The Effect of Autologous Temporal Fascia Graft on Erectile Function and Psychometric Properties in Peyronie's Disease Patients.

PURPOSE: The aim of this study is to evaluate the results of the surgical technique used by the authors on Peyronie's disease (PD) patients who underwent surgical treatment with a temporalis fascia autograft. MATERIALS AND METHODS: Patients with normal erectile functions and > 60° penile curvature who underwent surgical treatment with temporalis fascia autografts were included in this retrospective study. The patients were recruited between January 2017 and May 2021. Preoperative assessment included the International Index of Erectile Function erectile function (IIEF-EF) score, penile duplex and penile curvature angle measurement. Postoperative self-reports, penile deformity, IIEF-EF scores and the Patient Global Impression of Improvement (PGI-I) questionnaire were assessed every three months. RESULTS: Twenty-two patients with a mean age of 52.09 ± 6.61 years were included in the study, and no major complications developed in any case. Postoperative assessment revealed curvature relapse in seven patients (31.8%), although no intervention was performed on five patients with < 20° curvature. Six patients experienced a postoperative decrease in penile length and erectile function was completely preserved in 68.18%. The mean level of satisfaction with surgery measured using the visual analogue scale was 79.13 ± 21.23. CONCLUSION: The temporalis fascia graft, thin and durable graft, is a highly successful therapeutic option in the surgical treatment of PD patients and a good alternative in terms of its cosmetic and functional results.

Papillary Urothelial Carcinoma Arising from Ureterocele: Is it a Rare Occurrence?

Various hydronephrotic, dysplastic or clinical pathologies can accompany ureterocele, which is a cystic dilatation of the intravesical part of the submucosal ureter. However, the development of cancer in the ureterocele is highly unusual. Hematuria is the most common sign, although imaging can also indicate alterations in the wall of the ureterocele. Unfortunately, there is no current guideline for the management of papillary urothelial carcinoma arising from ureterocele. Non-muscle-invasive bladder cancer treatment and follow-up protocols are classically applied. However, the anatomical structure of the ureterocele differs from that of normal bladder tissue. It is unclear whether this difference represents a risk in terms of deep tissue tumour invasion. In addition, tumour cells may migrate to the upper urinary tract due to urinary reflux developing following tumour resection. The management of papillary urothelial carcinoma arising from ureterocele must therefore be specific to that condition. However, this depends on an increase in the number of patients reported in the literature. Our review of the literature revealed very few reports. The present study is therefore particularly valuable from that perspective and describes the clinical management of a patient developing papillary urothelial carcinoma in ureterocele. Key Words: Ureterocele, Bladder, Hematuria, Urothelial carcinoma.

The effect of aging on semen parameters in normozoospermic men: A cross-sectional study.

Background: Semen parameters change with age and are reported differently worldwide. Objective: This retrospective cross-sectional study aimed to investigate the semen quality pattern among aging men and the age thresholds for semen parameters. Materials and Methods: The records of men who had normal semen parameters from January 2015-June 2020 were retrospectively evaluated for andrological outpatient at Samsun Training and Research hospital and Gazi hospital in Samsun, Turkey. Adult men meeting the inclusion criteria were divided into 3 groups of I) 18-29 yr (n = 629), II) 30-39 yr (n = 775), and III) 40-49 yr (n = 190). Correlations between age and sperm parameters were then analyzed. Results: A total of 1594 men were enrolled in the study. Significant differences were observed in total sperm numbers, total motility rates, progressive motility rates, nonprogressive motility rates, normal morphology rates, mean semen volume, and sperm concentrations. The parameters of total sperm number, progressive motility rate, and normal morphology rate were significantly higher in group I than in the other 2 groups (p < 0.001, p < 0.001, and p < 0.001, respectively) and in group II compared to group III (p = 0.001, p = 0.003, and p < 0.001), respectively. Mean semen volume and total motility rate were significantly higher in group I than in the other groups (p = 0.001 and p < 0.001, respectively). However, no difference was observed between group II and group III (p = 0.61 and p = 0.04, respectively). Conclusion: Age has a significant impact on semen parameters capable of affecting male fertility, particularly total sperm numbers, the progressive motility rate, and the normal morphology rate.

