A Critical Analysis of the Magnetic Resonance Imaging Lesion Diameter Threshold for Adverse Pathology Features.

To investigate the relationship between lesion size determined using multiparametric magnetic resonance imaging (mpMRI) and histopathological findings of specimens obtained after mpMRI fusion biopsy and radical prostatectomy (RP). We retrospectively analysed 290 patients with PCa who underwent an MRI fusion biopsy. We measured the diameter of suspicious tumour lesions on diffusion-weighted mpMRI and stratified the cohort into two groups. Group A included patients with a suspicious tumour lesion 10 mm and Group B included those with a suspicious tumour lesion > 10 mm. In Group B, the PI-RADS score determined in mpMRI was higher than Group A, and there was a statistically significant difference between the two groups in terms of clinical T-stage. The PCa detection rate and the number of positive cores were statistically significantly higher in Group B than in Group A. In addition, there was a statistically significant difference between the two groups in relation to the biopsy, the International Society of Urological Pathology (ISUP) grade values, and the presence of clinically significant PCa. In Group B, pathological T-stage and extraprostatic extension (EPE) and surgical margin (SM) positivity were found to be higher among the patients who underwent RP. In the multivariate analysis, the mpMRI lesion size being > 10 mm was found to be an independent predictive factor for SM and EPE positivity. The clinical results of this study support the modification of the lesion size threshold as 10 mm for use in the differentiation of PI-RADS scores 4 and 5.

The role of penile elastography in the evaluation of erectile dysfunction in patients with chronic obstructive pulmonary disease.

Introduction: In this study, we aimed to measure the change in penile stiffness by evaluating corpus cavernosum (CC) with shear wave elastography (SWE) in patients with chronic obstructive pulmonary disease (COPD). Material and methods: Seventy outpatient patients aged 50-80 years who were diagnosed with COPD were evaluated using SWE. Patients were divided into 2 groups according to the International Index of Erectile Function-5 (IIEF-5) questionnaire (IIEF-5 >17: Group A, IIEF-5 <17: Group B). The measurements were made in both transverse and longitudinal sections. Results: The mean age of the patients was 60 ±7.9 years. The duration of COPD was significantly higher in Group B than in Group A (p = 0.003). The mean SWE values of right transverse mid-portion of corpus penis (RTM) and left transverse mid-portion of corpus penis (LTM) in Group B (21.1 ±5.6 kPa and 20.8 ±4.8 kPa, respectively) were significantly higher than in Group A (15.2 ±2.3 kPa and 15.8 ±2.7 kPa, respectively); (p <0.001 and p <0.001, respectively). There was a significant negative correlation between IIEF-5 scores and the duration of COPD (p <0.05). There was a significant negative correlation between IIEF values and RTM and LTM values of the patients (p <0.05 and p <0.05, respectively). There was a significant positive correlation between the duration of COPD and both RTM and LTM values (p <0.05 and p <0.05, respectively). Conclusions: In our study, according to the SWE findings, we showed the effect of systemic changes created by COPD on penile tissue and the negative effect of this on erectile function in patients.

Relationship of MRI-measured pelvimetric dimensions and surgical positions with anaesthesia parameters in robotic perineal prostatectomy. / Influencia entre las dimensiones pélvicas medidas por RMN y las posiciones quirúrgicas en parámetros anestésicos durante la prostatectomía radical robótica perineal.

INTRODUCTION AND OBJECTIVE: Theaim of this study was to determine the effect formedby pelvic diameters preoperatively measured throughmultiparametric magnetic resonance imaging (mp-MRI) and different surgical positions on anesthesiaparameters used during perineal robot-assisted radicalprostatectomy (p-RARP). MATERIALS AND METHODS: Six different pelvimetricdimensions were determined preoperatively.Respiratory and hemodynamic variables of the patientswere measured separately and repeatedly in thesupine position, exaggerated lithotomy position at thebeginning of the 15° Trendelenburg position and the60th minute of insufflation. RESULTS: There was a significant increase in thepartial pressure of oxygen (PaO2) in the exaggeratedlithotomy position compared to the supine position.There was no significant change in the partial pressureof carbon dioxide (PCO2) in the exaggerated lithotomyposition compared to the supine position. In the 60thminute of insufflation, there was a significant increasein the PCO2 compared to the supine and exaggerated lithotomy positions. There was no statistically significantchange in the end-tidal carbon dioxide tension(EtCO2), with surgical position or insufflation time. Asignificant negative correlation was observed betweenthe distance of the ischial spines (ISD) and PCO2 change,and a significant positive correlation was observedbetween the angle of the symphysis pubis-seminalvesicles (ASS) and PCO2 change. A significant positivecorrelation was observed between the ASS value andEtCO2 change between the 60th minute of insufflationand exaggerated lithotomy position. CONCLUSION: In our study, the effect caused by differingpelvimetric diameters, surgical positions, andduration of anesthesia during p-RARP on anesthesiaparameters were shown.

