Evaluation of serum fibronectin levels and fibronectin gene polymorphism in patients receiving intravesical BCG therapy for non-muscle invasive bladder cancer and its prognostic value.

BACKGROUND: Bladder cancer continues to be a significant health issue, leading to ongoing research into novel biomarkers and treatment strategies. This study aims to evaluate the potential of serum fibronectin levels and fibronectin gene polymorphisms as biomarkers for predicting the recurrence and treatment response in patients with NMIBC undergoing intravesical BCG therapy. METHODS: Between June 2022 and December 2022, data of 73 patients who applied to the Mersin University Urology Clinic due to NMIBC and were followed and treated in our clinic, receiving intravesical BCG treatment, when necessary, as well as 56 individuals without any malignancy, were prospectively examined. Serum fibronectin levels were measured using the enzyme-linked immunosorbent assay method. PCR testing was applied for the fibronectin gene RS10202709 and RS 35,343,655 gene polymorphisms by using Real-Time PCR. RESULTS: The mean serum fibronectin level in the patient group was 76.794 ± 66.998ng/ml. Simultaneously, it was 50.486 ± 25.156ng/ml in the control group, and these differences in serum fibronectin levels were statistically significant(p = 0.003). Out of the 73 patients included in the study, recurrence of bladder cancer was observed in 53 of them. They were divided into two groups based on the recurrence times: early recurrence and late recurrence. The mean fibronectin level in the early recurrence group was 102 ± 86.1 ng/ml, while it was 44.7 ± 11.8 ng/ml in the late recurrence group. Emphasize the significance of the higher fibronectin levels in the early recurrence group by stating, patients with early recurrence exhibited significantly higher serum fibronectin levels compared to those with late recurrence (p < 0.001), suggesting a potential role for fibronectin as a prognostic biomarker. CONCLUSIONS: The statistically higher concentrations of serum fibronectin levels in patients with bladder cancer observed in our study are a noteworthy finding. These findings suggest that serum fibronectin levels could serve as a valuable prognostic biomarker for early recurrence in NMIBC patients, although their predictive value for BCG treatment response remains limited.

Evaluation of preoperative procollagen type 1 N-terminal peptide and collagen type 1 C-telopeptide levels in the prediction of postoperative hypocalcemia in patients undergoing parathyroidectomy due to primary hyperparathyroidism.

PURPOSE: This study is aimed at investigating the role of preoperative procollagen type 1 N-terminal peptide (P1NP) and collagen type 1 C-telopeptide (CTx) levels in predicting the development of postoperative hypocalcemia in primary hyperparathyroidism (PHPT). METHODS: In this prospective observational study, preoperative complaints of patients with primary hyperparathyroidism and their urea, creatinine, glomerular filtration rate (GFR), calcium, albumin, urinary calcium, parathyroid hormone, and bone mineral density (BMD) were recorded. P1NP and CTx levels were analyzed in blood samples taken the day before surgery, and their relationship with calcium levels obtained on the first postoperative day was examined. RESULTS: The median age was 53 years for patients who developed hypocalcemia and 62 years for those who did not develop hypocalcemia (p = 0.01). The urea, creatinine, and GFR values were determined as 22 mcg/dl, 0.61 mcg/dl, and 105 ml/min, respectively, for the hypocalcemia group (Group 1) and 30.5 mcg/dl, 0.74 mcg/dl, and 90 ml/min, respectively, for the non-hypocalcemia group (Group 2) (p = 0.02, 0.001, and 0.01, respectively). The BMD femur Z-score was - 0.1 in Group 1 and 0.8 in the Group 2 (p = 0.02). The mean CTx values were 4.14 pg/dl and 1.98 pg/dl (p = 0.036), and the mean P1NP values were 252.84 mcg/dl and 269.04 mcg/dl (p = 0.427) for Groups 1 and 2, respectively. According to multivariate analysis, only CTx was a significant independent predictor of hypocalcemia (odds ratio 1.739). CONCLUSION: CTx level is a significant factor in predicting the risk of developing early postoperative hypocalcemia in patients scheduled for surgery due to primary hyperparathyroidism.

