Ertapenem plus meropenem combination treatment in carbapenem-resistant Klebsiella pneumoniae bacteremia: an analysis of 53 cases.

Herein, we aimed to describe the outcomes of patients with blood stream infections due to carbapenem-resistant Klebsiella pneumoniae (CR-Kp) who received ertapenem plus meropenem combination treatment (EMCT). A total of 53 patients with culture proven CR-Kp bacteremia treated with ertapenem + meropenem were included. The patients with secondary bacteremia due to urinary tract infection exhibited a significantly lower 1-month mortality (OMM), particularly in those with microbiological eradication and those with end-of-treatment success. Salvage EMCT resulted in 49% 1-month survival.

Analysis of risk factors of abdominal wound dehiscence after radical cystectomy.

OBJECTIVE: Wound dehiscence is associated with high morbidity and mortality. This study aimed to analyze the risk factors and comorbidities in the patients undergoing radical cystectomy with early postoperative wound dehiscence. METHODS: In all, 539 patients with bladder cancer who underwent radical cystectomy and urinary diversion at a single center between January 2008 and January 2022 were included in the study. The data related to the demographics, medical history, and perioperative clinical features were reviewed. Univariate and multivariate regression analysis was performed to identify risk factors for wound dehiscence. RESULTS: The mean age of the patients was 64.2 years (22-91). The mean body mass index was 26.4 kg/m2 (18.7-35.4). Wound dehiscence was observed in 43 (7.9%) of 539 patients. The patients with wound dehiscence had significantly higher mean BMI (27.8 vs. 26.3, p=0.006), ASA scores (p=0.002), history of chronic obstructive pulmonary disease (30.2 vs. 14.3%, p=0.006), diabetes mellitus (44.2 vs. 17.9%, p=0.003), previous abdominal surgery (18.6 vs. 7.7%, p=0.014), and postoperative ileus (58.1 vs. 16.9%, p=0.006). In the multivariable regression model, diabetes mellitus (odds ratio [OR] 4.9, 95%CI 2.3-10.1; p<0.001), postoperative ileus (OR 8.1, 95%CI 4.1-16.5; p<0.001), and chronic obstructive pulmonary disease (OR 2.6, 95%CI 1.2-5.7; p=0.013) were independent predictors of abdominal wound dehiscence following radical cystectomy. CONCLUSION: Diabetes mellitus, chronic obstructive pulmonary disease, and postoperative ileus were strongly associated with abdominal wound dehiscence following radical cystectomy. Both potential preventive and therapeutic interventions may decrease the risk of wound dehiscence.

Analysis of risk factors of abdominal wound dehiscence after radical cystectomy

SUMMARY OBJECTIVE: Wound dehiscence is associated with high morbidity and mortality. This study aimed to analyze the risk factors and comorbidities in the patients undergoing radical cystectomy with early postoperative wound dehiscence. METHODS: In all, 539 patients with bladder cancer who underwent radical cystectomy and urinary diversion at a single center between January 2008 and January 2022 were included in the study. The data related to the demographics, medical history, and perioperative clinical features were reviewed. Univariate and multivariate regression analysis was performed to identify risk factors for wound dehiscence. RESULTS: The mean age of the patients was 64.2 years (22-91). The mean body mass index was 26.4 kg/m2 (18.7-35.4). Wound dehiscence was observed in 43 (7.9%) of 539 patients. The patients with wound dehiscence had significantly higher mean BMI (27.8 vs. 26.3, p=0.006), ASA scores (p=0.002), history of chronic obstructive pulmonary disease (30.2 vs. 14.3%, p=0.006), diabetes mellitus (44.2 vs. 17.9%, p=0.003), previous abdominal surgery (18.6 vs. 7.7%, p=0.014), and postoperative ileus (58.1 vs. 16.9%, p=0.006). In the multivariable regression model, diabetes mellitus (odds ratio [OR] 4.9, 95%CI 2.3-10.1; p<0.001), postoperative ileus (OR 8.1, 95%CI 4.1-16.5; p<0.001), and chronic obstructive pulmonary disease (OR 2.6, 95%CI 1.2-5.7; p=0.013) were independent predictors of abdominal wound dehiscence following radical cystectomy. CONCLUSION: Diabetes mellitus, chronic obstructive pulmonary disease, and postoperative ileus were strongly associated with abdominal wound dehiscence following radical cystectomy. Both potential preventive and therapeutic interventions may decrease the risk of wound dehiscence.