INTRODUCCIÓN Y OBJETIVO: Determinarel efecto de los diámetros pélvicos preoperatoriosmedidos a través de la resonancia magnética multiparamétrica(RMNmp) y las diferentes posicionesquirúrgicas en los parámetros anestésicos durante laprostatectomía radical perineal. MATERIAL Y MÉTODOS: Se midieron seis dimensionespélvicas preoperatorias diferentes. Las variablesrespiratorias y hemodinámicas se midieron de formaseparada y repetida en las posiciones de decúbito supino,litotomía forzada al inicio del Trendelemburg a15º y a los 60min de insuflación. RESULTADOS: Se registró un aumento significativo dela presión parcial de oxigeno (PaO2) en litotomía forzada comparada a la posición de decúbito supino. Nohubo cambios significativos en la presión de dióxidode carbono (PCO2) en litotomía forzada comparada condecúbito supino. A los 60min de insuflación, hubo unaumento significativo de la PCO2 comparado con decúbitosupino y litotomía forzada. No hubo cambiossignificativos en la presión máxima de CO2 al final dela espiración (EtCO2) con las posiciones o el tiempo deinsuflación. Se observó una correlación negativa entrela distancia entre las espinas isquiáticas (EEII) y elcambio de PCO2, mientras que se observó correlaciónpositiva entre el ángulo de la sínfisis del pubis-vesículasseminales y el cambio de PCO2. Una correlaciónpositiva se observó entre el valor del ángulo sínfisispubis-vesículas seminales y EtCO2 con respecto a lainsuflación al minuto 60 y la litotomía forzada. CONCLUSIÓN: En nuestro estudio se demuestra lainfluencia de los diámetros pélvicos, las posicionesquirúrgicas y la duración de la anestesia en los parámetrosanestésicos durante la prostatectomía radicalrobótica perineal.

Robotic perineal radical prostatectomy in a patient with a pre-existing three piece inflatable penile prosthesis.

Radical prostatectomy (RP) is the primary and standard treatment for localized prostate cancer. As in many surgical procedures, RP can now be accomplished through minimally invasive methods. RP in a patient with a pre-existing 3-piece inflatable penile prosthesis (IPP) is an exceptional condition and involves coping with many difficulties. In this case report, we aimed to present a patient with pre-existing 3-piece IPP for whom we successfully performed robotic perineal RP (r-PRP).

A nationwide survey on the impact of COVID-19 pandemic on minimal invasive surgery in urology practice.

OBJECTIVE: The beta-coronavirus (COVID-19) pandemic has changed the clinical approach of 93% of urologists worldwide, and this situation has affected the use of laparoscopic and robot-assisted laparoscopic methods, which are known as minimally invasive surgery (MIS). This study aimed to determine the effects of the COVID-19 pandemic on MIS in urology practice at national level. DESIGN, SETTING AND PARTICIPANTS: A total of 234 urologists in Turkey participated in an online survey between August 22 and September 23, 2020. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Descriptive statistical analyses were conducted to determine the participants' demographic characteristics and responses to multiple-choice questions. RESULTS: While 54% of urologists stated that they were concerned about the possibility that the patients planned to undergo MIS were carrying COVID-19 or false-negative for the virus, 51% considered that open surgery was safer than MIS in this regard. The pandemic led to a difference in the preferences of 40% of the urologists in relation to open or MIS methods, and during the pandemic, 39% of the urologists always directed their patients to open surgery. It was determined that during the pandemic, there was a statistical decrease in the intensity and weekly application of MIS methods among all surgical procedures compared to the pre-pandemic (P < .001 and P < .001, respectively). MIS was preferred for oncological operations by 97.3% of the urologists during the pandemic, with the most performed operation being radical nephrectomy (90.7%). Among oncological operations, radical prostatectomy was most frequently postponed. To prevent virus transmission during MIS, 44% of the urologists reported that they always used an additional evacuation system and 52% took additional precautions. There were a total of 27 healthcare workers who took part in MIS and tested positive for COVID-19 after the operation. CONCLUSIONS: Although the number of operations has decreased during the ongoing pandemic, MIS is a method that can be preferred due to its limited contamination and mortality in urology practice provided that safety measures are taken and guideline recommendations are followed.