The presence of SARS-CoV-2 virus in semen samples of patients with COVID-19 pneumonia.

The SARS-CoV-2 set off a pandemic involving millions of people around the world. The topic of discussion is the possible viral detection in different body fluids than respiratory droplets. Therefore, we evaluated the possible presence of SARS-CoV-2 in semen and urine samples. Thirty patients were included in the study aged 35.67 ± 6.84 years. The day after the pharyngeal and/or nose swab of SARS-CoV-2 was positive, urine and semen samples were taken from patients, and the presence of SARS-CoV-2 was investigated. Laboratory tests and chest CT findings were evaluated simultaneously. SARS-CoV-2 was detected in four (13.3%) patients' semen samples and in seven (23.3%) patients' urine samples. White blood cell (WBC), neutrophil, C-reactive protein (CRP), ferritin, alanine transaminase (ALT), lactate dehydrogenase (LDH) and procalcitonin were significantly higher in patients with SARS-CoV-2 in semen (p < .05), though no statistical difference was found in urine (p > .05). Patients with severe pneumonia findings in Chest CT images are likely to be PCR positive in semen and urine samples (p = .005, p = .001). SARS-CoV-2 was not detected in urine and semen samples of patients after they had recovered (average duration 23 ± 4 days). SARS-CoV-2 can be detected in the urogenital fluids of patients with severe clinical conditions and high viral load.

Central neck dissection is an independent risk factor for incidental parathyroidectomy.

OBJECTIVE: This study aims to determine the frequency of incidental parathyroidectomy (IP), to reveal the risk factors and to present the clinical importance of IP through the experiences of our clinic. MATERIALS AND METHODS: Patients undergoing thyroid surgery between June 2016 and May 2019 were reviewed retrospectively. Along with demographic data, surgery reports, pathology results and postoperative follow-up data were examined. Factors assumed to be associated with IP and postoperative hypocalcemia were compared between the IP group and the non-IP group. RESULTS: A total of 633 patients with a mean age of 48 ± 13 years were included in this study. IP was detected in 138 (21.8%) patients and parathyroid glands were localized 29.72% intrathyroidal. Postoperative hypocalcemia in the IP group was approximately 2-fold higher than the no-IP group (%15.94 to %7.27), (p < .001). Gender (p = .014), body mass index (p = .021), both preoperative and postoperative diagnosis of malignancy (p < .001) and performing central neck dissection (CND) (p < .001) were significantly associated with IP in univariate analysis. However, multivariate analysis demonstrated that CND was independently associated with IP (OR = 0.301, 95% Cl: 0.161-0.562, p < .001). CONCLUSION: This study reveals that IP increases the frequency of postoperative temporary and permanent hypocalcemia in patients undergoing thyroid surgery, and CND is the only independent risk factor for IP. Highlights of the study This study reveals that central neck dissection is the most important and only independent risk factor for incidental parathyroidectomy in patients undergoing thyroid surgery. According to our analysis, both temporary and permanent hypocalcemia, which occurs in the postoperative period, are associated with incidental parathyroidectomy.

Can preoperative modified systemic inflammation score (mSIS) be used to predict malignancy in persistent nondiagnostic thyroid nodules?

