RM development and that this should be kept in mind at follow-up and when informing patients.

Significance and outcome of nuclear anaplasia and mitotic index in prostatic adenocarcinomas.

OBJECTIVES: The Gleason grading system measures architectural differentiation and disregards nuclear atypia and the cell proliferation index. Several studies have reported that nuclear grade and mitotic index (MI) are prognostically useful. PATIENTS AND METHODS: This study included 232 radical prostatectomy specimens. Nuclear anaplasia (NA) was determined on the basis of nucleomegali (at least 20µm); vesicular chromatin; eosinophilic macronucleoli, nuclear lobulation, and irregular thickened nuclear membranei. The proportion of area of NA was recorded in each tumor in 10% increments. The MI was defined as the number of mitotic figures in 10 consecutive high-power fields (HPF). RESULTS: In univariate analysis, significant differences included associations between biochemical prostate-specific antigen recurrence (BCR) and Gleason score, extraprostatic extension, positive surgical margin, the presence of high-pathologic stage, NA≥10% of tumor area, MI≥3/10 HPF, and preoperative prostate-specific antigen. In a stepwise Cox regression model, a positive surgical margin, the presence of a NA≥10% of tumor area, and a MI of≥3/10 HPF were independent predictors of BCR after radical prostatectomy. NA≥10% of tumor area appeared to have a stronger association with outcome than MI≥3/10 HPF, as still associated with BCR when Gleason score was in the model. CONCLUSIONS: The results of our study showed that, in addition to the conventional Gleason grading system, NA, and MI are useful prognostic parameters while evaluating long-term prognosis in prostatic adenocarcinoma.

Hematopoietic cell transplantation activity of Turkey in 2014: Ongoing increase in HCT rates.

Hematopoietic cell transplantation is an established treatment option with curative potential for a variety of clinical conditions. The last decade especially witnessed a remarkable increase in HCT activity in Turkey. In 2014, 696 pediatric and 2631 adult (total 3327) HCT were performed in Turkey. Corresponding transplant rates per 10 million inhabitants for autologous-HCT and allogeneic-HCT were 226 and 202, respectively. Total HCT procedures in Turkey increased 177% in the last 5 years and 791% in the last 14 years. This report focuses mainly on HCT activity of Turkey in 2014 based on the national HCT registry and presents a general picture of national HCT activity.

Outcomes of Gleason score 3 + 4 = 7 prostate cancer with minimal amounts (<6%) vs ≥6% of Gleason pattern 4 tissue in needle biopsy specimens.

OBJECTIVE: The International Society of Urological Pathology Gleason grading system was modified in 2005. Since the modified system was introduced, many cancers that previously would have been categorized as Gleason score (GS) 6 are now categorized as GS 7 based on biopsy specimens that only contain minimal amounts (<6%) of Gleason pattern (GP) 4 tissue. However, the clinical significance of observing <6% of GP 4 tissue in biopsies of GS 7 prostate cancer has not been studied. MATERIAL AND METHODS: This study was based on needle biopsy specimens that were categorized as GS 6 or GS 7 and were obtained from patients who underwent radical prostatectomy (RP) with available follow-up data. We assessed the quantity of GP 4 tissue in biopsy specimens of GS 7 prostate cancer. Further, we evaluated the correlation between the quantity of GP 4 tissue and disease progression after RP. RESULTS: GP 4 comprising 26-49% of the specimen, GS 4+3 and percentage of total core tissue scored as positive were significant and independent predictors of prostate-specific antigen (PSA) failure after RP, as assessed using a multivariate Cox regression model that included the quantity of GP 4 in the prostate biopsy specimen, preoperative PSA, perineural invasion, clinical stage, number of positive cores, and percentage of core tissue scored as positive. Cases with GS 3+3 and cases in which the observed GP 4 area was <6% did not differ significantly in terms of biochemical PSA recurrence (BPR) status. In contrast, cases with 6-25% GP 4 tissue, 26-49% GP 4 tissue, and GS 4+3 showed more frequent BPR than cases with GS 3+3. CONCLUSIONS: Our data suggest that the quantity of GP 4 tissue in GS 7 cancer has clinical significance. However, there is a need for larger studies of the clinical significance of biopsy specimens that include <6% GP 4 tissue. We should reconsider whether the amount of GP 4 should be included in standart pathology reports.

