The Clinical Management of Intrascrotal Extratesticular Masses With Evaluation of Histopathologic Findings.

OBJECTIVE: To contribute to the literature by sharing the clinical presentation, surgical approach, postoperative complications management, and follow-up protocols of the patients we operated on due to intrascrotal extratesticular mass. METHODS: Thirty-two patients admitted due to intrascrotal extratesticular mass were included in the study. Demographic and clinical characteristics of the patients such as age, initial clinical presentation, physical examination, radiological imaging findings, such as scrotal Doppler ultrasonography and magnetic resonance imaging, mass size, and characteristics, surgical treatment procedures, operation notes, and patient follow-up visits were retrospectively examined and evaluated from the patient files. RESULTS: The median age of the 32 individuals included in the study was 52 (interquartile range: [45.0-60.5]) years. The primary reason for initial presentation was a palpable mass in 25 (78.1%) patients, pain in 13 (40.6%) patients, and scrotal swelling in 8 (25%) patients. The median mass diameter was 4.4 (interquartile range: [3.1-5.7]) cm. Surgical treatment involved inguinal excision in 29 cases (90.6%) and inguinoscrotal excision in 3 cases (9.4%). All patients were treated with testicle-sparing surgery. The most common tumor location, observed in 27 cases (84.3%), was the epididymis. The most frequent histopathological diagnosis was epididymal cyst, identified in 13 patients (40.6%). Pathology results showed that the mass was removed with negative margins in all patients. CONCLUSION: Testicular-sparing surgery through the inguinal approach is one of the surgical methods that can be preferred for intrascrotal extratesticular masses. This approach can both preserve the testicle and achieve successful surgical results. Studies with larger samples are needed on this subject. TRIAL REGISTRATION: This study was approved by the Erzurum Medicine Faculty University Local Ethics Committee (approval number: BAEK 2023/08-105).

A Retrospective Analysis of 83 Patients with Testicular Mass Who Underwent Testis-Sparing Surgery: The Eurasian Uro-oncology Association Multicenter Study.

INTRODUCTION: Herein, we analyzed the histopathological, oncological and functional outcomes of testis-sparing surgery (TSS) in patients with distinct risk for testicular cancer. METHODS: This is a multicenter retrospective study on consecutive patients who underwent TSS. Patients were categorized in high- or low-risk testicular germ cell tumor (TGCT) according to the presence/absence of features compatible with testicular dysgenesis syndrome. Histology was categorized per size and risk groups. RESULTS: TSS was performed in 83 patients (86 tumors) of them, 27 in the high-risk group. Fifty-nine patients had a non-tumoral contralateral testis present. Sixty masses and 26 masses were benign and TGCTs, respectively. No statistical differences were observed in mean age (30.9 ± 10.32 years), pathological tumor size (14.67 ± 6.7 mm) between risk groups or between benign and malignant tumors (p = 0.608). When categorized per risk groups, 22 (73.3%) and 4 (7.1%) of the TSS specimens were malignant in the high- and low-risk patient groups, respectively. Univariate analysis showed that the only independent variable significantly related to malignant outcome was previous history of TGCT. During a mean follow-up of 25.5 ± 22.7 months, no patient developed systemic disease. Local recurrence was detected in 5 patients and received radical orchiectomy. Postoperative testosterone levels remained normal in 88% of those patients with normal preoperative level. No erectile dysfunction was reported in patients with benign lesions. CONCLUSION: TSS is a safe and feasible approach with adequate cancer control, and preservation of sexual function is possible in 2/3 of patients harboring malignancy. Incidence of TGCT varies extremely between patients at high and low risk for TGCT requiring a careful consideration and counseling.

Comparison of unilateral and bilateral microdissection testicular sperm extraction (MD-TESE) in patients with non-obstructive azoospermia: a prospective study.