Background/aim: Despite the use of ultrasound guidance, a significant part of thyroid biopsies are nondiagnostic (ND). We aimed to investigate the utility of the preoperative modified systemic inflammation score (mSIS) to predict malignancies in patients with persistent ND thyroid nodules (TNs). Materials and methods: Records of 924 patients underwent thyroidectomy between September 2016 and May 2019 were retrospectively reviewed. The calculation of mSIS was as follows: mSIS 0 [patients with albumin (ALB) ≥ 4.0 g/dL and lymphocyte to monocyte ratio (LMR) ≥ 3.4], mSIS 1 [ALB < 4.0 g/dL or LMR < 3.4], and mSIS 2 [ALB < 4.0 g/dL and LMR < 3.4]. Results: One hundred and thirty-six patients were included in the study. Of the patients with a median age of 49 (21­81) years, 26 (19.1%) were male, and 110 (80.9%) were female. Besides low lymphocyte count (P = 0.03), and ALB levels (P < 0.01), higher BMI (P = 0.02) were also associated with malignancy. In patients classified as mSIS 2, 1 and 0; malignancy rates were 100%, 25.8%, and 16.1%, respectively. The association between preoperative mSIS and thyroid malignancies was statistically significant (P < 0.01). Conclusion: We recommend that when patients with persistent ND TNs are assigned to mSIS 2 or 1, surgery should not be delayed due to the risk of malignancy.

The effect of testosterone replacement therapy on bladder functions, histology, apoptosis, and Rho-kinase expression in bladder outlet obstruction and hypogonadism rat model

Background/aim: The effect of testosterone replacement therapy was investigated on bladder functions, histology, apoptosis as well as Rho-kinase expression in the rat bladder outlet obstruction (BOO) and hypogonadism models. Materials and methods: 30 mature male rats divided into 4 groups: sham group (n = 8), BOO group (n = 8), BOO + orchiectomy group (n = 7), BOO + orchiectomy + testosterone (T) treatment group (n = 7). Cystometric findings, apoptosis index, Rho-kinase (ROCK-2) expression, and smooth muscle/collagen ratio were compared. Results: BOO did not change ROCK-2 expression level, compared to sham group (P > 0.05). However, when compared to BOO group (P < 0.01), BOO + orchiectomy led ROCK-2 increase. The testosterone treatment failed to reverse the up-regulation of ROCK-2 induced by orchiectomy although it tended to lower ROCK-2 level. Compared to sham group (P = 0.002), changes in maximal bladder capacity and leak point pressure were higher (P = 0.026, P = 0.001), and bladder compliance was lower in BOO group. Also, the apoptosis index was different between the two groups (P = 0.380). Smooth muscle/collagen ratio was higher in BOO + orchiectomy + T group than in BOO + orchiectomy group (P = 0.010). Conclusions: The research draws attention to alternating treatment approaches in case of the presence of hypogonadism and BOO.

Effect of microsurgical varicocele repair on sexual functions and testosterone in hypogonadal infertile men with varicocele.

OBJECTIVE: To investigate effect of microsurgical varicocele repair on sexual functions and serum total testosterone level in infertile hypogonadal men with varicocele, and also to determine factors that might predict improvement in total testosterone level after surgery. METHODS: The study included 202 infertile hypogonadal men (total testosterone level of <3.5 ng/mL) with varicocele who underwent microsurgical sub-inguinal varicocele repair. RESULTS: Mean serum total testosterone level significantly increased from 2.55 ± 0.66 ng/mL to 3.72 ± 1.34 ng/mL after varicocelectomy (p = .000), and 105 patients (52%) had serum total testosterone level of ≥3.5 ng/mL after the surgery. Mean international index of erectile functions (IIEF-EF) score significantly increased from 27.47 ± 2.96 to 28.61 ± 2.02, post-operatively (p = .000). Of the patients who had pre-operative IIEF-EF score of ≤26, 65.5% had IIEF-EF score of ≥26 after varicocelectomy. Of the patients who had pre-operative decreased libido, 86.6% had post-operative increased libido. Only older patient age was the predictor for having total testosterone level of ≥3.5 ng/mL after the surgery (p = .031). CONCLUSIONS: Data suggest that serum total testosterone level, IIEF-EF score and sexual libido significantly increase after varicocele surgery. As the age increases, total testosterone level increased after varicocele surgery. Therefore, varicocele repair could be offered to hypogonadal men with clinically varicocele.

Effect of serum total testosterone and its relationship with other laboratory parameters on the prognosis of coronavirus disease 2019 (COVID-19) in SARS-CoV-2 infected male patients: a cohort study.