Dexketoprofen vs. Tamsulosin vs. Silodosin vs. Tadalafil as Medical Expulsive Therapy for Distal Ureteral Stones in Men.

OBJECTIVE: To assess the effectiveness of the use of dexketoprofen, tamsulosin, silodosin, and tadalafil in medical expulsive therapy for distal ureteral stones in male patients. STUDY DESIGN: Cohort study. PLACE AND DURATION OF STUDY: Department of Urology, Gazi Hospital, Samsun, Turkey, from March 2020 to March 2021. METHODOLOGY: Adult males satisfying the inclusion criteria were randomly assigned into dexketoprofen (Group 1), tamsulosin (Group 2), silodosin (Group 3), or tadalafil (Group 4) treatment arms. The primary endpoint consisted of the stone expulsion rate at the end of four weeks, while the secondary endpoints were the expulsion rate after two weeks and the occurrence of adverse events. Clinical findings were then compared among the study groups. RESULTS: Altogether 193 patients, 50 (25.9%) in group 1, 48 (24.9%) in group 2, 49 (25.4%) in group 3, and 46 (23.8%) in group 4, were enrolled in the study. No significant difference was determined in terms of age, body mass index, stone characteristics, expulsion time, pain episodes, or total analgesic consumption among the four groups. Expulsion rates in the fourth week were 48%, 79.2%, 81.6%, and 78.3% in groups 1, 2, 3, and 4, respectively. Stone expulsion rates were significantly greater in groups 2, 3, and 4 compared to group 1 (p <0.001), but no significant differences were determined between groups 2, 3, and 4. No severe adverse effects occurred throughout the study period. CONCLUSION:   Tamsulosin, silodosin and tadalafil exhibited higher expulsion rates for distal ureteral stones in male patients, although none was significantly superior to the others. All three are safe, efficacious, and well-tolerated, with only very minor side-effects. Key Words: Dexketoprofen, Distal ureteral stones, Medical expulsive therapy, Silodosin, Tadalafil, Tamsulosin.

Risk Factors for Systemic Inflammatory Response Syndrome in Patients with Negative Preoperative Urine Culture after Percutaneous Nephrolithotomy.

OBJECTIVE: To explore the risk factors for systemic inflammatory response syndrome (SIRS) after percutaneous nephrolithotomy (PCNL) in patients with preoperative negative urine culture (UC). STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Department of Urology, Gazi Hospital, Samsun, Turkey, from January 2015 to January 2020. METHODOLOGY: Two hundred and twenty-eight patients, who underwent conventional PCNL for renal stones, were evaluated. The patients were divided into non-SIRS (Group 1) and SIRS (Group 2) groups, and the effects of the variables were investigated to predict the development of SIRS. RESULTS: Despite preoperative sterile UC, SIRS developed postoperatively in 29 (12.7%) patients. The univariate analysis revealed a statistically significant difference between groups in preoperative serum C-reactive protein (CRP) (p <0.001), platelet-to-lymphocyte ratio (PLR) (p <0.001), neutrophil-to-lymphocyte ratio (p = 0.001), urine white blood cell (p = 0.034), stone size (p = 0.023), operative time (p = 0.041), hemoglobin drop (p <0.001), blood transfusion (p = 0.002), hospital stay (p = 0.006), and complication rate (p = 0.001). Receiver operating characteristic analysis indicated that PLR >117.36 (p <0.001), CRP >3.16 mg/L (p <0.001), stone burden >471 mm2 (p = 0.023) and hemoglobin drop >2.3 g/L (p <0.001) are independent risk factors for post-operative SIRS after PCNL. CONCLUSION: PLR, CRP, stone size, and hemoglobin drop can predict SIRS after PCNL. This finding may help classify risk in patients before PCNL, especially in those with a sterile urine culture. Key Words: C-reactive protein, Percutaneous nephrolithotomy, Platelet/lymphocyte ratio, Systemic inflammatory response syndrome.

