Two-step treatment model for the adult patients with an obstructed kidney functioning below 10% of its capacity: a pilot study.

BACKGROUND: There is no written consensus as to when and in what conditions simple nephrectomy should be performed for hypo-functioning obstructed kidneys. We aimed to assess renal function and the requirement of nephrectomy in patients that underwent percutaneous nephrostomy (PCN) despite being indicated for nephrectomy due to a split renal function of less than 10% caused by ureteral obstruction. METHODS: This prospective study includes 18 patients with unilateral upper urinary tract obstruction and renal parenchymal loss on Technetium-99 m dimercaptosuccinic acid (DMSA) scintigraphy. Each patient underwent DMSA scan (DMSA-1) prior to PCN. After a 2-week follow-up period, a second DMSA scan was performed to assess renal function of each kidney (DMSA-2). Nephrectomy was performed in the kidneys functioning below 10% of their capacity, whereas kidneys functioning above 10% of their capacity were treated as appropriate to their etiologies. Renal functions and DMSA results were compared before and after nephrostomy with Paired-samples t-test and one-way ANOVA. RESULTS: Following nephrostomy, 8 (44.4%) patients had a kidney functioning above 10% of its capacity on DMSA scan and received etiology-based treatment. Glomerular filtration rates of these patients also improved significantly. A total of 9 patients who did not improve renal functions underwent nephrectomy. CONCLUSION: The results indicated that in obstructed kidneys functioning below 10% of their capacity, renal function can be recovered by using a diversion technique (such as PCN) that could alleviate the pressure within the renal pelvis and kidney parenchyma, instead of directly performing simple nephrectomy.

Comparison of pain levels in fusion prostate biopsy and standard TRUS-Guided biopsy.

OBJECTIVES: Fusion prostate biopsy (FPB) has recently emerged as a popular and successful biopsy technique on diagnosis of prostate cancer. The aim of this study was to compare the pain levels in TRUS-guided standard 12-core prostate biopsy (SPB) and MpMRI-guided FPB. MATERIALS AND METHODS: Patients detected with a PI-RADS (Prostate Imaging Reporting and Data System) ≥3 lesion on MpMRI underwent MpMRI-guided FPB (Group I) and the patients who had no suspected lesions or had a PI-RADS<3 lesion on MpMRI underwent TRUS-guided SPB (Group II). Pain assessment was performed using Visual Analog Scale (VAS) five minutes after the procedure. Following the procedure, the patients were asked to indicate the most painful biopsy step among the three steps. RESULTS: 252 patients were included in this study (Group I=159, Group II=93). The mean number of cores and the malignancy detection rate were significantly higher in Group I compared to Group II (p<0.001, p=0.043, respectively). No significant difference was found between the two groups with regard to VAS scores (p=0.070). The most painful part of the whole procedure was revealed to be the insertion of the probe into the rectum. However, no significant difference was found between the two groups with regard to the most painful biopsy step (p=0.140). CONCLUSION: FPB, with a relatively higher cancer detection rate, leads to the same pain level as SPB although it increases the number of biopsy cores and involves a more complex procedure compared to SPB. Further prospective studies with larger patient series are needed to substantiate our findings.

Comparison of the Upgrading Rates of International Society of Urological Pathology Grades and Tumor Laterality in Patients Undergoing Standard 12-Core Prostate Biopsy versus Fusion Prostate Biopsy for Prostate Cancer.

BACKGROUND: Histopathological discrepancies between biopsy and radical prostatectomy (RP) specimens may lead to unnecessary, excessive, or incomplete treatment in prostate cancer (PCa) patients. OBJECTIVES: To compare the upgrading rates of International Society of Urological Pathology (ISUP) grades and tumor laterality in patients that underwent standard 12-core transrectal ultrasound-guided standard prostate biopsy (SPB) versus multiparametric magnetic resonance-guided fusion prostate biopsy (FPB) for PCa. METHODS: This retrospective study included 152 patients that underwent prostate biopsy and RP in our clinic. The patients were divided into 2 groups: Group A (n = 90) included patients that underwent SPB and Group B (n = 62) included patients that underwent FPB (targeted biopsy + standard biopsy). Upgrading of ISUP grades, tumor laterality, and upgrading of tumor laterality were compared between the 2 groups. Upgrading of tumor laterality defined as detection of tumor at both lobes in RP pathology while it was at unilateral lobe in biopsy pathology. RESULTS: ISUP grade 1 was the most common histopathology in both groups. The ISUP upgrading rate on final pathology was significantly lower in the FPB group compared to the SPB group (22.7 vs. 37.7%; p < 0.048). Similarly, the upgrading rate of tumor laterality was lower in the FPB group compared to the SPB group (37.7 vs. 9.7%; p < 0.001). CONCLUSION: The results suggested that FPB can provide more accurate results compared to SPB.