OBJECTIVE: To compare sperm retrieval rates between unilateral and bilateral microdissection testicular sperm extraction (MD-TESE) procedures in patients with non-obstructive azoospermia and to contribute to the literature by comparing them with literature data. METHODS: This prospective study included 84 males with primary infertility who had azoospermic NOA, who had been married for at least one year, and whose female partners did not have a history of infertility. The study was conducted between January 2019 and January 2020. MD-TESE was applied bilaterally to 48% (n:41) (Group 1) and unilaterally to 52% (n:43) (Group 2) of the patients, and sperm retrieval rates were compared. RESULTS: There was no statistically significant difference between Group 1 patients and Group 2 patients in terms of sperm availability (61%, 56.5%, p=0.495, respectively). In addition, while no complications were observed in unilateral MD-TESEs, 3 complications were observed in bilateral MD-TESEs. CONCLUSIONS: In our study, it was determined that there was no significant difference between the groups in terms of sperm availability in patients with NOA. Considering the operative time and complication rates of bilateral MD-TESE in patients diagnosed with NOA and the possible MD-TESE procedures that may be performed later, we believe that unilateral MD TESE is a more preferable procedure for the patient and surgeon in this patient group.

Efficacy of transversalis fascia plane block as a novel indication for varicocelectomy surgery: prospective randomized controlled study.

BACKGROUND: Varicocele occurs as a result of dilatation of the pampiniform plexus in the spermatic veins. In this study, our primary aim was to evaluate the effect of Transversalis Fascia Plane Block (TFPB) on pain scores in the postoperative period in patients undergoing varicocelectomy surgery, and our secondary aim was to evaluate the effect of TFPB on analgesic consumption. METHODS: The study was initiated following local ethics committee approval, and sixty ASA I-II patients > 18y scheduled to undergo varicocelectomy and who consented to participation were enrolled. Before the procedure, the patients were randomly assigned two groups: Transversalis Fascia Plan block group (Group TFPB) or surgical incision site infiltration group (Group I).All surgeries were carried out under general anesthesia, and microsurgery using the subinguinal approach. After surgical suturing, TFPB and local infiltration blocks were applied prior to termination of anesthesia.For each block, 20 mL of 0.25% bupivacaine was utilized. Patients' demographic information, passive and active VAS ratings after surgery, usage of non steroidal anti-inflammatory medications and rescue analgesia, and the requirement for rescue analgesia, were recorded. RESULTS: A total of 60 patients were included in the study. In terms of demographic data, there was no difference between the groups. At all hours, there was a statistically significant decrease in favor of Group TFPB in terms of active and passive VAS scores (p < 0.001), non steroidal anti-inflammatory analgesic use (p < 0.05), and tramadol requirement (p < 0.001). CONCLUSION: This study has shown that TFPB can provide a more effective analgesia when compared to surgical site infiltration.

Efficacy of combination therapy with biofeedback and dapoxetine in lifelong premature ejaculation treatment: a prospective randomized study.

PURPOSE: Premature ejaculation (PE) is a common sexual dysfunction that significantly affects the quality of life of the patient and their partner. We aimed to compare the efficacy and safety of the combination therapy with biofeedback-guided pelvic floor exercise therapy (BFT) and dapoxetine 30 mg. METHODS: Sixty-five patients diagnosed with lifelong PE were included in the study. Patients were divided into three groups as BFT, dapoxetine 30 mg and a combination of BFT and dapoxetine 30 mg. The patients were compared with the intravaginal ejaculatory latency time (IELT) pre-treatment and post-treatment 1st and 3rd months. RESULTS: The mean IELTs of the patients in Group 1 were 40 s in pre-treatment, 115 s at the end of the 4th week and 140 s at the end of the 12th week. The IELT values of the patients in Group 2 were 40 s in pre-treatment, 145 s in the 4th week and 170 s in the 12th week. The IELT values were calculated in Group 3 as 42.5 s in pre-treatment, 185 s in the 4th week and 205 s in the 12th week When the IELT was statistically compared between the groups at 1st and 3rd months, the duration in the combination group was found to increase significantly (p < 0.001). CONCLUSION: Combination therapy with BFT and dapoxetine 30 mg in lifelong PE treatment is a good alternative with a low side effect profile and acceptable continuous efficiency.

Variation of Serum PSA Levels in COVID-19 Infected Male Patients with Benign Prostatic Hyperplasia (BPH): A Prospective Cohort Studys.