Effectiveness of acupuncture on chronic prostatitis-chronic pelvic pain syndrome category IIIB patients: a prospective, randomized, nonblinded, clinical trial.

OBJECTIVE: To compare the acupuncture treatment and the medical treatment with antibiotics and nonsteroidal anti-inflammatory drugs (NSAIDs) on pain control, urinary symptoms, and quality of life of category IIIB chronic prostatitis-chronic pelvic pain syndrome (CP-CPPS). METHODS: From November 2008 to May 2009, 54 male patients with category IIIB CP-CPPS were randomly divided into 2 groups: the medical treatment group (group 1, n = 28) and the acupuncture treatment group (group 2, n = 26). Group 1 took levofloxacin 500 mg daily and ibuprofen 200 mg twice a day for 6 weeks. In the acupuncture group (group 2), bilateral BL32 (Ciliao) and BL33 (Zhongliao) acupoints were used to stimulate the sacral nerve using an electrical pulse generator, twice a week for 7 weeks. The change in National Institutes of Health Chronic Prostatitis Symptom Index scores from the baseline to the end of the treatment was observed. RESULTS: The mean follow-up was 28 weeks from the baseline (range, 20-43 weeks). In acupuncture group, reduction of pain, urinary symptoms, quality of life, and total National Institutes of Health Chronic Prostatitis Symptom Index score was higher compared with the medical group. CONCLUSION: However the treatment of CP-CPPS is challenging and difficult for the urologists. This clinical study showed that the acupuncture treatment is a safe and effective treatment of category IIIB CP-CPPS.

Comparison of surgical, functional, and oncological outcomes of open and robot-assisted partial nephrectomy.

BACKGROUND: We aimed to compare the surgical, oncological, and functional outcomes of robot-assisted partial nephrectomy (RAPN) with open partial nephrectomy (OPN) in the management of small renal masses. MATERIALS AND METHODS: Between 2009 and 2013, a total of 46 RAPN patients and 20 OPN patients was included in this study. Patients' demographics, mean operative time, estimated blood loss (EBL), warm ischemia time (WIT), length of hospital stay, pre- and post-operative renal functions, complications and oncological outcomes were recorded, prospectively. RESULTS: Mean tumor size was 4.04 cm in OPN group and 3.56 cm in RAPN group (P = 0.27). Mean R.E.N.A.L nephrometry score was 6.35 in OPN group and 5.35 in RAPN group (P = 0.02). The mean operative time was 152 min in OPN group and 225 min in RAPN group (P = 0.006). The mean EBL in OPN and RAPN groups were 417 ml and 268 ml, respectively (P = 0.001). WIT in OPN group was significantly shorter than RAPN group (18.02 min vs. 23.33 min, P = 0.003). The mean drain removal time and the length of hospital stay were longer in OPN group. There were no significant differences in terms of renal functional outcomes and postoperative complications between groups. CONCLUSION: Minimally invasive surgical management of renal masses with RAPN offers better outcomes in terms of EBL and length of stay. However, the mean operative time and WIT were significantly shorter in OPN group. RAPN is a safe and effective minimally invasive alternative to OPN in terms of oncological and functional outcomes.

Significance of the cribriform pattern in prostatic adenocarcinomas.