Comparison of infection and urosepsis rates of ciprofloxacin and ceftriaxone prophylaxis before percutaneous nephrolithotomy: a prospective and randomised study.

This study aimed at determining the choice and administration duration of ideal antibiotic prophylaxis before percutaneous nephrolithotomy (PNL) operation, a treatment modality for nephrolithiasis. The study included 90 patients who had no internal problem, yet had a negative urine culture and underwent a PNL operation. We compared infection rates between ciprofloxacin and ceftriaxone groups and their subgroups. The results showed no statistical difference between ciprofloxacin and ceftriaxone groups in terms of systemic inflammatory response syndrome (SIRS) (CIP(P) = 0.306, CTX P = 0.334. As a result of this study no statistical difference was observed between ciprofloxacin and ceftriaxone in terms of SIRS. It seems, however, reasonable to choose ceftriaxone, considering antibiotic sensitivity of microorganisms and detection of three cases accepted as urosepsis in the ciprofloxacin group. As there is no difference between short, and long-term prophylactic use of these antibiotics, preference of short-term prophylaxis for patients with no risk of infection will be important to avoid inappropriate antibiotic usage.

The ectopic ureter opening into the vulva, which is a rare cause of lifelong urinary incontinence: Treatment with ureteroureterostomy.

Persistent urinary incontinence (UI) in adults may indicate a congenital anomaly. Before initiating medical treatment in these patients, a detailed physical examination is necessary for establishing an accurate diagnosis. In this study, we report on a patient who presented with the complaint of congenital UI associated with ectopic ureter and was detected with a right complete duplex collecting system and a ureter opening into the vulva and the surgical treatment applied to that patient.

Symptomatic paraganglioma of the urinary bladder: A rare case treated with a combined surgical approach.

Pheochromocytomas are tumors of the embryonic chromaffin cells, originating from the embryonic neural crest. The pheochromocytomas developing at extra-adrenal locations are termed paragangliomas, which are extremely rare and account for almost 0.06% of all bladder tumors. In this report, we present a 23-year-old woman who presented with a one-year history of repeated episodes of dizziness, hypertension, intermittent hematuria, and nausea/vomiting that occurred during urination and was operatively treated due to a diagnosis of paraganglioma of the urinary bladder.

Turkish Urologists' preferences regarding antibiotic prophylaxis for transrectal prostate biopsy.

OBJECTIVE: Antibiotic prophylaxis for transrectal prostate biopsy (PB) is very important in preventing infectious complications, and in this study, we aimed to evaluate the antibiotic preferences of Turkish urologist for transrectal PB. MATERIAL AND METHODS: The survey about PB and antibiotic prophylaxis behaviors was administered to urologists working in Turkey who had previously participated in at least one international and one national congress. RESULTS: A total of 237 urologists were included in the study. Antibiotic prophylaxis prior to PB was performed by 234 (98.7%) participants. Rectal swabbing prior to PB was not performed by 227 (95.8%) participants. The most common complication associated with PB was prostatitis (63%), followed by urinary tract infection (29%). Only 25.7% of Turkish urologists reported a single dose of antibiotic prophylaxis. Our participants often administered antibiotic prophylaxis for a period of 3, 5, or 7 days (16%, 21.1%, 35.9%, respectively). The most common antibiotic agent preferred for prophylaxis was ciprofloxacin (65%). CONCLUSION: The biopsy behavior of Turkish urologists was mostly compatible with the literature, but it was revealed that Turkish urologists do not prefer single-dose antibiotic therapy, and their practice patterns regarding the administration of pre-biopsy rectal swabbing are inconsistent with the literature.