OBJECTIVE: To investigate effect of serum total testosterone and its relationship with other laboratory parameters on the prognosis of coronavirus disease 2019 (COVID-19) in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected male patients. METHODS: This prospective cohort study included 221 consecutive male patients (>18 years old) with laboratory confirmed SARS-CoV-2 who had been hospitalized due to COVID-19. The patients were divided into 3 groups: Asymptomatic patients (n: 46), symptomatic patients who were hospitalized in the internal medicine unit (IMU) (n: 129), and patients who were hospitalized in the intensive care unit (ICU) (n: 46). RESULTS: As serum total testosterone level at baseline decreases, probability (%) to be in the ICU significantly increases (p = 0.001). As serum total testosterone level at baseline decreases, probability (%) of mortality significantly increases (p = 0.002). In the patients who had pre-COVID-19 serum gonadal hormones test (n: 24), serum total testosterone level significantly decreased from pre-COVID-19 level of 458 ± 198 ng/dl to 315 ± 120 ng/dl at the time of COVID-19 in the patients (p = 0.003). CONCLUSIONS: COVID-19 might deteriorate serum testosterone level in SARS-CoV-2 infected male patients. Low serum total testosterone level at baseline has a significant increased risk for the ICU and mortality in patients with COVID-19.

The prognostic value of different node staging systems in patients with ≤15 lymph nodes following surgery for gastric adenocarcinoma.

AIM: Lymph node (LN) status is an important prognostic indicator in patients with gastric cancer (GC). Although American Joint Committee on Cancer/International Union against Cancer (AJCC/UICC) is the most widely used staging system, there is a challenge in predicting survival of patients when the number of total harvested LNs is ≤15. Our aim was to investigate the prognostic performances of seventh edition AJCC/UICC, lymph-node ratio (LNR), and log odds of metastatic lymph nodes (LODDS) on the overall survival (OS) of GC patients with ≤15 examined LNs after gastric resection. MATERIAL AND METHOD: A total of 74 patients who underwent curative resection for gastric adenocarcinoma and had ≤15 LNs at the final histopathological examination were included in the study. The prognostic ability of three node staging models to predict OS was assessed using the area under the curve (AUC). RESULTS: Of the 74 patients, 15 (20.3%) had no LN metastasis whereas 59 (79.7%) had nodal involvement. The median OS was 26 months. When assessed as a continuous variable, LNR was the strongest staging system to stratify GC patients on the basis of LN status. LODDS had superiority on other node staging models when the number of LNs retrieved was modeled as categorical variable. CONCLUSIONS: LNR (continuous) and LODDS (categorical) were the strongest indicators of OS in GC when the number of LN harvested was ≤15. Therefore, they may be considered as an alternative nodal staging systems for GC.

Red cell distribution width as a predictor of mortality in acute pancreatitis.

INTRODUCTION: Acute pancreatitis (AP) is a common cause for hospitalization worldwide. Identification of patients at risk for mortality early in the course of AP is an important step in improving outcome. Red cell distribution width (RDW) is reflective of systemic inflammation. The objective of this study was to investigate the association between RDW and mortality in patients with AP. METHODS: A total of 102 patients with AP were included. Demographic data, etiology of pancreatitis, organ failure, metabolic disorder, hospitalization time, and laboratory measures including RDW were obtained from each patient on admission. RESULTS: Estimating the receiver operating characteristic area under the curve showed that RDW has very good discriminative power for mortality (area under the curve = 0.817; 95% confidence interval, 0.689-0.946). With a cutoff value of 14.8 for RDW, mortality could be correctly predicted in approximately 77% of cases. CONCLUSIONS: Red cell distribution width on admission is a predictor of mortality in patients with AP.

Artificial neural network analysis for evaluating cancer risk in multinodular goiter.