The prevalence of Burnout Syndrome among Turkish Urologists: Results of a Nationwide Survey.

OBJECTIVE: To investigate the prevalence of Burnout syndrome (BS) with its emotional exhausting (EE), depersonalization (DP), and personal accomplishment (PA) dimensions among Turkish urologists. MATERIAL AND METHODS: A total of 2,259 certified Turkish urologists were invited by e-mail to participate in this cross-sectional survey-based study. An online survey was conducted to evaluate three dimensions of BS ie: -EE, DP and PA-and their association with socio-demographic variables of Turkish urologists using the Maslach Burnout Inventory (MBI). RESULTS: Of the 2259 urologists contacted, 362 (with a mean age of 44±9.9 years) completed the survey. The mean EE, DP and PA scores were 16.8±8.7, 6.6±4.6 and 8.2±5.6, respectively. Cronbach's α reliability co-efficiencies were 0.920 for EE, 0.819 for DP and 0.803 for PA. Antidepressant drug usage was quite prevalent among participants (21.9%), and the most common comorbidity was hypertension (13%). The academic title, age, smoking status, monthly income and relationships between colleagues and employers were associated with BS (p<0.05). CONCLUSION: The prevalence of BS among Turkish urologists is quite prevalent in terms of EE and DP subscales and may negatively affect the psychosocial status and well-being of the urologists. In this study, a high prevalence of BS has been reported among Turkish urologists. In conclusion the BS could become an important occupational and health problem, if it is not properly managed.

The impact of thoracotomy on psychological and sexual function in men with lung cancer.

OBJECTIVE: We aimed to investigate the effect of major thoracic surgery on sexual functions and psychogenic aspects of men who underwent surgery for lung cancer. MATERIAL AND METHODS: This study was conducted to assess depression and erectile function in patients who underwent surgical treatment for lung cancer. The data of 50 patients in the study group, and 39 participants in the control group who met the criteria were analyzed. Erectile dysfunction (ED) and symptoms of depression were assessed in patients before and three months after surgery. RESULTS: The mean ages were 58.4±11.6 and 61.3±6.9 years; the mean BMIs were 25.6±4.3kg/m2 and 24.8±5.7kg/m2; the mean forced vital capacities (FVC) were 3.1±0.6L and 3.4±1.4L; the mean FEV1/FVC were 86.1±10.3 and 80.3±4.1; the mean Beck Depression Inventory scores were 9.3±6.9 and 6.0±6.2, and the mean FVC% were 82.9±14.9 and 82.0±26.2 for the study and control groups, respectively. The mean preoperative International Index of Erectile Function (IIEF-5) scores were 14.1±4.1 and 10.8±4.7 postoperative in the study group, and 17.4±8.6 in the control group. The logistic regression analysis showed that postoperative complications resulted in a 3.95-times higher risk of suffering from ED. CONCLUSION: Our study supported that surgical treatment of lung cancer adversely affected psychogenic status and sexual function due to its stringent nature. The fear of death affects the quality of life and the psychogenic aspect of the patients with lung cancer. Clinicians should thoroughly inform the patients about sexual dysfunction and psychogenic disorders, and when needed providing an appropriate sexual counseling and treatment is necessary. Good communication contributes to a better quality of life.

The effect of atorvastatin on penile intracavernosal pressure and cavernosal morphology in normocholesterolemic rats.