Can the expression level of PIWIL 2 gene be a serum marker for prostate cancer? A single-center prospective study.

OBJECTIVE: The aim of the present study was to evaluate the predictive value of the serum expression level of Piwi-like 2 (PIWIL2), a stem cell protein, for prostate cancer (PCa). MATERIALS AND METHOD: This randomized and prospective study included a total of 60 volunteers between 50 and 75 years old. Cases were assigned to three groups according to prostate-specific antigen (PSA) elevations and pathology reports, with 20 participants in each group. The first group included patients with a PSA level of >4 ng/dL and with PCa, the second group included patients with a PSA level of >4 ng/dL and with benign prostate hyperplasia, and the third group included patients with a PSA level of ≤4 ng/dL and with benign prostate hyperplasia. The levels of serum PSA and PIWIL2 expressions were compared between the groups. RESULTS: The median serum PSA levels were 28.5 (4.6-98.1) ng/mL, 8.89 (4.3-24.1) ng/mL, and 2.4 (0.3-3.8) ng/mL for groups 1, 2, and 3, respectively. The PSA levels were significantly different between the groups (p<0.001). The median PIWIL2 gene expression levels were 2.54 (0.28-9.27), 2.27 (0.6-9.38), and 1.17 (0.26-3.07) for groups 1, 2, and 3, respectively. The PIWIL2 gene expression level was found to be lower in patients with a PSA level of <4 (p=0.02). No significant difference was observed between patients with and without cancer among those with a PSA level of ≥4 (p>0.05). Patients diagnosed with cancer were grouped according to the criteria of the International Society of Urological Pathology (ISUP), and PIWIL2 gene expression was observed to be significantly higher among patients with ISUP of >3 than among those with ISUP of ≤3 (p=0.04). CONCLUSION: In our study, it was observed that the serum level of PIWIL2 gene expression could not be a diagnostic indicator of PCa; however, it could be a beneficial prognostic indicator particularly for progressed disease.

Multiparametric MRI fusion-guided prostate biopsy in biopsy naive patients: Preliminary results from 80 patients.

OBJECTIVE: The aim of this prospective study was to evaluate the early results of transrectal prostate biopsies performed under the guidance of multiparametric prostate magnetic resonance imaging (mpMRI) in biopsy naive patients. MATERIAL AND METHODS: Biopsy naive patients who had prostate-specific antigen level 4-10 ng/mL and/or abnormal digital rectal examination findings and provided informed consent were examined using mpMRI. The study included 80 patients with an MRI-defined lesion with a Prostate Imaging and Reporting and Data System (PIRADS) score of ≥3. All mpMRIs were reported by the same uro-radiologist according to PIRADS version 2. An MRI-targeted biopsy was performed by an ultrasonography system with rigid fusion registration software. The first two to five core biopsies per MRI-defined lesions were obtained, and then a standard random 12-core biopsy was performed. Transrectal biopsies were performed under local anesthesia or sedoanalgesia. RESULTS: Of the 80 patients, 29 (36.3%) were found to have cancer using the conventional 12-core biopsy, but only 20 (25%) were found to have prostate cancer using the MRI-targeted prostate biopsy. Combining the two biopsy methods (conventional+MRI-targeted), cancer detection rate increased to 43.8% (35/80 patients). The cancer detection rate using the combined method was statistically higher than that using the conventional biopsy method (p=0.03). Using the conventional biopsy method, 960 core biopsies were collected from 80 patients. Of the 960 core biopsies, 111 (11.6%) were found to be cancer. Further, 101 suspected lesions were detected using mpMRI in 80 patients. In addition, 397 core biopsies were obtained from these lesions. Of the 397 core biopsies, 62 (15.6%) were reported as prostate cancer. The core positivity rate of MR-targeted biopsy was statistically higher than that of conventional biopsy (p=0.04). CONCLUSION: The preliminary results of MRI-targeted prostate biopsy combined with conventional biopsy suggested that the combined biopsy method was crucial in prostate cancer diagnosis especially in patients with prostate cancer suspicion and no biopsy history. However, larger sample prospective studies are needed to validate the effectiveness of MRI-targeted biopsy and combined biopsy methods.