BACKGROUND: The aim of this study was to create a diagnostic model using the artificial neural networks (ANNs) to predict malignancy in multinodular goiter patients with an indeterminate cytology. MATERIALS AND METHODS: Out of 623 patients, 411 evaluated for multinodular goiter between July 2004 and March 2010 had a fine-needle aspiration biopsy. All patients underwent total thyroidectomy. The interpretation was consistent with an indeterminate lesion in 116 (18.6%) patients. Patient's medical records including age, sex, dominant nodule size, pre-operative serum thyroid-stimulating hormone level, thyroid hormone therapy and final pathologic diagnosis were collected retrospectively. RESULTS: The mean age of the patients was 44.6 years (range, 17-78 years). About 104 (89.7%) were female and 12 (10.3%) were male patients. Final pathology revealed 24 malignant diseases (20.7%) and 92 (79.3%) benign diseases. After the completion of training, the ANN model was able to predict diagnosis of malignancy with a high degree of accuracy. The area under the curve of ANNs was 0.824. CONCLUSION: The ANNs technique is a useful aid in diagnosing malignancy and may help reduce unnecessary thyroidectomies in multinodular goiter patients with an indeterminate cytology. Further studies are needed to construct the optimal diagnostic model and to apply it in the clinical practice.

D1 versus D2 dissection in gastric carcinoma: Evaluation of postoperative mortality and complications.

OBJECTIVE: Surgery is the only curative treatment for patients with gastric cancer. However, the extent of lymph node dissection is still debated. The aim of the study was to evaluate complications, postoperative length of hospital stay and postoperative mortality after D1 or D2 lymph node dissection for gastric cancer in a non-specialized hospital. MATERIAL AND METHODS: All patients who underwent surgery for pathologically confirmed gastric cancer at our 3rd General Surgery Department, Ankara Numune Training Hospital between January 1999 and 2007 were retrospectively reviewed. A consecutive series of 71 gastric cancer patients was identified. D1 resection (level 1 lymphadenectomy) was compared with D2 resection (levels 1 and 2 lymphadenectomy). RESULTS: The D2 group had higher postoperative mortality (16% vs. 8%; p<0.005) and morbidity (54% vs. 34%; p<0.005), and their postoperative length of stay was longer. Splenectomy did not have an effect on postoperative morbidity and mortality in either the D1 or the D2 group. CONCLUSION: The D2 procedure was associated with significantly higher postoperative mortality, morbidity, and postoperative length of hospital stay.

Primary hydatid cyst of the axilla: report of a case.

OBJECTIVE: The aim of this work was to report a case of hydatid cyst located in the axilla. CLINICAL PRESENTATION AND INTERVENTION: A 36-year-old female presented with a painless right axillar swelling of 6 months duration. We removed the entire cyst surgically, and macroscopic and histopathological examinations confirmed the diagnosis of axillar hydatid disease. Seventeen months after the operation there was no recurrence. CONCLUSION: This case report showed that in cases of a cystic mass in an endemic zone, the diagnosis of hydatid cyst should be considered.

The effect of intraoperative neuromonitoring on the number of lymph nodes excised and recurrence when applied during neck dissection in cases of papillary thyroid cancer.

PURPOSE: The aim of this study was to evaluate the effect of neuromonitoring on the number of lymph nodes (LNs) removed when applied during neck dissection. METHODS: A total of 166 patients receiving neck dissection due to papillary thyroid cancer were separated into 2 groups (monitoring group, n = 76; non-monitoring group, n = 90). RESULTS: The number of LNs dissected was observed to be statistically significantly higher in the monitoring group (P = 0.001), and the difference between the groups in the number of positive LNs was significant (P = 0.031). There was seen to be a negative relationship between the number of positive LNs dissected and recurrence (r = -0.404, P = 0.005). CONCLUSION: Intraoperative neuromonitoring during neck dissection makes a positive contribution to the prevention of the development of recurrence by increasing the number of LNs excised and the number of metastatic LNs.

An Evaluation of the Factors Affecting Failure of the Procedure in Reoperated Thyroidectomies: A Retrospective Analysis.