INTRODUCTION: There is now increased understanding that invasive cribriform carcinoma is a relatively aggressive disease. In some recent publications, the recommendation is that all cribriform patterns be classified as Gleason pattern (GP) 4 rather than GP 3. MATERIALS AND METHODS: We assessed the cribriform foci (CF) associated with the more definitive patterns 3, 4, and 5 elsewhere on the 185 radical prostatectomy specimens and evaluated the association of the cribriform pattern with extraprostatic extension, surgical margin. RESULTS: CF were more frequently observed in cases with definitive patterns 4 and 5 than in cases with pattern 3 (all cases with pattern 5 exhibited CF). Cases with Gleason score 3+3 and CF were more frequently associated with extraprostatic extension, and a positive surgical margin. CONCLUSIONS: Our results demonstrate that diagnosing all cribriform patterns as at least GP 4 would significantly affect further therapeutic options and prognosis. However, as many of these modifications are empirical and supported by only a few studies, long-term follow-up studies with clinical endpoints are necessary to validate these recommendations.

Comparison of surgical and functional outcomes of open, laparoscopic and robotic pyeloplasty for the treatment of ureteropelvic junction obstruction.

OBJECTIVE: To compare the surgical and functional outcomes of open, laparoscopic and robotic dismembered pyeloplasty for the treatment of patients with ureteropelvic junction obstruction (UPJO). MATERIAL AND METHODS: Between 2007 and 2012, a total of 56 patients underwent conventional open (Group 1; n=25), laparoscopic (Group 2; n=16), and robotic (Group 3; n=15) dismembered pyeloplasty operations. Preoperative evaluation was performed using urinalysis, urine culture, blood biochemistry, urinary ultra-sound, intravenous pyelogram (IVP) (optional) and Mercaptoacetyltriglycine (MAG-3) renal scan. The mean operation time, estimated blood loss, drain removal time, narcotic analgesic requirements, length of hospital stay and functional outcomes were compared among groups. Statistical analyses were performed using Statistical Package for the Social Sciences (SPSS) v. 20 (IBM, Armonk, NY, USA) software, and statistically significant differences were determined using a p value <0.05. RESULTS: The mean age of the patients was 30 years in Group 1, 34.3 years in Group 2 and 32.9 years in Group 3. The mean operation time was 127, 130 and 114 min (p=0.32), and the estimated blood loss was 105, 31 and 28 mL, respectively (p=0.001). The drain was removed after 4.36 (±1.3), 2.33 (±0.6) and 1.8 (±0.6) days after surgery (p<0.001), and the mean hospital stay was 4.14 (±1.8), 2.8 (±0.75) and 2 (±1) days, respectively (p<0.001). Narcotic analgesic requirement was significantly higher in Group 1 compared with Groups 2 and 3 (p=0.02). The radiographic and symptomatic success rates were 96% in Group 1, 93.75% in Group 2 and 93.3% in Group 3. CONCLUSION: Laparoscopic and robotic pyeloplasty are feasible, effective, reliable and minimally invasive treatment approaches for the treatment of UPJO as compared with open dismembered pyeloplasty.

Predictive preoperative factors for positive surgical margins in robotic radical prostatectomy in low-risk prostate cancer.

OBJECTIVE: Positive surgical margins after radical prostatectomy for localized prostate cancer is a powerful predictor of PSA recurrence. Clinical stage, Gleason score and preoperative PSA are predictive factors for positive surgical margin after radical prostatectomy. In this study, we aimed to identify preoperative factors affecting surgical margin positivity in low-risk prostate cancer after robotic radical prostatectomy (RARP). MATERIAL AND METHODS: Between 2008 and 2011 (

The effect of prostate weight on the outcomes of robot-assisted radical prostatectomy.