Do bony pelvis parameters affect perioperative outcomes in open radical prostatectomy?

Objective: The present study aimed to evaluate the predictive value of bony pelvic parameters measured by computerized tomography (CT) for use in the estimation of the likely technical difficulties that may be encountered when performing open radical prostatectomy (RP) for localized prostate cancer. Material and methods: One hundred patients, undergoing open RP for localized prostate cancer, were evaluated between October 2016 to November 2018. All operations were performed by the same experienced surgeon. Pelvic parameters were measured using spiral CT images. Data were retrospectively collected from medical, operative, radiology, and pathology records and analyzed. Positive surgical margin (PSM), presence of vesicourethral anastomosis stricture (VUAS) and urine leakage, operative time, urethral catheterization time, and estimated blood loss were used as indicators of operative difficulty. Univariate and multivariate analyses were performed to determine the significance of these variables. Results: There was no significant correlation between the pelvic parameters of the patients and the presence of PSM, VUAS, and urine leakage. Only PSA levels and pathological tumor stage were higher in patients with PSM (p = 0.002 and p = 0.001). On univariate and multivariate analyses, none of the individual pelvic parameters assessed showed a significant relationship with the operation time, estimated blood loss, and urethral catheterization time. In univariate analysis, there was a significant relationship between PSA levels and pathological tumor stage and operation time (p = 0.048 and p = 0.001, respectively). Conclusion: Bony pelvic parameters may not be a significant factor in influencing the perioperative outcomes of open RP. Higher PSA levels and pathological tumor stage may lead to surgical margin positivity and longer operative time.

The Influence of the Intraductal Carcinoma of the Prostate on the Short-Term Oncological Outcomes.

AIM: The presence of intraductal carcinoma of the prostate (IDC-P) in radical prostatectomy (RP) specimens correlates with adverse prognostic factors such as worse biochemical recurrence-free survival, higher grade and stage disease. This study aimed to investigate the effect of IDC-P in radical prostatectomy specimens on short-term oncological outcomes. MATERIALS AND METHODS: Patients who underwent RP at our clinic for prostate cancer between May 2016 and November 2019 were included in the study. They were divided into two groups based on the presence of IDC-P in RP specimens. Their clinical, pathological, and oncologic data were evaluated retrospectively. RESULTS: A total of 98 patients underwent RP with a mean age of 65.5 years (50-83) and a mean follow-up time of 31.2 months (6-52). Seventy and 28 patients were evaluated in the group without IDC-P and group with IDC-P, respectively. Surgical margin positivity (p=0.307) and lymph node metastasis (p=0.017) rates were higher in the group with IDC-P. Although there were no statistical differences between the groups, at follow-up biochemical recurrence rate (p=0.052) was higher, and mean time to biochemical recurrence rates were lower (p=0.057) in the group with IDC-P. The group with IDC-P was associated with a 3-fold increase in prostate cancer-specific mortality to the group without IDC-P (p=0.037). CONCLUSIONS: Patients with IDC-P at RP specimens have more advanced disease, shorter biochemical recurrence-free, and cancerspecific survival than those without IDC-P. Defining the presence of IDC-P in RP specimens is critical in choosing the appropriate treatment strategy and predicting the prognosis.

Postchemotherapy retroperitoneal residual mass resection for germ cell testicular tumors: a single-center experience.

OBJECTIVE: Postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) plays an important role in the management of advanced germ cell testicular tumors. Bilateral template lymph node dissection is considered a standard treatment in postchemotherapy residual masses; however, modified unilateral templates have gained acceptance in patients with unilateral residual disease. In this study, we aimed to demonstrate the perioperative and oncological outcomes of the patients with advanced testicular cancer who underwent unilateral modified template PC-RPLND in our center. METHODS: This is a retrospective study in which patients who underwent PC-RPLND in a referred center between 2004 and 2021 were investigated. All patients had three or four cycles of chemotherapy and retroperitoneal residual masses. Data were retrospectively collected from medical, operative, radiology, and pathology records and analyzed. RESULTS: A total of 57 patients underwent PC-RPLND. The mean age was 32.7±8.1 years (19-50). According to the disease stage at presentation, there were 39 patients with stage 2 and 18 patients with stage 3. The average tumor size after chemotherapy was 57.6±2.7 mm (25-117). The overall complication rate was 35% (20/57 patients). No grade 4 and 5 complications were observed. Pathologic review demonstrated the presence of teratoma in 28 (49.1%) patients, fibrosis and/or necrosis in 15 (26.3%) patients, and viable germ cell tumor in 14 (24.5%) patients. The mean follow-up was 69.4 months (8-201). During follow-up after surgery, 14 (24.5%) deaths occurred due to advanced disease. CONCLUSION: PC-RPLND is a major component of the management of advanced testicular germ cell cancer. Our study demonstrated that modified unilateral template is an effective and safe procedure in the postchemotherapy setting for selected patients.