OBJECTIVE: To investigate the effect of SARS CoV-2 on serum total PSA levels in men with BPH diagnosed with COVID-19. METHODS: The PSA (Kit: Immunoassay Program- Cycle 18, Siemens Atellica IM Analyzer) levels in patients who had had a PSA check at least 3 months, but no more than 6 months, prior to diagnosis of acute COVID-19 infection, were examined retrospectively. PSA levels were measured and recorded from these patients on the first day of diagnosis of COVID-19. These patients were called back for urology outpatient follow-up at the third month after the end of the COVID-19 treatment. PSA levels measured in the pre-COVID-19 period, during the period of active infection with COVID-19, and in the post-COVID-19 period were compared. RESULTS: In total, 91 patients had a serum PSA level of 1.58 ± 1.09 ng/mL in the pre-COVID-19 period, a serum PSA level of 4.34 ± 3.78 ng/mL measured in the COVID-19 period and 2.09 ± 2.70 ng/mL in the post-COVID-19 period. It was determined that the serum PSA level measured during active COVID-19 infection was statistically significantly higher than the PSA levels measured according to the pre-COVID-19 period and the post-COVID-19 period (P < .001, P < .001; respectively). CONCLUSION: SARS-CoV-2 infection in men diagnosed with BPH causes significant increases in PSA levels during the active period of the disease. Measurement of PSA values used in the diagnosis, differential diagnosis, and follow-up of prostate diseases in the acute period of infection and in the early period after infection treatment may cause false evaluations that may affect the diagnosis and treatment steps of prostate diseases in these patients.

The relationship of serum testosterone levels with the clinical course and prognosis of COVID-19 disease in male patients: A prospective study.

BACKGROUND: A potential role of testosterone among sex hormones has been hypothesized in identifying sex-related differences in the clinical consequences of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. Due to the high global prevalence of hypogonadism, the relationship between hypogonadism and SARS-CoV-2 infection outcomes deserves an in-depth study. OBJECTIVE: The present study aimed to investigate the relationship of serum testosterone with other laboratory parameters on the prognosis of coronavirus disease-19 (COVID-19) in male patients with COVID-19 diagnosis. MATERIALS AND METHODS: This prospective cohort study included 358 male patients diagnosed with COVID-19 and 92 COVID-19 negative patients admitted to the urology outpatient clinics as a control group. The COVID-19 patients were divided into groups according to prognosis (mild-moderate and severe group), lung involvement in chest computed tomography (<50% and >50%), intensive care unit needs, and survival. RESULTS: The measured serum total testosterone level of the COVID-19 patients group was found to be significantly lower than that of the control group (median, 140 ng/dl; range, 0.21-328, 322 ng/dl; range, median, 125-674, p < 0.001, respectively). The serum TT levels were statistically significantly lower in severe COVID-19 patients compared to mild-moderate COVID-19 patients (median, 85.1 ng/dl; range, 0.21-532, median, 315 ng/dl; range, 0.88-486, p < 0.001, respectively), in COVID-19 patients in need of intensive care compared to COVID-19 patients who did not need intensive care (median, 64.0 ng/dl; range, 0.21-337, median, 286 ng/dl; range, 0.88-532 p < 0.001, respectively), and in COVID-19 patients who died compared to survivors (median, 82.9 ng/dl; range, 2.63-165, median, 166 ng/dl; range, 0.21-532, p < 0.001, respectively). DISCUSSION AND CONCLUSION: Our data are compatible with low TT levels playing a role on the pathogenesis of the disease in Covid-19 patients with poor prognosis and a mortal course and may guide clinicians in determining the clinical course of the disease.

A review of hypogonadotropic hypogonadism cases followed up in our clinic in the last decade.