Comparison of two different grafts for the surgical treatment of peyronie's disease.

The aim of this study was to compare two different graft techniques, namely saphenous vein (SV) and buccal mucosa (BM) used together with plaque incision for the treatment of Peyronie's disease (PD) in terms of success, safety and patient and partner satisfaction. The study included 41 patients diagnosed with PD and treated with plaque incision and grafting between December 2015 and November 2019. Eighteen patients underwent plaque incision and BM grafting while the remaining 23 patients underwent plaque incision and SV grafting. Pre-operative plaque size, curvature angle, curvature start time and penis length were statistically similar between the SV and BM graft groups. No statistical difference was detected between the BM and SV graft groups in terms of the sixth- and 12th-month mean International Index of Erectile Function scores, Patient Global Impression of Improvement scores, penis lengths and final partner satisfaction rates during the follow-up period. Residual curvature was observed in three (13.1%) patients in the SV graft group and two (11.2%) patients in the BM graft group. With their high success and low side effect rates, both grafting techniques with plaque incision can be safely performed for tunical lengthening, based on the surgeon's experience.

Perineoscopic vesicourethral reconstruction: A novel surgical technique for anastomotic stricture following radical prostatectomy.

OBJECTIVE: Vesicourethral anastomotic stenosis (VUAS) is frequently seen after prostate surgery because of various operative and postoperative factors. In this study, we aimed to present our results of perineoscopic bladder neck reconstruction, which is a new technique of the perineal approach in the treatment of patients with VUAS after prostate cancer surgery. MATERIAL AND METHODS: Sixteen consecutive patients who underwent perineoscopic bladder neck reconstruction in our clinic between July 2017 and March 2019 were included in the study. Demographic characteristics, surgical history, postoperative continence status, and additional treatment requirements were recorded. Perineoscopic surgery is defined as the visualization of the surgical site with instruments used in laparoscopy and the surgeon performing the entire operative procedure through the screen. RESULTS: The mean number of preoperative endoscopic bladder neck resections of the patients was 7±5.1, with a history of suprapubic cystostomy in 7 (43.7%) and radiotherapy in 5 (31.2%) patients before surgery. The mean surgical time was 126.2±13.1 min. The mean follow-up period was 13.2±6.8 months, and the success rate was 81.25%. During follow-up, two (12.5%) patients received perineoscopic re-do reconstruction because of stricture recurrence, and one (6.2%) patient was included in a urethral dilatation program. CONCLUSION: Improving visualization and ergonomics with the perineoscopic approach can increase the success rate of bladder neck reconstruction in comparison with the standard approach. In addition, the lack of need for expanded dissection (corporal separation, inferior pubectomy) reduces postoperative complication rates.

Female Urethroplasty With Dorsal Onlay Labia Minora Graft: Technical Details and Initial Results.

OBJECTIVE: The objective of this study was to evaluate the functional results of dorsal onlay labia minora graft urethroplasty in the treatment of female urethral strictures. MATERIALS AND METHODS: Data were retrospectively examined for 13 patients who underwent augmentation urethroplasty through the dorsal approach using labia minora grafts between September 2017 and January 2019. Demographic, intraoperative, and postoperative data and follow-up conditions were recorded for all patients. RESULTS: The mean age of the patients was calculated as 48.2±7 years. The etiology of urethral strictures was found to be trauma in 2 patients, iatrogenic in 4 patients, and idiopathic causes in 7 patients. The mean urethral stricture length of the patients was 1.5±0.4 cm (range, 1-2.5 cm). The mean surgical duration was 95±11.4 minutes (range, 70-110 minutes). The mean postoperative American Urology Association symptom score, maximum urine flow rate, and postmictional residue values were statistically significantly different compared with preoperative data (P < 0.05). No peroperative and postoperative complications were detected in any patients. The mean follow-up duration of the patients was 19±5.3 months, and no recurrence of stricture was observed in any patients based on the cystourethroscopic examinations. All patients are being followed up in our clinic without any stricture recurrence or symptoms. CONCLUSIONS: The dorsal onlay labia minora graft urethroplasty technique in female urethral strictures is an efficient and applicable method with postoperative anatomic and functional results. Studies with longer follow-up periods and larger patient populations are required to present the success and reliability of this technique.