BACKGROUND: The aim of this study was to determine the factors affecting procedure failure in revision thyroidectomy surgery. METHODS: A total of 148 patients applied with revision surgery were separated into 2 groups according to the surgical success status. Comparisons were made of the 2 groups of patients where residual tissue was totally excised (Group 1, n:132) and patients where residual tissue could not be completely excised (Group 2, n:16). The patients were examined in respect of factors affecting the success of the procedure. RESULTS: The patients comprised 133 (89.9%) females and 15 (10.1%) males with a mean age of 49.68±12.02 years. Surgical failure was observed in 7 patients as the lesion could not be determined despite the use of intraoperative USG, and in 9 patients because of weak signal or signal loss. The determination of residual tissue ≤25mm on preoperative USG examination was seen to have a significant negative effect on surgical success (r=-0.329, p0.001). The patient having undergone ≥3 previous operations was determined to have a negative effect on surgical success (r=-0.229, p=0.005), and nerve damage on the opposite side to the lesion in a previous surgical procedure was determined to be the most important factor with a negative effect on surgical success (r=-0.571, p<0.001). In multinomial logistic regression analysis of the factors affecting success, the preoperative presence of nerve damage in the contralateral lobe to the lesion (OR: 33.11, 95% CI: 4.22-192.28, p<0.001) and lesion size ≤25 mm (OR: 10.10, 95% CI: 3.54-75.01, p=0.001) were determined to contribute significantly to surgical failure. CONCLUSION: The results of this study clearly showed that as residual tissue size ≤25mm and contralateral nerve damage in the preoperative ultrasonographic evaluation are associated with surgical failure, alternative treatment methods such as radioactive iodine ablation may be preferred in these patients.

Which surgical procedure offers the best treatment for pilonidal disease?

PURPOSE: Our aim was to determine the most effective surgical procedure for treatment of pilonidal disease, by comparing different surgical techniques. METHODS: A total of 354 patients who underwent operation for pilonidal disease were enrolled in this prospective study. The data included patient's demographic characteristics, age, gender, body mass index, occupation, smoking, concomitant diseases, surgeon's experience, wound-healing problems (wound separation and infection), time to return to work, and development of recurrence. RESULTS: Of the 354 patients, total excision + primary closure was performed in 133 (37.6%), D-flap in 101 (28.5%), Karydakis technique in 74 (20.9%), and Limberg flap surgery in 46 (13%). The male/female ratio was 8.5:1, which is a statistically significant difference (p < 0.05). The average follow-up period was 37 months (range, 12-97 months); during this period, wound-healing problems were observed in 70 (19.7%) patients, and 34 (9.6%) patients developed recurrence. There was no difference in the rate of recurrence of pilonidial disease between procedures done by trainees and staff surgeons. Recurrence rates were similar for all four treatment methods (7.5-13.5%). Wound-healing problems were higher for D-flap than for other methods (p = 0.027). The average time to return to work with the D-flap method was longer than that for the other methods (p < 0.01). Recurrence increased 14.44-fold following the development of wound infection. Higher recurrence rates were also noted in obese patients (8.10-fold) and in females (6.72-fold). CONCLUSIONS: Despite the increasing volume of data on the treatment of pilonidal disease, the optimal treatment has yet to be established.

Identification of the recurrent laryngeal nerve during thyroidectomy can affect the complication rate.

