Risk Factors of Open Surgery Conversion in Laparoscopic Partial Nephrectomy to Achieve Nephron Sparing.

OBJECTIVES: We aimed to evaluate the risk factors for the conversion from laparoscopic partial nephrectomy (LPN) to open surgery to achieve partial nephrectomy (PN). METHODS: Data from patients who underwent LPN between June 2020 and September 2023 were analyzed retrospectively. Patients in whom the PN procedure could be completed laparoscopically were recorded as the 'Fully Laparoscopic' (FL) group (n = 97), and those converted to open surgery from laparoscopy were recorded as the 'Conversion to Open' (CTO) group (n = 10). The demographic and pathologic variables were compared between groups. Regression analyses were used to define predictor factors, and receiver operating characteristic analysis was used to define the cut-off value of the surgical bleeding volume. RESULTS: Conversion to open surgery was found in 10/107 patients (9.3%). There was no statistical difference between groups in demographic and pathologic variables. Intraoperative blood loss volume, upper pole localized tumor, and posterior localized tumor were found to be statistically higher in the CTO group (p = 0.001, p = 0.001, and p = 0.043, respectively). Furthermore, these factors were only found to be statistically significant predictors of conversion to open surgery in both univariate and multivariate regression analyses. 235 cc was found to be the cut-off value of intraoperative blood loss volume for predicting conversion to open surgery (p = 0.001). CONCLUSION: Using these predictive factors in clinical practice, treatment planning will lead to the possibility of starting the treatment directly with open surgery instead of minimally invasive options, and it may also provide a chance of being prepared for the possibility of conversion to open surgery peroperatively.

A New Nephrometry Score for Predicting Positive Surgical Margin After Laparoscopic Partial Nephrectomy.

PURPOSE: To introduce the KESKIN ratio as a novel predictor of positive surgical margin (PSM) after laparoscopic partial nephrectomy (PN) and to evaluate other clinical characteristics and nephrometry scores (including RENAL, PADUA, and C-index) for predicting PSM. METHODS: We retrospectively analyzed 95 patients who underwent laparoscopic PN between June 2020 and April 2023. The KESKIN ratio was defined for all patients. The KESKIN ratio, tumor and patient-related paramaters, and nephrometry scores were analyzed to predict PSM. RESULTS: Positive surgical margin was found in 12 of 95 patients (12.6%). There was no statistical difference between the PSM and negative surgical margin (NSM) groups in RENAL, PADUA, and C-index scores. Only the KESKIN ratio was found to be a statistically significant predictor of PSM in both univariate and multivariate regression analysis (p = 0.007 and p = 0.043, respectively). Mean endophytic diameter and endophytic percentage were found to be statistically significant predictors of PSM in only univariate analysis (p = 0.005 and p = 0.01, respectively). The value of 0.5 was determined as the cut-off value for the KESKIN ratio. Values higher than 0.5 indicate an increase in PSM. CONCLUSIONS: The KESKIN ratio is a novel, easily measurable, and calculable image-based parameter that can be used to predict PSM after laparascopic PN. If externally validated in a larger patient population, the KESKIN ratio may be used in future versions of the current nephrometry scoring systems for predicting the PSM.

Effect of preoperative single-dose methylprednisolone administration on early postoperative pain following retrograde intrarenal surgery.

PURPOSE: To evaluate the effect of preoperative single-dose methylprednisolone use on postoperative early pain after retrograde intrarenal surgery (RIRS). METHODS: Patients who had 10-20 mm solitary kidney stones and underwent RIRS procedures were included in this prospective cohort study between February 2022 and May 2023. Patients who were administered methylprednisolone at a dose of 1 mg/kg preoperatively were included in group 1 (n: 31), and the other first 90 patients who met the inclusion criteria and did not receive methylprednisolone before surgery were included in group 2 (n: 90). Demographic data, features of stone, postoperative pain at 1, 6, 12, 18, and 24 hour, the need for analgesics, changes in serum glucose levels, and the prevalence of postoperative fever were compared. RESULTS: Age, sex, stone laterality, localization, size, Hounsfield Unit, modified Satava scores, stone-free status, duration of the RIRS procedure, and duration of the ureteral access sheath were found to be similar between groups. Visual Analog Scale (VAS) scores at postoperative 1, 6, 12, 18, and 24 h were found to be statistically significantly lower in group 1 (p = .001, p = .001, p = .001, p = .001, and p = .001, respectively). Similarly, postoperative analgesic requirements were found to be significantly lower in group 1 (p = .048) with a similar postoperative fever rate and changes in serum glucose levels between groups. CONCLUSION: Giving a single dose of methylprednisolone at a dose of 1 mg/kg preoperatively for the RIRS procedure is safe and effective at preventing early pain and the need for analgesics after the RIRS procedure.