Postchemotherapy retroperitoneal residual mass resection for germ cell testicular tumors: a single-center experience

SUMMARY Objective: Postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) plays an important role in the management of advanced germ cell testicular tumors. Bilateral template lymph node dissection is considered a standard treatment in postchemotherapy residual masses; however, modified unilateral templates have gained acceptance in patients with unilateral residual disease. In this study, we aimed to demonstrate the perioperative and oncological outcomes of the patients with advanced testicular cancer who underwent unilateral modified template PC-RPLND in our center. Methods: This is a retrospective study in which patients who underwent PC-RPLND in a referred center between 2004 and 2021 were investigated. All patients had three or four cycles of chemotherapy and retroperitoneal residual masses. Data were retrospectively collected from medical, operative, radiology, and pathology records and analyzed. Results: A total of 57 patients underwent PC-RPLND. The mean age was 32.7±8.1 years (19-50). According to the disease stage at presentation, there were 39 patients with stage 2 and 18 patients with stage 3. The average tumor size after chemotherapy was 57.6±2.7 mm (25-117). The overall complication rate was 35% (20/57 patients). No grade 4 and 5 complications were observed. Pathologic review demonstrated the presence of teratoma in 28 (49.1%) patients, fibrosis and/or necrosis in 15 (26.3%) patients, and viable germ cell tumor in 14 (24.5%) patients. The mean follow-up was 69.4 months (8-201). During follow-up after surgery, 14 (24.5%) deaths occurred due to advanced disease. Conclusion: PC-RPLND is a major component of the management of advanced testicular germ cell cancer. Our study demonstrated that modified unilateral template is an effective and safe procedure in the postchemotherapy setting for selected patients.

Effect of vesicourethral anastomosis technique on functional results in retropubic radical prostatectomy.

AIM: We aimed to compare the functional results of two different vesicourethral anastomosis (VUA) techniques used in open retropubic radical prostatectomy. METHODS: A total of 476 patients including the first group with four-focus VUA at 12-, 3-, 6-, and 9-o'clock positions (n = 288) and the second group with six-focus VUA at 12-, 2-, 4-, 6-, 8-, and 10-o'clock (n = 188) were included in the study. Perioperative data, erectile function, and continence status over a 12-month period were compared. RESULTS: Demographic and perioperative data were similar between two groups. The number of patients with VUA stricture in the first group was significantly higher those in the second group (5.1% vs 3.2%, P = .017). The mean time to stricture development was also shorter in the first group (48.9 vs 74.3 days, P = .002). The number of continent patients at the 6th and 12th months were higher in the second group (79.3% vs 62.8%, P < .001; 92.4% vs 81.3%, P = .032, respectively). There was no significant difference between two groups in terms of the number of potent patients (P = .194 for 6 months and P = .351 for 12 months). CONCLUSIONS: Better continence results can be provided with the six-focus VUA technique compared with the four-focus technique. The number of anastomotic sutures in VUA may affect functional results and can be a determinative factor for surgeons who focus on functional results as well as oncological results.

A new technique in the treatment of ureteroenteric anastomosis stricture: Repair of ureteroenteric anastomosis stricture with low lombotomy incision (retroperitoneal approach).