INTRODUCTION: The aim of the present study was to evaluate, with this retrospective study, the patients with hypogonadotropic hypogonadism, who were followed up in our clinic in the last decade and were reviewed in terms of the incidence of the disease, diagnostic methods and differential diagnoses, treatment modalities, fertility rates, and treatment success. METHODS: After a very careful differential diagnosis, 81 patients (1.5% of infertile men presenting to the outpatient clinic) were diagnosed with hypogonadotropic hypogonadism. This study only included patients diagnosed with idiopathic hypogonadotropic hypogonadism. The treatment was undertaken in two periods depending on whether or not the patients wanted to have children at that time: testosterone replacement therapy and gonadotropin therapy. To induce spermatogenesis, the patients were treated using human chorionic gonadotropin and urinary or recombinant follicle-stimulating hormone. RESULTS: The pregnancy rates of the spouses of the patients were as follows: spontaneous 64.6% (n = 42), intrauterine insemination 12.3% (n = 8), in vitro fertilization 15.3% (n = 10), and microscopic testicular sperm extraction + intracytoplasmic sperm injection 4.6% (n = 3). CONCLUSION: Idiopathic hypogonadotropic hypogonadism is a rare but easily diagnosable and treatable cause of male infertility. After a long period of the treatment, almost all idiopathic hypogonadotropic hypogonadism patients can be treated with gonadotropins (human chorionic gonadotropin + follicle-stimulating hormone) in order to have children. The most important issue in the treatment is the dose of the drugs used in the treatment and the duration of the treatment. The most important result is that the required gonadotropin dose varies according to each patient. Therefore, the treatment dose and duration should be increased until patients have children.

Vesicovaginal fistula repair experiences in a single center high volume of 33 years and necessity of cystostomy.

OBJECTIVE: The aim of this study was to retrospectively examine the patients who underwent surgical treatment for vesicovaginal fistula (VVF) repair in our clinic, to evaluate our surgical preferences, success, and treatment results, to compare these with the literature, and firstly to reveal the necessity of cystostomy and its effect on treatment success. MATERIAL AND METHODS: Between 1985 and 2018, a retrospective evaluation was performed on the records of 102 patients who underwent surgical treatment for VVF repair. All cases underwent a detailed physical examination and had their routine laboratory tests and imaging methods. In obese patients, a Foley catheter was moved into the bladder through the fistula tract, then inflated in order to push the vagina and bladder wall upwards. A transurethral catheter was used in all cases, and cystostomy was used in 58 (56.9%). RESULTS: The most common cause was prior hysterectomy for benign diseases in 35 (34.31%) cases. Among a total of 102 cases with for VVF, 95 (93.1%) were primary, 5 (4.9%) secondary, and 2 (1.9%) tertiary. The transvesical and O'Connor approaches (transabdominal) were performed in 61 (59.8%) and 41 (40.2%) cases, respectively. Transvaginal approach was not used in any of the cases. Cystostomy was applied in 58 (56.9%) of cases and not applied in 44 (43.1%). CONCLUSION: Complete excision of the fistula tract and sealing of the layers separately using the water-tight technique are extremely crucial factors to increase the success rate of VVF repair. In cases where good transurethral drainage is ensured, cystostomy is unnecessary and may increase the risk of infection.

A comparison between the efficacy and safety of microscopic inguinal and subinguinal varicocelectomy.

OBJECTIVE: To compare microscopic inguinal (MIV) and subinguinal varicocelectomy (MSV) surgeries with respect to efficacy and safety. MATERIAL AND METHODS: Patients who underwent varicocelectomy between January 2002 and January 2018 were evaluated retrospectively and prospectively. The patients who underwent varicocelectomy until December 2015 were analyzed retrospectively and the cases after January 2016 were analyzed prospectively. In our study, the married infertile male cases were compared on the basis of operation duration, number of ligated veins, number of preserved veins, postoperative pain score (visual analogue scale: VAS), patient satisfaction, surgeon satisfaction, changes in sperm parameters, testicular consistency, pregnancy rates, and complications, such as hydrocele, testicular atrophy, and recurrence of varicocele. Surgical success rates were compared by semen analysis between unmarried infertile male cases because pregnancy rates cannot be tested. The patients were recalled for control examinations every 3 months for 1 year and tested the above-mentioned parameters. Statistical Package for the Social Sciences Version 20 Windows Software was used for data analysis and comparison between the two groups. RESULTS: The study included a total of 136 adult patients. Mean age of the patients was 28.14 (20-41) years. MSV and MIV were performed in 62 (45.6%) and 74 (54.4%) patients, respectively. No statistically significant difference was detected between the two groups in terms of admission duration, semen parameters within the 1-year follow-up process, hormonal changes, and complication rates. Operation duration was significantly longer in the MSV group. It was determined that a fewer number of veins were ligated, and a fewer number of veins needed to be ligated in the MIV group. The analysis of all the patients revealed that pain scores at 4 and 24 hours postoperatively were significantly statistically lower in the MSV group. CONCLUSION: MIV and MSV are distinct, efficient, and safe surgical techniques with specific advantages and disadvantages. Their efficacy and safety rates are similar.