Comparison of erectile and ejaculatory functional outcomes between unilateral and bilateral cavernosal rupture in penile fractures.

This study aimed to compare the erectile and ejaculatory functional outcomes of unilateral and bilateral ruptures of the corpus cavernosum in penile fractures. Sixty patients' data were analyzed retrospectively between June 2020 and January 2023. The patients were divided into two groups based on the affected corpus cavernosum (unilateral and bilateral). Preoperative and postoperative 3rd-, 6th-, and 12th-month self-estimated intravaginal-ejaculation-latency-time (IELT), and international index of erectile function-erectile function (IIEF-EF) scores as well as the presence of urethral injury were compared. Bilateral corpus cavernosum fractures were detected in 18.3% of the patients. The IIEF-EF scores of both groups at 3rd-, 6th-, and 12th-month were found to be significantly lower than the preoperative scores (unilateral group:24.1 ± 2.7 vs 23.2 ± 3.5 and 23.3 ± 3.4, respectively, p = 0.011 and 0.014, respectively; bilateral group: 24 ± 1.9 vs 23 ± 1.8 and 23.2 ± 1.5, respectively, p = 0.027 and 0.047, respectively). No significant difference was found between the preoperative and the postoperative 12th month IIEF-EF scores in either group (unilateral group: 24.1 ± 2.7 vs 23.4 ± 3.6, p = 0.207;bilateral group:24 ± 1.9 vs 23.2 ± 1.5, p = 0.057). The self-estimated IELTs of both groups at the postoperative 3rd, 6th, and 12th months demonstrated a significant increase from the preoperative values (unilateral group: 221.6 ± 81.8 vs 252 ± 94.6, 256.5 ± 97.6, and 250.5 ± 104.8, respectively, p < 0.001; bilateral group:241.8 ± 61.6 vs 278.1 ± 55.4, 281.8 ± 56.1, and 283.6 ± 54.2, respectively, p = 0.041, 0.030, and 0.047, respectively). The changes in self-estimated IELTs and IIEF-EF scores between the preoperative period and the postoperative 3rd, 6th, and 12th-months were compared, and no statistical difference was found between patients with unilateral and bilateral corpus cavernosum fractures (p > 0.05). In conclusion, no significant difference in erectile function was found in either group at the 12-month follow-up, and the self-estimated IELTs were found to be prolonged in both groups. Furthermore, no difference was noted between the groups at any follow-up. To explain the effects of unilateral and bilateral injuries on erectile and ejaculatory functions, further studies with a larger-number of patients are necessary.

Transrectal shear wave elastography for detection of prostate cancer.