Evaluation of factors affecting sexual dysfunction in female patients with diabetes mellitus

ABSTRACT Objective Our objective in this study was to evaluate the factors predicting female sexual dysfunction (FSD) in patients with diabetes mellitus (DM). Subjects and methods The study included 149 women with DM. Sexual function was evaluated with the Female Sexual Function Index (FSFI) questionnaire, in which total scores under 26.55 characterized the occurrence of FSD (Group 1 > 26.55, Group 2 < 26.55). We recorded the patients' demographic, metabolic, and hormonal data. Ophthalmologic, neurologic, and renal complications were also evaluated. The antioxidant status of the patients in both groups was determined by measuring the activity of the enzymes paraoxonase-1 (PON-1) and arylesterase (ARE). Results Based on the FSFI scores, 60 patients were allocated to Group 1 (26.6 ± 12.3) and 89 to Group 2 (22.6 ± 9.5). Group 2 compared with Group 1 had significantly (p < 0.05) higher mean concentrations of glycated hemoglobin (HbA1c), glucose, triglycerides, and insulin, along with higher rates of metformin use, smoking, retinopathy, and nephropathy. The mean serum ARE concentrations were significantly lower in Group 2 compared with Group 1 (p = 0.000), but the mean serum PON-1 concentrations were similar between both groups (p = 0.218). On multivariable regression analysis, age, ARE activity, Beck Depression Inventory (BDI) score, and menopause were significant independent predictors of FSD (p < 0.05). Conclusions In this study, we evaluated the predictive factors determining FSD caused by DM. Despite the significant results found in our study, future randomized controlled studies with a long follow-up and a larger number of patients are required to determine how DM affects FSD.

Effect of pelvimetric diameters on success of surgery in patients submitted to robot-assisted perineal radical prostatectomy

ABSTRACT Objective: Minimally invasive techniques are used increasingly by virtue of advancements in technology. Surgery for prostate cancer, which has high morbidity, is performed with an increasing momentum based on the successful oncological and functional outcomes as well as cosmetic aspects. Materials and methods: Sixty two patients underwent robot-assisted perineal radical prostatectomy (R-PRP) surgery at our clinic between November 2016 and August 2017. Six pelvimetric dimensions were defined and measured by performing multiparametric magnetic resonance imaging (mpMRI) prior to operation in all patients. In light of these data, we aimed to investigate the effect of pelvimetric measurements on surgery duration and surgical margin positivity. Results: By using this technique in pelvic area, we observed that measurements only representing surgical site and excluding other pelvic organs had a significant effect on surgery duration, and pelvic dimensions had no significant effect on surgical margin positivity. Conclusion: In R-PRP technique, peroperative findings and oncological outcomes can vary depending on several variable factors, but although usually not taken into account, pelvimetric measurements can also affect these outcomes. However, there is a need for randomised controlled trials to be conducted with more patients.

Evaluation of factors affecting sexual dysfunction in female patients with diabetes mellitus.

OBJECTIVE: Our objective in this study was to evaluate the factors predicting female sexual dysfunction (FSD) in patients with diabetes mellitus (DM). SUBJECTS AND METHODS: The study included 149 women with DM. Sexual function was evaluated with the Female Sexual Function Index (FSFI) questionnaire, in which total scores under 26.55 characterized the occurrence of FSD (Group 1 > 26.55, Group 2 < 26.55). We recorded the patients' demographic, metabolic, and hormonal data. Ophthalmologic, neurologic, and renal complications were also evaluated. The antioxidant status of the patients in both groups was determined by measuring the activity of the enzymes paraoxonase-1 (PON-1) and arylesterase (ARE). RESULTS: Based on the FSFI scores, 60 patients were allocated to Group 1 (26.6 ± 12.3) and 89 to Group 2 (22.6 ± 9.5). Group 2 compared with Group 1 had significantly (p < 0.05) higher mean concentrations of glycated hemoglobin (HbA1c), glucose, triglycerides, and insulin, along with higher rates of metformin use, smoking, retinopathy, and nephropathy. The mean serum ARE concentrations were significantly lower in Group 2 compared with Group 1 (p = 0.000), but the mean serum PON-1 concentrations were similar between both groups (p = 0.218). On multivariable regression analysis, age, ARE activity, Beck Depression Inventory (BDI) score, and menopause were significant independent predictors of FSD (p < 0.05). CONCLUSIONS: In this study, we evaluated the predictive factors determining FSD caused by DM. Despite the significant results found in our study, future randomized controlled studies with a long follow-up and a larger number of patients are required to determine how DM affects FSD.