A novel therapeutics agent: antioxidant effects of hydroxylfasudil on rat kidney and liver tissues in a protamine sulphate-induced cystitis rat model; preliminary results.

Cystitis is defined as an inflammation of the bladder caused by a bacterial infection, and it can be dangerous and painful when it spreads through the internal organs. In this study, antioxidant effects of hydroxylfasudil (HF) at the enzymatic and molecular level on kidney and liver tissues in cystitis rat model, which is caused by inflammation of the rat bladder with a protamine sulphate (PS), was examined. Quantitative changes of reduced glutathione (GSH) and lipid peroxidation (LPO) levels, which are a marker for oxidative stress, were determined in rat kidney and liver tissues for each groups. And then molecular and biochemical impact of HF treatment on antioxidant enzymes including superoxide dismutase (SOD) and catalase (CAT) in cystitis model were studied. The results suggest that HF could be beneficial to the renal and hepatic antioxidant system. Thus, HF might be used as a novel therapeutics agent to eliminate interstitial cystitis.

Evaluation of testicular catch-up growth in adolescent microsurgical varicocelectomy.

OBJECTIVE: The incidence of varicocele is approximately 15% in adolecent men. Early treatment with varicocele is aimed to resolve testicular hypotrophy and ensure catch-up growth. The aim of this study was to evaluate ipsilateral catch-up growth rates relative to contralateral testicular growth in adolescents with varicocele undergoing microsurgical subinguinal varicocelectomy. MATERIAL AND METHODS: Fifty adolescents with unilateral grade 2-3 varicoceles were included in the study. All patients underwent microsurgical subinguinal left varicocelectomies performed by the same experienced surgeon. All patients were evaluated clinically and using orchidometric measurements to define the grade of varicocele and testicular volume at presentation and follow-up. The number of internal and external spermatic veins, testicular arteries and lymphatic vessels preserved during the subinguinal microsurgical varicocelectomy were recorded. The mean follow-up period was 26 months (range 6-48 months). RESULTS: At presentation, mean patient age was 12.9±2.1 years. Mean testicular preoperative volumes were 7.1±4.3 mL for the right and 5.4±3.4 mL for the left testis. There were significant differences between mean volumes of the right and left testis (p=0.002). At the final postoperative follow-up visit, mean testicular volumes were 10.8±5.1 mL (range 3-25) for the right and 9.9±4.3 mL (range 2-20) for the left, and the difference between the right and left testicular volumes was insignificant (p=0.47). In our series, catch-up growth was observed in 70% (35/50) of our patients. CONCLUSION: Adolescent varicocelectomy is associated with a higher percentage of patients showing testicular catch-up growth. In our study, similarly to the available literature the catch-up growth rate was found as 70% and observed to have positive effects of adolescent varicocelectomy on testicular growth.

Micropercutaneous Nephrolithotomy in the Management of Bilateral Renal Stones in a 7-Month-Old Infant: The Youngest Case in the Literature.

During infancy, the renal parenchyma and pelvicalyceal system are relatively fragile. Therefore, percutaneous nephrolithotomy for the management of renal stones in this age group is a challenging procedure for urologists. Herein, we present the uneventful management of bilateral renal stones using micropercutaneous nephrolithotomy (microperc) administered to a 7-month-old infant with recurrent urinary tract infections. In this paper, the advantages and disadvantages of the microperc procedure are discussed. As far as we know, our patient is the youngest case in whom the microperc procedure has been performed.

The Sexual Beliefs of Turkish Men: Comparing the Beliefs of Men With and Without Erectile Dysfunction.