INTRODUCTION AND AIM: Ureteroenteric anastomosis stricture (UEAS) is one of the complications of urinary diversion and may lead to serious consequences. In this study, we evaluated our UEAS revision technique outcomes performed with a low lombotomy incision in the lateral decubitus position. MATERIALS AND METHODS: Eleven patients who underwent surgical repair due to isolated right UEAS between January 2010 and June 2019 were included in the study. Anastomosis stricture was confirmed by ultrasonography, computed tomography or magnetic resonance urography techniques. Ultrasonography was used to detect hydronephrosis, which is a finding secondary to stricture. However, opaque urography imaging methods were used to confirm the definitive diagnosis of the stricture. Demographic and clinical data, preoperative and postoperative 3rd month serum creatinine, estimated glomerular filtration rate (eGFR) and dynamic renal scintigraphy data of patients were evaluated. RESULTS: The mean operation time was 49.7 ± 9.3 minutes. No perioperative complications were observed. While the overall stricture rate was 11.4%, the isolated right-sided stricture rate was 5.7%. Preoperative and postoperative serum creatinine values were similar. Preoperative eGFR value was 58.8 ± 12.9 mL/min/1.73 m2 and postoperative value was 53.5 ± 11.5 mL/min/1.73 m2 . T½ level decreased in postoperative period (22.3 ± 8.2 min vs 15.1 ± 4.3 min). CONCLUSIONS: Open revision of the UEAS with retroperitoneal approach provides lower morbidity rates and shorter hospitalisation time compared to other methods. The retroperitoneal approach is the main advantage of this technique and prevents morbidity caused by other techniques performed intraperitoneally and owing to it is an open technique, it can be easily applied in isolated right-sided UEAS.

Comparison of robotic and open radical prostatectomy: Initial experience of a single surgeon.

OBJECTIVE: In this study, we aimed to make a comprehensive comparison of the first hundred robot-assisted radical prostatectomy (RARP) and open retropubic radical prostatectomy (RRP) cases of a single surgeon in a high-volume center. METHODS: Preoperative, perioperative and postoperative data were collected retrospectively. Perioperative, oncological data and functional results in the first year were compared between the two groups. There were 204 RARPs between January 1, 2014 and December 31, 2019, and 755 RRPs between April 1, 2007 and December 31, 2019. RESULTS: While the operation time was in favor of the open group (117 vs 188 min, p<0.001), the estimated blood loss (328 vs 150 ml, p<0.001), blood transfusion rate (12 vs 2, p=0.021), and re-operation rate (6 vs 0, p=0.001) were in favor of the robotic group. Mean length of hospital stay (5.4 vs 3.1, p<0.001), urine leak rate (11 vs 2, p=0.033), complication rate (37 vs 16, p=0.018), and the 12th month continence rate (67 vs 85, p=0.002) were better in the robotic group. CONCLUSIONS: RARP may provide better perioperative outcomes and lower complication rates after the surgeon factor is eliminated in the early period. Since our case group includes the initial 100 patients, studies with larger patient groups with longer follow-up are needed to adapt these early results to general outcomes.

Multiparametric Prostate Magnetic Resonance Imaging Before Radical Prostatectomy: Can it Predict Histopathology?

PURPOSE: We aimed to investigate the histopathological correlation of the suspected prostate malignancy detected in multiparametric prostate magnetic resonance imaging (mpMRI). MATERIALS AND METHODS: The data of 93 patients underwent radical prostatectomy and had preoperative mpMRI were examined. Age and pre-operative Prostate-Specific Antigen value were retrospectively collected from patient files. The pathology specimens were examined again and post-operative ISUP grade group, other pathological findings (seminal vesicle invasion, lymph node involvement and extraprostatic extension), pre-operative mpMRI were re-examined and PIRADS score, extracapsular extension, seminal vesicle invasion, neurovascular bundle invasion, lymph node involvement and ADC values were recorded. RESULTS: 151 (92,07%) of 164 lesions detected in mpMRI were histopathologically correlated. 80% of patients with seminal vesicle invasion (P < 0.001), 28.8% of patients with extracapsular extension (P < 0.052) and 42.9% of patients with lymph node involvement (P = .001) in mpMRI were histopathologically correlated. A significant relationship was found between PIRADS scores and ISUP grade groups (P < 0.001). There was a negative correlation between ADC values and ISUP grade groups (P < 0.001). CONCLUSION: Our study showed that the lesions detected by mpMRI showed a high histopathological correlation.

Factors affecting the success of pediatric extracorporeal shock wave lithotripsy therapy: 26-year experience at a single institution.