Effect of pelvimetric diameters on success of surgery in patients submitted to robot-assisted perineal radical prostatectomy.

OBJECTIVE: Minimally invasive techniques are used increasingly by virtue of advancements in technology. Surgery for prostate cancer, which has high morbidity, is performed with an increasing momentum based on the successful oncological and functional outcomes as well as cosmetic aspects. MATERIALS AND METHODS: 62 patients underwent robot-assisted perineal radical prostatectomy (R-PRP) surgery at our clinic between November 2016 and August 2017. Six pelvimetric dimensions were defined and measured by performing multiparametric magnetic resonance imaging (mpMRI) prior to operation in all patients. In light of these data, we aimed to investigate the effect of pelvimetric measurements on surgery duration and surgical margin positivity. RESULTS: By using this technique in pelvic area, we observed that measurements only representing surgical site and excluding other pelvic organs had a significant effect on surgery duration, and pelvic dimensions had no significant effect on surgical margin positivity. CONCLUSION: In R-PRP technique, peroperative findings and oncological outcomes can vary depending on several variable factors, but although usually not taken into account, pelvimetric measurements can also affect these outcomes. However, there is a need for randomised controlled trials to be conducted with more patients.

The association between CHA2DS2-VASc score and erectile dysfunction: a cross-sectional study.

PURPOSE: This study aims to assess the association between CHA2DS2-VASc score and erectile dysfunction in patients who were admitted to cardiology outpatient clinics. MATERIALS AND METHODS: One hundred and two male patients who were admitted to the cardiology outpatient clinic were included to the study. Erectile dysfunction was evaluated in the urology outpatient clinic in the same hospital and scored using Turkish Version of The International Index of Erectile Function. CHA2DS2-VASc score was calculated for every patient using the current associated guidelines. RESULTS: There was a negative correlation between The International Index of Erectile Function score and CHA2DS2-VASc score, age, hypertension, heart failure, diabetes mellitus, stroke respectively. Smoking and dislipidemia were not correlated with The International Index of Erectile Function score (p>0.05). CONCLUSION: CHA2DS2-VASc score can be used to detect Erectile dysfunction in patients who are admitted to the cardiology outpatient clinics.

The association between CHA2DS2-VASc score and erectile dysfunction: a cross-sectional study

ABSTRACT Purpose: This study aims to assess the association between CHA2DS2-VASc score and erectile dysfunction in patients who were admitted to cardiology outpatient clinics. Materials and methods: One hundred and two male patients who were admitted to the cardiology outpatient clinic were included to the study. Erectile dysfunction was evaluated in the urology outpatient clinic in the same hospital and scored using Turkish Version of The International Index of Erectile Function. CHA2DS2-VASc score was calculated for every patient using the current associated guidelines. Results: There was a negative correlation between The International Index of Erectile Function score and CHA2DS2-VASc score, age, hypertension, heart failure, diabetes mellitus, stroke respectively. Smoking and dislipidemia were not correlated with The International Index of Erectile Function score (p>0.05). Conclusion: CHA2DS2-VASc score can be used to detect Erectile dysfunction in patients who are admitted to the cardiology outpatient clinics.

Robotic-assisted perineal versus transperitoneal radical prostatectomy: A matched-pair analysis.