AIM: To evaluate the value of transrectal shear-wave-elastography(SWE) to differentiate benign and malignant tissues in patients with suspected prostate cancer. MATERIALS AND METHODS: Between January and May 2019, the study was designed as a prospective clinical study. The SWE value of 504 cores measured before biopsy and the pathology result of each core were used in the statistical analysis. The SWE values of benign and malignant cores were compared according to pathology results. ROC analysis was used to calculate the best cut-off SWE value for differentiating malignancy from benign tissues. Specificity, sensitivity, negative, and positive predictive values (NPV, PPV) were also calculated for cut-off value. RESULTS: Prostate cancer was detected in 74 (14.7%) of 504 core biopsies. The mean SWE values were found significantly higher in malignant cores (71.1 kPa) than benign cores (42.3 kPa) (p < 0.001). Cores with gleason score 7 had a significantly higher SWE value than Gleason score 6 (p = 0.009). The cut-off value to differentiate malignancy and area-under-curve were calculated 35.85 kPa, 0.733, respectively. The sensitivity, specificity, NPV, and PPV were 83%, 49%, 78%, and 95%, respectively for 35.85 kPa value. CONCLUSIONS: The malignant tissues have significantly higher SWE values. Also high gleason score was shown to be associated with high SWE values. To predict the prostate cancer, the difference of SWE values of between benign and malignant tissues has high sensitivity. In the near future, to prevent unnecessary prostate biopsies, SWE will be part of the standard protocol for prostate imaging.

The severity of renal colic pain: Can it be predicted?

INTRODUCTION: We aimed to determine whether there was a relationship between the perception of renal colic pain and different psychosocial and physiological factors. METHODS: Between May 2021 and July 2022, we prospectively analyzed 320 patients over the age of 18 who were diagnosed with renal colic occurring unilaterally and secondary to a single kidney stone of any size. Body mass index (BMI), education level, hospital anxiety and depression scale (HADS), somatosensory amplification scale (SAS), and the visual analog scale (VAS) features of stone (diameter, Hounsfield value, and localization) and degree of hydronephrosis were analyzed. Correlation analysis of VAS score and these parameters were completed with Spearman's test. The regression analysis was used to determine the predictive factors of severe pain. RESULTS: There was no significant difference found between sex and VAS scores of colic pain (p=0.122). We found a significant correlation between VAS score and localization of kidney stone, degree of hydronephrosis, and anxiety level of patients. High grade of hydronephrosis and high anxiety level were found to be associated with high VAS scores (p<0.001 and p=0.035, respectively). It was shown that SAS and level of depression did not correlate with pain. Only a high degree of hydronephrosis was found to be a predictive factor for severe pain (p<0.01). CONCLUSIONS: The patient's high anxiety level and a high degree of hydronephrosis were positively correlated with renal colic pain caused by kidney stones. With this study, the severity of pain in patients with a high degree of hydronephrosis and high anxiety can be predicted and may be a criteria to select suitable treatment to reach faster response.

Use of autologous fascia in midurethral sling surgeries; comparison of transobtrator and retropubic ways.

OBJECTIVES: To compare autologous transobturator-tape (A-TOT) and autologous transvaginal tape (A-TVT) surgeries in terms of effectivity and complications. MATERIAL AND METHODS: Preoperative data, duration of the operation, complications and postoperative visual analogue scores were noted. Patients were assessed 12 months after surgery. An objective cure was defined as a negative CST and no need for reoperation due to SUI. Subjective cure was defined as a PGI-I score ≤ 2. Symptom severity and QoL were measured using the total score and the total QoL score of the ICIQ-FLUTS. RESULTS: Retrospectively 44 patients (A-TOT:29, A-TVT:15) were enrolled in this study. Mean follow-18 months. Preoperative parameters were similar. The VAS score at the 8th hour postoperatively was higher in the A-TOT group and similar at the 24th h (p = 0.007 and p = 0.587, respectively). Grade 3 complications according to clavien dindo were only observed in the A-TOT group. At 12 month the objective cure rates according to CST were 96.5% and 100 the subjective cure rates according to PGI-I veew 96.5% and 100%. A positive CST findingwasrecorded in one patient (3.3%) in the A-TOT group. Total score and total quality of life (QoL) scores on the ICIQ-FLUTS were found to be significantly improved in both groups (p = 0.001 and p = 0.001, respectively) (Tab. 4). Similar improvements were found in both groups in the overall and quality of life subscores of the ICIQ-FLUTS filling and voiding sections (p = 0.476, p = 0.315, p = 0.520, and p = 0.448, respectively). CONCLUSIONS: The A-TOT technique has objective, subjective cure, and overall complication rates comparable to those of the A-TVT technique. The use of autologous fascia provides an opportunity to avoid mesh-related complications.