OBJECTIVE: The effect of prostate volume on the surgical, functional, and oncological outcomes of robot assisted radical prostatectomy (RARP) was evaluated. MATERIAL AND METHODS: A total of 180 patients who underwent RARP and had at least a 1-year follow-up were included. The patients were divided into 3 groups based on prostate weight (Group 1: <45 g, Group 2: 45-75 g, and Group 3: >76 g). Erectile function and continence were evaluated at 3, 6, 9, and 12 months postoperatively. The International Index of Erectile Dysfunction (IIEF) score and daily pad usage were evaluated as indicators of erectile function and continence, respectively. The measurement of two prostate-specific antigen (PSA) values over 0.2 ng/mL was considered biochemical disease recurrence. RESULTS: Patients with larger prostates were older and had a longer operative time and higher PSA level compared with patients with smaller prostates (p<0.05). The positive surgical margin rate was higher in patients with smaller prostates (p=0.06). However, patients with a prostate weight <45 g had higher IIEF scores at 3 and 6 months. IIEF scores were similar at the end of the 1-year follow-up period. Pad usage and time to continence were higher in patients with larger prostates (p>0.05). CONCLUSION: Although prostate weight affected the surgical outcomes of RARP, the functional and oncological outcomes were similar among all patients. Long-term follow-up is needed to determine their impact on oncological outcomes.

Comparison of surgical and functional outcomes of minimally invasive and open pyeloplasty.

OBJECTIVE: To compare the surgical and functional outcomes of minimally invasive pyeloplasty versus open pyeloplasty. SUBJECTS AND METHODS: Between 2008 and 2010, 20 patients underwent transperitoneal minimally invasive (13 robot-assisted and 7 laparoscopic) pyeloplasty, and 22 patients underwent conventional open pyeloplasty. Operative and functional outcomes were compared between the minimally invasive and open pyeloplasty groups. The statistical analysis was performed using Fisher's exact test, unpaired t test, and Mann-Whitney U test. RESULTS: The mean age was 31 years in the minimally invasive group and 27 years in the open group. The mean operative time was 131 minutes in the minimally invasive group and 128 minutes in the open group (P=.71). The estimated blood loss was 30 mL in the minimally invasive group and 108 mL in the open group (P=.001). The drain was removed after 1.75 days and 4.48 days in the minimally invasive and open groups, respectively (P=.001). The mean hospital stay was 1.94 days and 4.19 days in the minimally invasive and open groups, respectively (P=.001). Crossing vessels were observed in 21% of all patients, and the transposition of the ureter was performed in all patients with an anterior crossing vessel. One patient in each group had symptomatic and radiographic recurrence and persistently obstructed drainage pattern on diuretic renography. The radiographic and symptomatic success rate was 95% in the minimally invasive group and 95.5% in the open group. CONCLUSIONS: Minimally invasive pyeloplasty has low morbidity, short length of stay, and less blood loss compared with open surgical repair. It is an effective and feasible minimally invasive treatment modality for ureteropelvic junction obstruction.

Minimum 1.5-year results of "surgeon-tailored" transvaginal mesh repair for female stress urinary incontinence and pelvic organ prolapse.

OBJECTIVE: To evaluate our minimum 1.5-year results with "surgeon-tailored" polypropylene mesh (STPM) in stress urinary incontinence treatment and the impact of concomitant pelvic organ prolapse repair on functional outcomes. METHODS: All patients who were treated for stress urinary incontinence and pelvic organ prolapse using STPM between 2006 and 2010 were reviewed. Fifty-two patients received transobturator midurethral sling alone. Concomitant pelvic organ prolapse repair was performed in 74 (67 cystocele, 14 rectocele). Pre- and postoperative evaluation included subjective assessment of the impact of voiding and prolapse symptoms with International Consultation on Incontinence-Short Form and Prolapse Quality of Life (P-QOL) questionnaires, uroflowmetry, and urodynamic studies when necessary. Surgical outcomes at the last follow-up and complications were compared between the transobturator midurethral sling and transobturator midurethral sling + pelvic organ prolapse repair groups. RESULTS: One-hundred eighteen women were available for analysis. With a mean follow-up of 33.4 and 41.2 months for transobturator midurethral sling and transobturator midurethral sling + pelvic organ prolapse repair groups, stress urinary incontinence was cured in 86.4% and 81.1% of the patients, respectively. Preoperative urge symptoms resolved in 53.8% and 62.5%, and de novo urge symptoms developed in 22% and 15% of patients with respect to study groups. Pelvic organ prolapse was cured in 98.6% patients, with a significant improvement in all domains of the P-QOL questionnaire at the last follow-up. Vaginal mesh erosions were detected in 11 (14.8%) patients with concomitant pelvic organ prolapse repair. CONCLUSION: STPM may represent a cost-effective option for stress urinary incontinence treatment. Concomitant pelvic organ prolapse repair with STPM does not affect incontinence outcomes and provides high anatomic success and patient satisfaction in the long term. However, mesh-related complications with this approach is a major concern that deserves further investigation of risk factors and better definition of patient selection criteria.