OBJECTIVE: A debate is open on the effects of lipid-lowering drugs on sexual function. We aimed to investigate the effect of atorvastatin use on penile intracavernosal pressure (ICP) and cavernosal morphology. MATERIAL AND METHODS: Fourteen mature male Sprague-Dawley-rats were randomly assigned to either the control group (which received standard food and water ad libitum) or the atorvastatin group (which received standard food, water, and statin) for twelwe weeks. At the end of the study, ICPs were measured with cavernosometry. Penectomy specimens were histologically examined. RESULTS: The following mean values were obtained for the control and atorvastatin groups, respectively: pre-study body weights (350±16.9 g and 331.4±24.9 g); post-study body weights (356±18 g and 368±22.5 g (p>0.05); ICPs at 5 V (5.96±5.16 mmHg and 2.11±1.22 mmHg (p=0.07)); ICPs at 10 V (18.28±14.1 mmHg and 5.56±5.58 mmHg) (p=0.09); testosterone (1.23±0.78 and 0.78±0.58 mmol/dL) (p=0.39); blood glucose (151±22 mg/dL and 168.6±16.2 mg/dL) (p=0.12); triglyceride (93.4±19.8 mg/dL and 52.1±18.6 mg/dL) (p=0.01); total cholesterol (50.2±7.2 mg/dL and 47.7±6.6 mg/dL) (p=0.51); and low-density lipoprotein (LDL) cholesterol (10.0±4.4 mg/dL and 3.5±2.1 mg/dL) (p=0.01). The mean collagen thickness was similar (p=0.09); but the mean elastin thickness increased in the atorvastatin group (p=0.01). CONCLUSION: The present study showed that the use of atorvastatin reduced the intracavernosal pressure in 10 V stimulation, and minimally decreased testosterone levels in rats, within a short period of time. When statin treatment is considered for its protective properties on cardiovascular system or for its lipid-lowering effect. It should be kept in mind that atorvastatin may also adversely contribute to erectile dysfunction.

Pure large cell neuroendocrine carcinoma of the bladder without urological symptoms.

Neuroendocrine carcinoma is one of the uncommonly seen pathologies of the urinary bladder. Macroscopic hematuria is frequently encountered symptom in patients with neuroendocrine carcinoma. We report a 45-year-old man with left solitary kidney and oliguria for five days the development of acute renal failure (ARF) with the impaired general condition. The underlying cause being identified as pure type large-cell neuroendocrine carcinoma of the bladder. Large-cell neuroendocrine carcinoma of the bladder is an uncommon fatal tumor. No macroscopic hematuria or urological symptom was observed in our case. Advanced ectasia was not observed in the kidney, and the patient's clinical status was complicated with ARF. It must not be forgotten that in some bladder tumors, the patient's general condition may be impaired without urological symptoms.

Low dose daily versus on-demand high dose tadalafil in diabetic patients with erectile and ejaculatory dysfunction.

The aim was to compare the differences between daily 5 mg and on-demand 20 mg tadalafil use in diabetic patients with erectile dysfunction (ED), and the effects of two different tadalafil protocols on ejaculatory and lower urinary tract symptoms (LUTS). Of the 63 diabetic patients with ED, 31 were given 5 mg tadalafil once a day, and 32 were given 20 mg tadalafil on-demand four times a month over three months. Erectile function, erectile hardness, ejaculatory function, and LUTS were assessed at pretreatment, first- and third-month controls. Both tadalafil protocols increased International Index of Erectile Function (IIEF) scores in all patients under 65 years, whereas patients older than 65 years did not benefit. Ejaculatory function, the quality of the hardness of an erection, and LUTS improved in both groups in the study. Tadalafil improved sexual function with acceptable side effects in diabetic men with ED. Both protocols equally improved LUTS and the quality of the erection. Daily use of 5 mg of tadalafil significantly improved the quality of ejaculation and LUTS more than the on-demand use of 20 mg of tadalafil. It may be beneficial to give 5 mg tadalafil daily to patients over 65 years old who do not benefit from treatment with 20 mg of tadalafil or in patients who have LUTS over 65 years old.

A Comparison of Prilocaine vs Prilocaine + Bupivacaine in Periprostatic Block in Ambulatory Prostate Biopsies: A Single-Blind Randomized Controlled Study.