Despite its widespread use, few studies have evaluated the success of extracorporeal shock wave lithotripsy (ESWL) in pediatric patients with several parameters and a large group of patients. In the present study, we aimed to analyze the factors that affect the outcomes of pediatric ESWL treatment, which we have practiced for 26 years. This study included 1012 pediatric patients who underwent ESWL between March 1991 and November 2017. Pre-procedure radiological evaluations were performed using kidney-ureter-bladder and/ or urinary system ultrasonography. Demographic data, stone characteristics, and ESWL treatment data and complications were recorded and univariate and multivariate analyses were performed for the stone-free rate (SFR). Receiver operating characteristic (ROC) analysis was performed to determine the cut-off values for stone size to predict ESWL success for both kidney and ureteral stones. Age, body mass index (BMI), congenital renal anomaly, stone location, stone size, number of stones, and stone composition significantly affected the SFRs in univariate analysis; however, only age, BMI, stone location, and stone size were significant in the multivariate analysis. If no residual fragments were detected after three sessions of ESWL application, the procedure was considered successful. The cut-off stone size values for the kidney and ureter that predicted treatment success were 96.28 mm2 and 44.16 mm < sup > 2 < /sup > , respectively. ESWL is an effective and safe treatment in the pediatric age group that provides high SFRs. Age, BMI, and stone location, size, and composition are particularly critical factors that can predict the success of ESWL.

Evaluation of lower urinary tract symptoms in children with Down syndrome: A prospective, case-controlled cohort study.

AIMS: In children with Down syndrome (DS) which causes cognitive impairment and intellectual disability (ID), dysfunctional voiding is proposed to be more common than in the normal population. In this study, we aimed to compare the voiding symptoms of DS children with a control group by validated questionnaires. METHODS: Thirty-seven DS children without any previous urological complaints and 59 non-DS healthy children as control group was included in the study. Overactive bladder symptoms and dysfunctional voiding were evaluated with validated Overactive Bladder Questionnaire (OAB-V8) and Dysfunctional Voiding Symptom Score (DVSS) questionnaire, respectively. Data were arranged, descriptive and comparative statistical analysis were performed. RESULTS: Demographic data of the two groups were similar except age of completing toilet training being higher in DS group. Total OAB-V8 and DVSS scores were significantly higher in the DS group. The mean scores of questions regarding voiding frequency, urgency and urgency incontinence in OAB-V8 were significantly higher in the DS group. The mean daytime incontinence, urgency, urgency incontinence, and quality of life scores in the DVSS were also significantly higher in the DS group. CONCLUSIONS: DS children have more frequent dysfunctional voiding than the normal population. ID of these children may prevent the expression of these symptoms. Awareness and early detection of these symptoms are crucial to prevent devastating complications such as renal failure. Therefore, validated questionnaires are simple, useful, and noninvasive methods.

Predisposing factors for erectile dysfunction and response to treatment in younger males: Are they different from those of older men? An observational-comparative study.

We aimed to correlate the predisposing demographic and clinical factors for erectile dysfunction (ED) in young men and treatment response in these men with data from older men. The patients were divided into two groups: <40 years (group I, n = 58) and ≥40 years (group II, n = 73). ED was evaluated with the International Index of Erectile Function-5 (IIEF-5) questionnaire, and Beck's Depression Inventory (BDI) questionnaire was used to evaluate mood status. The number of patients with morning rigidity and normal libido was higher in group I (70.7% vs. 16.4%, p = .039 and 72% vs. 37%, p = .047). The increase in scores other than IIEF-Orgasmic Function and Sexual Desire domain scores after treatment was higher in the first group (p = .029, p = .035 and p < .001 respectively). In multivariate analysis, the factors predicting the low IIEF-Erectile Function domain score in young men were testosterone level and BDI score (p = .026 and p = .034). Although psychogenic factors contribute significantly to the aetiology of ED, hormone profile is more preserved in young men than in older men.

Ho:YAG laser versus pneumatic lithotripsy for management of pediatric ureteral stones: a prospective-comparative analysis with adults.