Reconstruction of distal urethral strictures confined to the glans with circular buccal mucosa graft.

OBJECTIVE: To report our results with 1-stage reconstruction in short distal urethral strictures using circular buccal mucosa graft (cBMG). METHODS: The data of 19 patients (median age 41.8 years, range 25-58) operated between 2001 and 2010 were reviewed. Patients were evaluated with American Urological Association (AUA) symptom score, uroflowmetry, voiding cystourethrography (VCUG), and intraoperative urethroscopy. Stricture was limited to the glanular urethra (≤ 2 cm.) in all cases and 16 patients had lichen sclerosus. Strictured urethra was resected 0.5 cm proximal to the healthy urethra and a rectangular BMG with 4-cm length and 1.5- to 2.5-cm width (depending on the length of the defect) was rolled on a 24-Fr sound that calibrated the urethra. Proximal and distal edges of the cBMG were anastomosed circumferentially to the healthy mucosa and meatus, respectively. Foley catheter was removed within 10-14 days. Voiding symptoms, uroflowmetric parameters, and cosmesis were assessed at 1, 3, and 6 months, and yearly thereafter. RESULTS: With a median follow-up of 38 months (range 12-96), 16 (84.2%) patients were cured. One patient developed early graft loss, and 2 patients developed stricture at proximal anastomotic site. Mean Q(max) (mL/s) increased from 7.8 ± 5.4 preoperatively to 21.8 ± 9.2 postoperatively (P = .001), and mean AUA score decreased from 26.7 ± 3.9 preoperatively to 7.3 ± 3.8 postoperatively (P < .001). CONCLUSION: Our results suggest cBMG as a feasible alternative in 1-stage reconstruction of distal strictures confined to the glanular urethra because the glans penis has a good blood supply, providing an efficient circumferential graft take.

Priapism due to a single dose of quetiapine: a case report.

Priapism is characterized by a prolonged and painful erection in the absence of sexual desire and arousal. Priapism is a rare and serious side effect of psychotropic drugs, and is thought to be attributable to blockage of alpha-1 adrenergic receptors in the corpus cavernosum. Although priapism is commonly associated with typical antipsychotics, there are some (but not many) case reports of priapism due to atypical antipsychotics. This side effect has been reported in patients taking ziprasidone, risperidone, clozapine, quetiapine, aripiprazole, and olanzapine. Not all antipsychotics bind to alpha-1 adrenergic receptors with the same intensity; as compared to other antipsychotics, quetiapine has an intermediate affinity. Priapism could be considered an idiosyncratic reaction, because it is correlated neither with the dose nor duration of psychotropic drug use. Herein we present a case of priapism caused by a single 300-mg dose of quetiapine, and a brief review priapism in the light of this case.

The learning curve of robot-assisted radical prostatectomy.