AIM: Identification of recurrent laryngeal nerve (RLN), performed via different techniques, decreases nerve injury during thyroidectomy. We aimed to evaluate the effect of different anatomic levels at which RLN was identified on postoperative complications. MATERIAL AND METHODS: The patients underwent total thyroidectomy or lobectomy without lymph node dissection were included. Two different surgical methods were performed: thyroidectomy identifying RLN at level of inferior thyroid artery (ITA) (Group 1); at level of Berry's ligament (Group 2). Patients were evaluated with indirect laryngoscopy on 3rd postoperative day, if nerve damage was determined, at each six months. Nerve damage and postop hypocalcemia were accepted transient up to 6th month, permanent after 6th month. Total serum calcium levels were postoperatively measured on 24th and 48th hours, and then monthly. RESULTS: Unilateral and bilateral RLN damage were detected as 4.4% and 2.2% in Group 1; and 8% and 2.67% in Group 2, respectively. The frequency of RLN damage was similar (p=0.62). Postoperative hypocalcemia was significantly higher in Group 1 (p=0.04); hypocalcemia was similar (p=0.149). One patient in Group 1, and 2 patients in Group 2 had f superior laryngeal nerve (SLN) injury. Three patients from each group showed permanent hypocalcemia. One patient in Group 1, and two in Group 2 developed permanent hoarseness. DISCUSSION: RLN injury was similar in both groups, however, temporary hypocalcemia was more frequent in patients undergone thyroidectomy with RLN identification at ITA level. CONCLUSIONS: Devascularization of parathyroid glands may be accused. Future studies are needed. KEY WORDS: Recurrent laryngeal nerve, Thyroidectomy.

Is there any priority between the alpha blockers on voiding functions after transrectal ultrasound guided prostate biopsy?

OBJECTIVE: Transrectal ultrasound-guided prostate biopsy is the gold standard in the diagnosis of prostate cancer. Major and minor complications may develop at varying rates after prostate biopsies, one of which is voiding impairment. This study aimed to evaluate whether all alpha1-blockers were effective in preventing voiding impairment after a transrectal ultrasound-guided prostate biopsy and if so, was one superior to the others. MATERIAL AND METHODS: This study included 240 patients who underwent a transrectal ultrasound-guided 12-core prostate biopsy and were prospectively randomized. Of the patients, 40 received 10 mg alfuzosin, 40 received 4 mg doxazosin, 40 received 8 mg silodosin, 40 received 0.4 mg tamsulosin, and 40 received 5 mg terazosin beginning on the day before the biopsy and for the following 30 days. The international prostate symptom score (IPSS), maximal flow rate, and post-void residual urine were recorded in all the patients before the procedure and on post-biopsy days 7 and 30. All he patients were followed up and questioned about voiding difficulty and acute urinary retention after the procedure. RESULTS: In all the alpha1-blocker groups, the IPSS and post-void residuals were statistically significantly lower, and the maximal flow rate was statistically significantly greater on post-biopsy days 7 and 30 compared with the baseline values (p<0.05). No patient in any of the alpha1-blocker groups developed acute urinary retention after the biopsy. CONCLUSION: To prevent voiding impairment and deterioration in the quality of life after a prostate biopsy, preemptive therapy with alpha1-blockers may have a protective role, especially in patients with large prostate volumes.

Diagnostic value of modified systemic inflammation score for prediction of malignancy in patients with indeterminate thyroid nodules.

BACKGROUND: Approximately 20% of the thyroid biopsies render an indeterminate (ID) cytology. We evaluated the diagnostic value of preoperative modified systemic inflammation score (mSIS) in predicting the malignancy of ID thyroid nodules (TNs). METHODS: Data of 162 patients with indeterminate TNs were examined retrospectively. The mSIS was calculated as follows: mSIS 0 [patients with albumin (ALB) ≥ 4.0 g/dL and lymphocyte-to-monocyte ratio (LMR) ≥ 3.4], mSIS 1 [ALB < 4.0 g/dL or LMR < 3.4], and mSIS 2 [ALB < 4.0 g/dL and LMR < 3.4]. RESULTS: Patients were classified into mSIS 0 (n = 105), mSIS 1 (n = 34) and mSIS 2 (n = 23) groups. The malignancy rates for the mSIS 0, 1 and 2 groups were 34.3%, 64.7% and 100% respectively. Preoperative mSIS was significantly associated with the presence of thyroid malignancy (p < 0.001). CONCLUSIONS: If the mSIS of patients with ID cytology is 1 or 2, appropriate surgical treatment should be performed without delay, due to the increased risk of malignancy.