BACKGROUND: There are limited number of studies comparing the results of Holmium:YAG laser lithotripsy (LL) and pneumatic lithotripsy (PL) for pediatric ureteral stones. OBJECTIVES: To perform a comparative analysis of LL and PL in the management of ureteral stones in children and adults. STUDY DESIGN: Ninety-eight children (56 boys and 42 girls) and 623 adults (360 men and 263 women), who were treated for ureteral stones at our clinic between 2017 and 2019, were the subjects of this study. Patients were grouped according to their age as group 1 (n:98, pediatric [<18 age]) and group 2 (n:623, adult [≥18 age]). The patients were then grouped according to lithotripter type as laser (n:580) and pneumatic (n:141). The effects of lithotripter type, stone size and location, and operative times on success and complication rates were investigated. RESULTS: In both groups, mean operation time was in favor of PL (14.6 vs 22.8 min, p = 0.042 and 26.4 vs 36.3 min, p = 0.013, respectively). In both groups, overall stone-free rates (SFR) were in favor of LL (86.8% vs 66.7%, p < 0.001, and 83% vs 73.9%, p = 0.005, respectively), but there was no significant difference in overall SFRs between adults and children (78.4% vs 76.7, p = 0.390). Retreatment rates were higher in the pneumatic group in both children and adults (p = 0.026 and p = 0.041, respectively). While there was no significant difference in the overall complication rates between adults and children (53.5% vs 40.6%, p = 0.816), the rate of complications with LL was lower in adults (37.7% vs 69.4%, p < 0.001) (TABLE). DISCUSSION: This paper is the first to report a comparative analysis of factors affecting URS success in adults and children. SFRs were higher in all ureteral locations for LL. LL, lower ureteral location, and <6 mm ureteral stone were determined as the predictors of success for both pediatric and adult patients. The presence of multiple surgeons with different levels of experience is the main limitation of this study. CONCLUSION: Both LL and PL are safe in children and adults with similar clinically insignificant complication rates. However, in the short term, LL provides better SFRs in both children and adults, especially in the upper ureteral stones. Surgeons should decide the energy technique to be used in URS according to the characteristics of the stone rather than the patient's age group.

Carbapenem-resistant Klebsiella pneumonia infection outbreak in a tertiary urology clinic: analysis of influencing factors with a controlled trial

Background/aim: Carbapenem-resistant Klebsiella pneumoniae (CR-KP) infections encountered in urology patients differentiate from infections caused by other factors, both in respect to prophylaxis and treatment stage, and require a special approach. We aimed to analyse the predisposing factors and the antibiotherapies for CR-KP infection outbreak in a tertiary urology clinic. Materials and methods: There were 75 patients in the CR-KP positive group (Group I) and 146 patients in the CR-KP negative group (Group II). Analysis of the predisposing factors for CR-KP infection and comparison of the reinfection rate and the antibiotherapies in the 2 groups were the endpoints. Results: In the first group, age, comorbidity, previous antibiotic use, and nephrostomy tube rates were higher (P = 0.015, P = 0.001, P = 0.004, and P < 0.001, respectively). In the second group, open urological surgery rate, and the proportion of patients presenting with flank pain, lower urinary tract symptoms, and haematuria were higher (P = 0.029, P < 0.001, P < 0.001, and P = 0.007). In the first group, the proportion of patients treated with transurethral bladder tumour resection was higher, whereas, percutaneous nephrolithotomy was higher in the second group (P = 0.045 for both). While hospitalization and Foley catheterization duration were longer in the first group (P < 0.001 for both), double J stent and nephrostomy duration were longer in the second group (P < 0.001 and P = 0.005). Mean leukocyte count at admission was higher in the first group (P < 0.001). Conclusion: Advanced age, comorbidities, previous antibiotic use, and prolonged Foley catheterization duration are predisposing factors for this infection in the urology department. Two-week administration of combination antibiotic regimens containing carbapenem were effective for the treatment of this infection.

The effect of Hydrodistension in combination with Pentosan Polysulfate on treatment outcomes and compliance in the treatment of bladder pain syndrome.

OBJECTIVE: In the present study, we investigated the efficacy of bladder hydrodistension combined with pentosan polysulfate (PPS) treatment in interstitial cystitis (IC)/bladder pain syndrome (BPS). METHODS: In this study, 339 patients diagnosed with IC/BPS were categorized into two groups. The first group only received 300 mg/day PPS, while the second group received 300 mg/day PPS following bladder hydrodistension. The results were evaluated at the 3rd, 6th, and 12th months after the first dose using the interstitial cystitis symptom index (ICSI), international cystitis problem index (ICPI), visual analog scale (VAS), and female sexual function index (FSFI). RESULTS: PPS treatment started just after hydrodistension was significantly more effective than PPS treatment alone and combined treatment significantly reduced the rate of non-compliance such that, at the end of the 3rd month, 12.1% patients in Group-1 did not continue their treatment whereas only 1.9% of patients in Group-2 did not continue. CONCLUSIONS: The study results indicate that PPS treatment started just after hydrodistension yields significantly better results in terms of both symptom improvement and treatment compliance in patients with IC/BPS.