PURPOSE: To evaluate the learning curve of a surgeon with no previous laparoscopy experience in performing robot-assisted radical prostatectomy (RARP). PATIENTS AND METHODS: A total of 120 patients with a 1-year follow-up after RARP were included to the study prospectively. Patients were grouped as the first, second, and third 40 patients. Surgical, oncologic, and functional outcomes were compared among groups. Analysis of variance, chi-square, and Kruskal-Wallis test were used for statistical analysis. RESULTS: All groups were similar with respect to age, prostate-specific antigen level, body mass index, Gleason score, and distribution of the clinical stage. The operative time was 182 minutes for group 1, 168 minutes for group 2, and 139 minutes for group 3 (P=0.01). Individual times of various stages of the procedure (dissection of the seminal vesicles, entering the extraperitoneal space and dissection of the endopelvic fascia, incision of the bladder neck, division of the prostatic pedicles and preservation of the neurovascular bundle, and urethrovesical anastomosis) decreased significantly over time. Estimated blood loss was 287 mL for group 1 238 mL for group 2, and 170 mL for group 3 (P=0.04). The length of stay was 5.1 days for group 1, 4.0 days for group 2, and 3.1 days for group 3 (P=0.005). Positive surgical margin rates were 22% (9) for group 1, 17% (7) for group 2, and 6% (2) for group 3 (P=0.03). While seven patients in group 1 and two patients in group 2 had biochemical recurrence, no patient in group 3 had biochemical recurrence (P=0.04). Continence rates at 12 months were 72.5%, 85%, and 92.5% in groups 1, 2, and 3, respectively (P=0.01). Potency rates at 12 months for groups 1, 2, and 3 were 60.5%, 66.7%, and 76.6%, respectively (P=0.03). CONCLUSION: Surgical, oncologic, and functional outcomes of RARP improve with increasing experience. Outcomes similar to the published series by high-volume centers could be achieved after 80 to 120 RARP cases.

Healing of the urethral plate after deep incision: does catheterization change the course of this process?

BACKGROUND: We aimed to evaluate the sequence of healing process as well as possible effects of stent placement on the healing process after deep urethral plate incision. METHODS: A deep urethral plate incision was done at the 12 o'clock position. After that, in the first group (n = 14) the anterior urethra was stented with a silicon catheter. Animals in the second group (n = 14) underwent the same incision procedure, however no stent was placed after this operation. All animals in both groups were again divided into three groups with respect to the follow-up period (7-14 and 21 days). Partial penectomy was performed in all subgroups and histopathologic evaluation performed. RESULTS: In the first group after 7 days, limited neovascularization and granulation tissue formation could be noted far away from the epithelial lumen. Evaluation of these specimens during the long-term follow-up (21 days) demonstrated an almost completely healed tissue with a remarkable neovascularization and well-developed granulation tissue. In the second group during 14-21 days, evaluation progression of tissue healing along with increasing vessel formation and re-epithelialization were demonstrated. Although the incision edges did show evident approximation, no sign of fibrosis could be demonstrated in these specimens. CONCLUSION: We may say that tissue healing with a desired and complete re-epithelialization could be achieved without inserting a catheter. Prevention of re-approximation along with the limited urinary extravasations to the subepithelial area might be responsible for tissue protection that will limit the long-term aforementioned adverse effects of the procedure.

Operative failure during ureteroscopic pneumatic lithotripsy: factors affecting successful outcome.

AIM: We aimed to evaluate the predictive factors that would in turn indicate stone migration and the effects of these factors on the ultimate success of the intervention. METHOD: Patients were divided into two groups with respect to the migration of the stone treated. Group I: patients demonstrating stone migration during manipulation; group II: no migration of the stones noted. In the second phase of the study, the results of ureteroscopic management in 433 patients were evaluated with respect to the success rates obtained. Parameters such as stone size, stone burden, experience of the surgeon, length of the ureter proximal to the stone treated, and lastly transverse diameter of the ureter were noted in all patients as possible risk factors for stone migration. RESULTS: Statistical analysis of ureteroscopic success in all patients revealed that there was a meaningful correlation with respect to the length of the proximal ureteral portion (p < 0.0001) and surgeon's experience (p = 0.004). p value for the correlation between stone burden and operative success was 0.056. There was no significant correlation between stone size (p = 0.51), ureter diameter (p = 0.78), and operative success. CONCLUSION: Stones that are close to the renal pelvis and treated by inexperienced physicians are the ones most likely to migrate to the renal pelvis during manipulation with pneumatic lithotripsy.