OBJECTIVE: We compared the outcomes of robotic-assisted radical perineal prostatectomy (r-PRP) versus robotic-assisted transperitoneal laparoscopic radical prostatectomy (RARP). MATERIAL AND METHODS: Between November 2016 and September 2017 in our center, 40 patients underwent r-PRP, and 40 patients underwent RARP. All patients also underwent multiparametric magnetic resonance imaging (mpMRI) to exclude the cases with locally advanced disease. Patients with localized prostate cancer (C-T2N0M0) were included in the study. The exclusion criteria were contraindications for undergoing robotic radical prostatectomy; the Gleason score ≥4+3; extracapsular extension proven on biopsy or suspected on mpMRI; clinical stage ≥T2c; required pelvic lymph dissection according to Partin's normogram; previous radiation therapy; hormonal therapy; any previous prostatic, urethral, or bladder neck surgery; and preoperative urinary incontinence or erectile dysfunction. Patients were placed in the exaggerated lithotomy position with 15° Trendelenburg for r-PRP and 40° Trendelenburg for RARP. RESULTS: The mean age for the r-PRP and RARP groups were 61.2 (46-73) and 62.2 (50-75) years, respectively. The mean body mass index was significantly higher in the r-PRP group (p=0.02). The mean procedure duration time was 169.4 (100-255) minutes for the r-PRP group and 173.1 (130-210) minutes for the RARP group. The mean console time and anastomosis time were significantly lower for the r-PRP group. The mean estimated blood loss was significantly lower for the r-PRP group (p=0.002). Immediate continence rates in the r-PRP and RARP groups following the urethral catheter removal were 42% and 35% (p=0.30), respectively. Continence rates increased to 94.2% in the r-PRP and 72% in RARP (p=0.001) group at the 6th month, and to 95% in the r-PRP and 85.2% in RARP (p=0.02) group at the 9th month follow-up period. According to the International Index of Erectile Function-5 (IIEF-5), the erectile function rates at the 3-, 6-, and 9-month follow-up in the r-PRP group were 44%, 66%, and 75%, respectively. The rates in the RARP group at the 3-, 6-, and 9-month follow-up were 25%, 42%, and 66% (p=0.001), respectively. CONCLUSION: In our experience, r-PRP has acceptable morbidity, excellent surgical and pathological outcomes, and satisfactory oncologic and functional results compared to RARP.

Evaluation of the results of dorsolateral buccal mucosal augmentation urethroplasty.

OBJECTIVE: Evaluation of the results of dorsolateral buccal mucosal augmentation urethroplasty in patients with a long- segment urethral strictures. MATERIAL AND METHODS: Twenty male patients who underwent urethroplasty in our clinic between November 2015 and January 2017 were evaluated. The outcomes of single-stage dorsolateral buccal mucosal augmentation urethroplasty were retrospectively evaluated. Patients were followed-up at 2nd-3rd weeks, 3rd and 6th months after the operation. RESULTS: Mean age of the patients was 59.45±13.6 years. Mean length of the strictures was 4.59±1.99 cm (3-11 cm) and mean length of buccal mucosal graft was 6.8±1.98 cm (5-13 cm). Mean duration of operation was 149.25±47.39 minutes (95-270 min) and mean blood loss was calculated as 165.5±63.05 mL (75-280 mL). The success rate of dorsolateral buccal mucosal augmentation urethroplasty was calculated as 85% after a mean follow-up of 7.38±2.6 months. There were no perioperative or postoperative complications in the urethroplasty region or the mouth except one patient. Three patients who were found to have a decline in the maximum voiding rate in the postoperative 3rd month were included in the dilation program. CONCLUSION: Single-stage dorsolateral buccal mucosal augmentation urethroplasty is a surgical option to be used in the treatment of long segment urethral strictures with high success and low complication rates in experienced hands.

Comparison of cold-knife optical internal urethrotomy and holmium:YAG laser internal urethrotomy in bulbar urethral strictures.

INTRODUCTION: To compare the results of cold-knife optical internal urethrotomy (OIU) and Holmium:YAG laser internal urethrotomy (HIU) in primary bulbar urethral strictures. MATERIAL AND METHODS: A total of 63 patients diagnosed with primary bulbar urethral stricture between August 2014 and September 2015 were assigned to the OIU (n = 29) and HIU (n = 34) groups. The demographic variables, biochemistry panels, and preoperative and postoperative uroflowmetry results including the maximum flow rate (Qmax) and mean flow rate (Qmean) values, retrograde urethrography, and diagnostic flexible urethroscopy findings were recorded prospectively. Demographic features and preoperative values were not statistically different between groups (p >0.05). Mean surgical times were 18.4 ±2.3 min for OIU and 21.9 ±3.8 min for HIU groups, which was statistically significant (p <0.05). There was no significant difference in complication rates in both groups (p = 0.618). RESULTS: Postoperative Qmax values were increased in both groups even though postoperative Qmax values were not significantly different between the two groups in the short- and long-term results at 3, 6, and 12 months (p >0.05). There was no recurrence in the first 3 months in either group. The urethral stricture recurrence rate up to month 12 was not statistically significant for the OIU group (n = 6, 20.7%) as compared to the HIU group (n = 11, 32.4%; p = 0.299).At follow-up, the SFR and IFR was 96% and 88% at 3-months, and 82% and 71% at 12-months, respectively (p <0.001). While almost three-quarters of patients were stone and infection free at 12-months, the majority of those with stones recurrence also had recurrence of their UTI. CONCLUSIONS: HIU is an alternative method to OIU, and it has similar success rates in the treatment of short segment bulbar urethral strictures.