Analysis of factors affecting repeat microdissection testicular sperm extraction outcomes in infertile men.

OBJECTIVE: There is no clear consensus on which patients and how many of microscopic testicular sperm extraction (mTESE) procedures will be successful. In this study, we aimed to evaluate the sperm retrieval rates and factors affecting these rates in men who underwent repeat mTESEs. MATERIAL AND METHODS: A total of 346 patients who underwent mTESE for sperm retrieval were included in the study. Patients were divided into groups according to the number of mTESE operations. Patients' karyotype, follicle-stimulating hormone (FSH) and testosterone levels, varicocele presence, and testis volumes were recorded from patient files. The sperm retrieval rates were compared between groups, and predicting factors for successful sperm retrieval were evaluated. RESULTS: Microscopic TESE was applied for the first time in 244 patients, 1-2 times in 73 patients, and 3-4 times in 29 patients. There was a significant difference between groups in preoperative FSH values and postoperative testicular histopathology (p=0.004 and p<0.001). The sperm retrieval rate in the group of patients who had not undergone previous TESE was higher than the group of patients that had undergone TESE for 1-2 times and 3-4 times (p=0.028). In addition, testicular volume, histology, karyotype, and Y-chromosome microdeletion were predicting factors for successful sperm retrieval (p=0.011, p=0.039, p=0.002, and p<0.001, respectively). CONCLUSION: Our results confirm the necessity for repeat mTESE operations to be performed by experienced surgeons in reference centers to optimize the chance of reduced sperm retrieval rates with recurrent biopsies.

The effect of percutaneous nephrostomy implementation on the outcome of ureteroscopic stone treatment.

PURPOSE: We aimed to investigate the effect of percutaneous nephrostomy (PCN) implementation on the second ureteroscopy (URS) outcomes after a failed URS. MATERIALS AND METHODS: The data of four hundred forty-eight patients with an unsuccessful URS history were evaluated. Patients were divided into two groups; patients who underwent PCN before second URS (Group A) and patients who did not (Group B). We compared the stone access rate in the second URS between the two groups according to patient and stone characteristics and operative data. Then, group A was subdivided into two groups according to stone access as; access succeeded (Group A1) and access failed (Group A2). We also compared stone access rates between these two groups in terms of gender, age, body mass index, stone size, side, location, grade of hydronephrosis and PCN duration.  All data were available immediately after surgery and obtained from patient files and the outcome assessment was performed during the study period. RESULTS: Stone access rate was higher in group A than group B (143/196 vs 41/252, P = .0018). Mean nephrostomy duration and mean hydronephrosis grade were significantly higher and mean stone size was significantly lower in group A1 than group A2 (18.74 vs 9.62 days, P < .001; grade 3.25 vs 1.21, P = .038; and 7.286 vs 12.631 mm P < .001, respectively). CONCLUSION: PCN is a favourable intervention after a failed URS and increases the success rate of the second operation with ease of implementation and minimal morbidity.

Management of ureteral endometriosis and review of the literature.

Endometriosis can affect 10-15% of the women in their reproductive age and it is characterized with the presence of the functional endometrium tissue outside the uterine cavity. Up to 10% of the cases with urinary system endometriosis may involve the ureter. Left distal ureter is the most common site of involvement. The differentiation between intrinsic and extrinsic endometriosis is very substantial for the selection and application of definitive treatment. Medical and surgical treatment alternatives are available for endometriosis management and histopathologic examination is required for definitive diagnosis. In this case report, a 33-year-old patient underwent segmental ureter excision and ureteroureteral anastomosis due to endometriosis causing obstruction in the left distal ureter. The operation was performed through a left Gibson incision and a 6 Fr double J stent was implanted in the ureter. The stent was removed after 4 weeks and the control magnetic resonance imaging-urography was performed at 3 months postoperatively. Obstruction and hydroureteronephrosis were observed to be completely regressed in control. If there is no other obvious etiology for the presence of unilateral hydroureteronephrosis in women in their reproductive age, the diagnosis of endometriosis should be considered.