Objective: The purpose of this study was to evaluate the analgesic effect of a prilocaine + bupivacaine combination in patients undergoing periprostatic nerve block (PNB) by comparing its effects with those of prilocaine alone. Design: Single center, single-blind, prospective descriptive study. Subjects: Four hundred patients with transrectal prostate biopsy pain. Methods: The patients in this prospective, randomized controlled study were divided into two groups. The first group received prilocaine during PNB (Group 1), whereas the second received a prilocaine + bupivacaine combination (Group 2). Results: The mean visual analog scale (VAS) scores immediately after biopsy were 2.52 ± 0.7 and 2.53 ± 0.9, respectively (P = 0.35). VAS values were significantly lower in Group 2 at one and six hours following the procedure. The most painful part of the biopsy according to many patients was the probe insertion. Conclusions: The prilocaine + bupivacaine combination is an effective analgesic method during prostate biopsies and for one and six hours after prostate biopsy.

Does antegrade JJ stenting affect the total operative time during laparoscopic pyeloplasty?

OBJECTIVE: We aimed to show the effect of retrograde JJ stenting and intraoperative antegrade JJ stenting techniques on operative time in patients who underwent laparoscopic pyeloplasty. MATERIAL AND METHODS: A total of 34 patients were retrospectively investigated (15 male and 19 female) with ureteropelvic junction obstruction. Of the patients stentized under local anesthesia preoperatively, as a part of surgery, 15 were retrogradely stentized at the beginning of the procedure (Group 1), and 19 were antegradely stentized during the procedure (Group 2). A transperitoneal dismembered pyeloplasty technique was performed in all patients. The two groups were retrospectively compared in terms of complications, the mean total operative time, and the mean stenting times. RESULTS: The mean ages of the patients were 31.5±15.5 and 33.2±15.5 years (p=0.09), and the mean body mass indexes were 25.8±5.6 and 26.2.3±8.4 kg/m2 in Group 1 and Group 2, respectively. The mean total operative times were 128.9±38.9 min and 112.7±21.9 min (p=0.04); the mean stenting times were 12.6±5.4 min and 3.5±2.4 min (p=0.02); and the mean rates of catheterization-to-total surgery times were 0.1 and 0.03 (p=0.01) in Group 1 and 2, respectively. The mean hospital stays and the mean anastomosis times were similar between the two groups (p>0.05). CONCLUSION: Antegrade JJ stenting during laparoscopic pyeloplasty significantly decreased the total operative time.

Effect of a Carbohydrate-Rich Diet on Rat Detrusor Smooth Muscle Contractility: An Experimental Study.

OBJECTIVES: We aimed to investigate the effect of a carbohydrate-rich diet on detrusor contractility in rats. MATERIALS AND METHODS: Sprague-Dawley rats were randomized into two groups. The control group received regular food and water. The study group received carbohydrate-rich diet for six weeks. The rats' detrusor muscle was isolated for pharmacological and histopathological examinations. RESULTS: In the control and study groups, mean body weights were 431.5 ± 27.6 g and 528.0 ± 36.2 g, respectively (p < 0.001). Electrical stimulation of the detrusor strips of the control group resulted in gradual contraction. A decreased contractile response was shown in the study group. Acetylcholine in 10-7-10-3 molar concentration produced a decreased contractile response in the study group, compared to the control group (p < 0.01). The study group showed marked subepithelial and intermuscular fibrosis in the bladder. CONCLUSION: Carbohydrate-rich diet causes marked subepithelial and extracellular fibrosis and changes in contractility in the detrusor within a six-week period. Changes have higher costs in therapeutic choices and correction of these changes remains difficult. Putting an end to carbohydrate-rich diet would seem to be more cost-effective than dealing with the effects of consuming it in high proportions which should be the national policy worldwide.

Retrospective evaluation of the effects of periprostatic local anesthesia on recurrent prostate biopsy.