Robotic perineal radical prostatectomy with high prostate volume.

BACKGROUND: Minimally invasive techniques are ever improving and are preferred more. Many techniques were developed in radical prostatectomy operations. Robotic radical prostatectomy with the perineal approach is a new technique. CASE PRESENTATION: A 66-year-old male patient presented because of lower urinary tract symptoms, a PSA value of 5.5 ng/ml was detected, prostate biopsy was performed under transrectal ultrasound guide, a Gleason 3+3 adenocarcinoma on 3/12 foci was reported at pathology. Robotic perineal radical prostatectomy (r-PRP) operation was performed in the patient who had a prostate volume of 130 cc with middle lobe and a body mass index of 32 without additional disease. The duration of operation was 140 minutes in total and the duration at the console was 95 minutes, the amount of bleeding was 85 cc and no intraoperative complication was detected. CONCLUSION: r-PRP is a technique that can be applied safely without prolonging the operation period and without additional morbidity to the patient, preserving the oncologic and functional outcomes in patients with surgical history and large prostate volume.

Robotic perineal radical prostatectomy and robotic pelvic lymph node dissection via a perineal approach: The Tugcu Bakirkoy Technique.

OBJECTIVE: To describe The Tugcu Bakirkoy robotic perineal radical prostatectomy and pelvic lymph node dissection technique, and present the results of seven patients. MATERIAL AND METHODS: We performed seven robotic perineal radical prostatectomy and pelvic lymph node dissection operation using Da Vinci Xi HD Surgical System (Intuitive Surgical, Inc., Sunnyvale, California, USA) on single Gel-port platform. The operation is completed in 4 stages: stage 1 open perineal dissection and gel port placement, stage 2 robotic perineal radical prostatectomy, stage 3 robotic pelvic lymph node dissection, stage 4 vesico-urethral anastomosis. In addition to describing the operation technique step by step, we aimed to present the perioperative and postoperative findings of the seven patients who underwent The Tugcu Bakirkoy Technique. RESULTS: All operations were successfully completed without any complications in fully the robotic procedure by a single surgeon. Demographic data of the patients were as follows: Mean age (62.1±8 years), mean body mass index (28.2±0.7 kg/m2), mean prostate specific antigen value (10.7±3 ng/mL), and mean prostate volume (64.2±15.3 cc). Mean operative time (184.1±20.2 mins), blood loss (64.2±15.3 cc), hospitalization time (2.1±0.6 days), and time to withdrawal of the urethral catheter (7.8±0.8 days) were also estimated. According to the pathology results, lymph node metastasis was detected in 3 patients while the surgical margin was positive in one. CONCLUSION: We demonstrated for the first time that a new The Tugcu Bakirkoy robotic perineal radical prostatectomy technique which was previously tested in a cadaveric model, can be safely applied for the first time in vivo, and presented our results. On the basis of this, for problems that can not be overcome by traditional methods, this method is a good alternative as a way out. In this regard, it is necessary to carry out advanced studies so that this method can be applied to daily practice.

Scrotal Kaposi's Sarcoma in HIV-negative patient: A case report and review of the literature.

Kaposi's Sarcoma (KS) is a malignancy that generally effects the skin, and can be systemic with internal organ involvement. It originates from the vascular endothelium. KS's relationship with human immunodeficiency virus (HIV) infection is well known. Isolated scrotal KS in the urogenital system is quite rare and scrotal KS in an HIV-negative patient is limited to a few cases. In this case report, the biopsy result from the violescent nodular lesions on the scrotum of the HIV-negative 81-year-old patient was found compatible with KS and a pathology was not detected in the systemic screening. With a diagnosis of isolated scrotal KS, the patient underwent surgical excision aimed at the lesions on the scrotum. KS is rare in HIV-negative patients and it is associated with human herpes virus-8 infection.