Sexual beliefs underlying male sexual dysfunction are known to emphasize excessively high sexual performance, among other inaccuracies. The purpose of this study was to determine the frequency of certain sexual beliefs among Turkish men with and without erectile dysfunction. In this comparative-descriptive study, demographic data and participant views regarding 50 common sexual beliefs were collected with a questionnaire. The study was conducted at the urology clinic of a university hospital in Turkey between May 2011 and August 2013. Participants were 815 men: 304 with erectile dysfunction and 511 without. Men with erectile dysfunction endorsed 8 beliefs about sexual activity more frequently than did men without erectile dysfunction. Findings indicate the association of certain cognitions with erectile dysfunction. Most of these cognitions concerned high expectations of male sexual function.

Renal epithelioid angiomyolipoma mimicking urothelial carcinoma of the upper urinary tract.

Epithelioid angiomyolipoma is a rare mesenchymal tumor arising mainly in the kidney that can potentially behave aggressively. Epithelioid angiomyolipoma can often resemble sarcomatoid renal cell carcinoma, high grade renal carcinoma or sarcoma. Its similarity to renal cell carcinoma has been emphasized in most of the cases reported in literature. With the purpose of contributing to the awareness of this similarity, a 32-year-old female patient with renal epitelioid angiomyolipoma in the left kidney which radiologically mimicked urothelial cell carcinoma of the upper urinary tract is presented.

Primary vesical actinomycosis in a 23-year-old man.

Introduction. Actinomycosis can affect any organ of the body, although cutaneous fistulas are common in actinomycotic infections, and other organs such as the bladder are only rarely involved. Case Presentation. Herein we report and discuss a young male patient with primary vesical actinomycosis. A 23-year-old man was hospitalized complaining of intermittent gross hematuria over a 6-month duration. The patient underwent a cystoscopic examination under general anesthesia; an edematous, hyperemic, wide-based mass, which protruded from the dome of the bladder, was seen and incompletely resected. The histopathological examination of the material showed Actinomyces organisms surrounded by inflammation and a photomicrograph showed the microorganism. After confirmation of bladder actinomycosis, the patient received penicillin. A CT scan of the abdomen and pelvis showed no evidence of the mass at the postoperative 6th month. Cystoscopic examination showed complete healing of the transurethral resection area at the dome of the bladder. Conclusion. In conclusion, we believe that the gold standard treatment for vesical actinomycosis should include the combination of a transurethral resection of the mass and long-term penicillin treatment.

Endoscopic guided additional access for staghorn calculi.

BACKGROUND AND PURPOSE: Flexible nephroscopy is an important technique in the management of staghorn renal calculi to reach peripheral calices. In this study, we present our experience with flexible nephroscopy and fluoroscopy-guided additional access creation for staghorn renal calculi. PATIENTS AND METHODS: We conducted a retrospective analysis of patients with staghorn renal calculi who were treated with multiple percutaneous renal tracts created with the guidance of flexible nephroscopy and fluoroscopy. Additional tracts were performed with combined flexible nephroscopy and fluoroscopy guidance. Flexible nephroscopy was used to help target the calix and ensure the safety of access. RESULTS: Additional percutaneous renal access was achieved using combined flexible nephroscopy and fluoroscopy guidance in 26 patients with complete staghorn (n=21) and partial staghorn (n=5) kidney stones. The cumulative stone size was 59.3 mm. The mean procedure times, fluoroscopy times, and hospitalization times were 91.5 minutes, 3.4 minutes, and 2.7 days, respectively. The postoperative hematocrit drop was 4.96±3.8. Upper and lower calices were the most common primary access tracts in 11 and 15 patients, respectively. Stone-free status was achieved in 22 (84.6%) patients with a mean 2.1±0.3 tract number. Postoperative complications were observed in six (23.1%) patients. CONCLUSIONS: In the requirement of additional access for staghorn renal calculi, use of flexible nephroscopy with fluoroscopy increases the safety of the procedure by confirmation of precise renal access.

Ureteroscopy and holmium laser lithotripsy: is this procedure safe in pregnant women with ureteral stones at different locations?