OBJECTIVES: The aim of the study was investigate the pain palliation effect of 2% dose of lidocaine on the periprostatic nerve block in prostate biopsy patients. METHODS: Extended (12 cores) and saturation (22 cores) biopsy patients were included. The patients were separated into three groups: extended biopsy patients (Group I), saturation biopsy patients (Group II), and control group patients undergoing a biopsy procedure for the first time (Group III). All patients received 2% lidocaine (10 mL) on both the seminal vesicular junction and apex of the prostate with transrectal ultrasonography guidance. Following the procedure, the pain levels of patients were assessed using a 10-cm linear Visual Analog Scale (VAS). RESULTS: Following the procedure, the VAS values of each group were 2.96±1.06, 3.2±1.47, and 2.93±0.94, respectively (p>0.05). While the highest pain score was seen in the saturation group patients (II), the lowest pain level was seen in the control biopsy group (III). However, no statistical di erence was observed among the groups. CONCLUSION: Herein, we observed that a local injection using 2% lidocaine was effective as local anesthetic in recurrent prostate biopsies. In addition, it was found that the pain level increases as the number of cores taken in recurrent prostate biopsies increases; however, this has not been established statistically.

The efficacy of low-dose tadalafil in patients undergoing hemodialysis with end-stage renal disease.

BACKGROUND: Erectile dysfunction (ED) is a disorder that is frequently observed in people with chronic kidney disease who undergo hemodialysis (HD). In the context of evidence-based medicine, we aimed to investigate the effect of low-dose tadalafil on sexual function in patients undergoing HD. METHODS: The medical records of 30 males (aged 29-65 years) with end-stage renal disease (ESRD) on a HD program, and who had received 5 mg tadalafil twice weekly, were retrospectively evaluated. Changes in erectile and ejaculatory function were evaluated using the International Erectile Function Index questionnaire, the Erection Hardness Scale (EHS), and the Male Sexual Health Questionnaire (MSHQ). RESULTS: The mean age of the patients was 47.6 ± 10.1 years, their mean body mass index was 24.3 ± 4.2 kg/m2, their mean hemoglobin was 11.9 ± 0.9 g/dL, and their mean creatinine clearance was 5.8 ± 1.1 mL/min. At the third month of treatment, 36.6% of the patients had no ED, 40% had mild ED, 10% had mild-to-moderate ED, and 13.3% had moderate ED. The mean MSHQ scores (p < .05) and the mean EHS scores (p = .001) were significantly improved. There was no significant difference between Beck's Depression Inventory scores (p > .05), but Hamilton anxiety rate scores decreased significantly (p = .001). The quality-of-life score improved throughout the study period (p < .05). CONCLUSIONS: Tadalafil therapy is an effective therapeutic option in patients with ESRD who undergo HD, not only for the treatment of ED, but also for ejaculatory function, with acceptable adverse effects.

Ureterorenoscopy with Stenting and Its Effect on Female Sexual Function.

PURPOSE: Various etiological factors have been studied which negatively affect female sexual function, but theeffects of ureteroscopic stone surgery on women's sexual dysfunction remain unknown. The aim of this study wasto investigate the effect of ureteroscopic stone surgery with postoperative stenting on female sexual function. MATERIALS AND METHODS: This study included 30 sexually active female patients who underwent ureteroscopicstone surgery with JJ stenting (study group) and 26 age-matched female patients with ureteral stone surgerywithout JJ stenting (control group). Sexual function was assessed at preoperative and at the first and 3rd monthspostoperative using the Female Sexual Function Index. Overall satisfaction in relation to the age, operation time,presence of stents, body mass index, educational status, previous operations, income status, and psychogenic statuswas evaluated. RESULTS: Sexual function was adversely affected by ureteroscopic stone surgery with JJ stenting; but psychogenic,educational and income status remained stable. Mean individual female sexual function subscores were statistically significant between the study and control groups, but the differences in the mean Beck scores minimally improved between the two groups at preoperative (p = 0.19) visit, whereas first month (p = 0.08) and third month (p = 0.31) of postoperative controls were deteriorated but the differences were not statistically significant, respectively. CONCLUSION: Ureterorenoscopy with JJ stenting has considerably negative effects on female sexual function. JJ stenting causes temporary sexual deterioration in women and it generally ceases at the end of the 3rd month after ureteroscopic surgery. Therefore, JJ stenting should be avoided or used for as short a time as possible. If JJ stenting is inevitable, patients should be warned about a temporary decline in their sexual function during the first month of the operation that resolves at most in three months.

A rare cause of acute urinary retention in women: meatal condyloma accuminata, a case report.

Acute urinary retention in women is a rarely seen phenomenon due to pharmacological, neuromuscular, anatomical, functional and infectious causes. Human papillomaviruses causing condyloma acuminata is one of the rarely reported viral infectious cause of acute urinary retention in case reports. A 45-year-old woman with acute urinary retention was found to have a round solid lesion on external urethral meatus. Histopathological examination revealed as condyloma acuminata. Urethral condyloma can be treated by local excision as an effective method for early improvement of voiding function. Even if the genital condyloma can be locally excised, patients should be referred to the gynecologists for cervical cancer screening.

Smoking and Lower Urinary Tract Symptoms.

PURPOSE: Pharmacologic effects of nicotine are multifaceted and complicated. Despite numerous studies, the effect of smoking on lower urinary tract functions, have not been yet studied in detail. In this study, we aimed to investigate the effects of smoking addiction on lower urinary tract and sexual functions on the basis of respiratory functions. MATERIALS AND METHODS: A total of 186 male patients who have been evaluated between May 2014 and January 2015 were recruited in this study. Smoking history, respiratory symptoms, respiratory function tests, uroflowmetry parameters relating to lower urinary tract symptoms (LUTS), prostate volume, post-voiding residual urine volume and sexual functions of patients have been retrospectively investigated. RESULTS: We determined that as the mean number of cigarettes smoked daily increases, post-void residual urine volume and International Prostate Symptom Score (IPSS) also increase. Moreover in accordance with this finding, mean urinary flow rates and quality of life scores were statistically significantly decreased. In smoking addicts who have high mean package/year, post-void residual urine volume and IPSS levels were increased but proportionately maximum urinary flow rate and average urinary flow rate plus quality of life scores were found to be statistically significantly decreased. In patients with forced expiratory volume in first second:forced vital capacity (FEV1/ FVC) ratio less than 80%, mean urinary flow rates were found to be statistically significantly low. Also, we determined that in smoking addicts who have high mean package/year, erectile functions were statistically significantly impaired. CONCLUSION: We showed negative impacts of smoking addiction on LUTS, patient's quality of life, and sexual functions.

Extracorporeal shock wave lithotripsy in the primary treatment of encrusted ureteral stents.

Double pigtail (JJ) ureteral stents, are the most commonly used method of urinary diversion in the ureteral obstructions. Encrustations may occur as a result of prolonged exposure due to forgetting these stents in the body. Removing these materials might be an annoyance. Forty-four patients from three tertiary referral centres with forgotten JJ stents left in them between the years 2007 and 2014 were included in the study. Stents could not be removed by attempted cystoscopy. As an alternative approach, extracorporeal shock wave lithotripsy (ESWL) was the first choice since it is minimally invasive. The results of that treatment are presented along with the relevant demographic data. JJ stenting for urolithiasis was performed in 36 patients, after open surgery in five patients, and for oncological reasons in three patients. ESWL was applied to stents or to any suspicious region adjacent to the stent. In 29 of 44 patients, the stents were easily removed under cystoscopic procedures while in one patient the fragmented residual stent was spontaneously excreted. In eight patients, ureteroscopy was required; in five patients, percutaneous nephrolithotripsy was required; and in one patient, open surgery was required in order to remove stents. ESWL can be considered as a first-line treatment when a forgotten JJ stent is detected despite all precautions after any kind of urological intervention involving insertion of ureteral stents.