OBJECTIVES: The aim of this study was to assess the safety and effectiveness of ureteroscopy and Holmium: Yttrium-Aluminum-Garnet lithotripsy for the treatment of ureteral stones with different localizations in symptomatic pregnant women. METHODS: A retrospective analysis was performed on 19 pregnant patients referred to our center between January 2005 and December 2012 with symptomatic hydronephrosis requiring surgical intervention. 7.5 F and 9.5 F semirigid ureterorenoscopy with Holmium laser lithotripsy was used for treatment in all patients. Complications were stratified according to modified Clavien criteria. RESULTS: The mean age of patients was 25.4 (18-41) years, and the mean gestation duration was 24.8 (7-33) weeks. Six cases (31.5%) had a history of stone. Solitary kidney secondary to previous nephrectomy was observed in 2 patients and 1 patient had a hypoplastic kidney. Abdominal ultrasonography was used as the main diagnostic tool. Mean stone size was 9.2 mm (6-13). The location of the stones was the lower, middle, and upper ureter in 8 (42.1%), 5 (26.3%) and 6 (31.5%) cases, respectively. All stones were fragmented with Holmium laser lithotripsy. Of the 19 patients, 11 (57.8%) required double J stent insertion peroperatively. Intraoperative urological and obstetric complications were not observed. Postoperatively two complications were noted. According to Clavien criteria a complication was level 1, and the other was level 2. CONCLUSIONS: For treatment of pregnant women with symptomatic ureteral stones in every location, Holmium laser lithotripsy with a semirigid ureteroscopy can be used as judicious treatment. This approach is effective and safe with an acceptable complication rate.

Association between neuropathic pain, pregabalin treatment, and erectile dysfunction.

INTRODUCTION: The pathophysiology of erectile dysfunction (ED) may be vasculogenic, hormonal, anatomical, neurogenic, drug-induced and/or psychogenic in origin. Neuropathic pain (NP) may facilitate ED, because it is frequently associated with anxiety, depression, and its drug, pregabalin, may also contribute ED. AIM: The objective of this study was to determine whether pregabalin treatment for patients with neuropathic pain promotes erectile dysfunction. METHODS: The study sample consisted of a total of 102 male subjects that were subdivided into three groups. Group 1 patients (n = 31) had a pre-existing diagnosis of NP and was treated with 300 mg/day of pregabalin for at least 3 months. Group 2 patients (n = 34) were diagnosed with NP for at least 3 months; however, neither were they treated with pregabalin nor did they received physical therapy throughout the study. Lastly, healthy age-matched control subjects comprised group 3 (n = 37). MAIN OUTCOME MEASURES: Patients in all groups completed the International Index for Erectile Function (IIEF) questionnaire. RESULTS: Mean age and mean body mass index did not differ significantly between each of the three groups. The cause of NP and the mean duration of having a diagnosis of NP did not differ significantly in groups 1 and 2. However, IIEF scores were significantly lower for group 1 when compared to group 2 in terms of erectile function, orgasmic function, overall satisfaction and total score. Yet groups 1 and 2 did not diverge significantly in the intercourse satisfaction and sexual desire scores. Overall IIEF scores for group 3 were significantly higher than those of group 2 except for mean erectile function scores. CONCLUSION: Taking pregabalin for the treatment of neuropathic pain poses an increased risk for developing ED in male patients. Thus, clinicians prescribing pregabalin to patients diagnosed with neuropathic pain should assess for ED before and during treatment with this medication.

Percutaneous nephrolithotomy for the treatment of radiolucent renal stones in children: is it different opaque stone treatment?

We aimed to evaluate the effectiveness of percutaneous nephrolithotomy (PNL), stone-free rates, and related complications in children with radiolucent renal stones. A total of 56 patients aged <16 years from four institutions were enrolled in our study. Asymptomatic, clinically insignificant residual fragments measuring <4 mm or a complete stone-free status was accepted as the criterion for clinical success. Complications were evaluated according to the modified Clavien classification. The mean age of the patients was 7.8 ± 4.5 years. The mean stone size was calculated as 24.07 ± 10.4 mm. The median operative and fluoroscopy times were 53.2 min (15-170 min) and 172.4 s (5-520 s), respectively. The success rate after PNL monotherapy was 87.4%; the total success rate with shock wave lithotripsy used as an auxillary treatment method was detected as 94.6%. The total complication rate was 19.6% (11 patients). No adjacent organ injury was observed. All of the complications that occurred were minor according to the Clavien classification (Clavien Grades I-II). PNL can be applied to radiolucent pediatric renal stones in children with similar success, and complication rates as noted for radiopaque stones.