When should contralateral testicular fixation be performed in postpubertal patients with testicular torsion: A comparative study.

OBJECTIVE: In this study, we aimed to describe the timing of contralateral testicular fixation with our ten year results in postpubertal patients with testicular torsion with a patient-based approach. METHODS: Postpubertal patients diagnosed with testicular torsion in a tertiary hospital between January-2012 and September-2022 were divided into 2 groups according to the "patient-based approach" criteria we adopted in our clinic. Group 1 in whom the contralateral teste was fixed in the same surgical act and group 2 in whom the fixation was deferred. Both groups, were retrospectively examined, statistically analyzed and compared. RESULTS: A total of 41 patients were included in the study. Among those, 19 (46.3%) were fixed in the same act, and 22 (53.7%) underwent postponed elective contralateral testicular fixation. Early term wound dehiscence was observed in one patient in each group (4.5% Group 1 vs. 5.3% Group 2). In the postoperative period, no contralateral testicular atrophy or torsion was detected in the study groups during 1-year follow-up. CONCLUSION: There is no algorithm for when contralateral testicular fixation should be performed in postpubertal patients with testicular torsion. Patient-based approaches, in which the clinical characteristics of the patient are prioritized in determining the timing of contralateral testicular fixation, can produce more effective and safe results.

Factors associated with pathological tumor stage and T3a upstage in clinical T1-2 renal cell carcinoma.

INTRODUCTION: Considering the oncological outcomes, understanding the preoperative factors associated with and predicting advanced stage and T3a upstage will help in risk assessment and selection of the right treatment. MATERIAL AND METHOD: Patients with postoperative pathology of Renal Cell Carcinoma (RCC) and stage T1-2 N0M0 were included in the study. Demographic and pathological characteristics of the patients, Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and De Ritis- the ratio of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were recorded. Patients were classified according to T stage (T1-2 vs T3-4) and T3a upstage (T3a upstaged vs non-T3a upstaged). RESULTS: A total of 289 patients participated in the study when inclusion and exclusion criteria were applied. No difference was found between the groups in terms of age, gender, body mass index, laterality, ABO blood group, Rh positivity and comorbidities. According to multivariate analysis, PLR, AST/ALT, Fuhrman grade, open radical nephrectomy (RN) and Clear Cell pathological subtype were found to be significant-independent factors in predicting advanced stage (T3-4) and T3a upstage (P<0.05). CONCLUSION: It was found that higher PLR and AST/ALT ratios were associated with more advanced stage and postoperative T3a upstage in RCC patients. In addition, these patients more frequently had open RN and had higher Fuhrman grades, while the clear cell subtype was less common.

A novel model using computed tomography parameters to predict shock wave lithotripsy success in ureteral stones at different locations.

OBJECTIVE: To combine non-contrast computerized tomography (NCCT)-based parameters with stone and patient characteristics that are already known to affect shock wave lithotripsy (SWL) success and assess this novel model's effectiveness in predicting SWL success for single ureteral stones in different locations. MATERIALS AND METHODS: Data of patients treated by SWL for a single ureteral stone between January 2017 and January 2019 were retrospectively reviewed. Demographic parameters of patients and stone characteristics were combined with NCCT-based parameters. NCCT-based parameters included the presence or absence of hydronephrosis, perinephric stranding, periureteral edema, diameter of the proximal ureter, ureteral wall thickness (UWT) at ureteral stone site. The logistic regression method was used for the development of a useful predictive model. Subsequently, the receiver operating curve was used to determine cut-off levels, and a scoring system was developed for prediction of SWL success. RESULTS: Stone-free rate was 77,1% (267/346) in the entire cohort. Univariate analysis revealed that age, stone volume, density, perinephric stranding, diameter of proximal ureter, and UWT, were associated with SWL success. In multivariate analysis, proximal ureteral stone location, stone volume, density, and UWT were independent predictors of SWL success. The formula used during logistic regression analysis was: 1/[1 + exp {-8.856 + 0.008 (stone volume) + 0.002 (stone density) + 0.673 (UWT) + 1026 (proximal ureteral stone)}]. The scores of 0, 1, 2, 3 and 4 were associated with 97,8%, 83,4%, 60,8%, 33,2% and 11,1% success rates, respectively, in the prediction model based on these parameters. CONCLUSION: We conclude that our model can facilitate decision-making for SWL treatment of ureteral stones in different locations.

Does time elapsed between urine culture and retrograde intrarenal surgery affect the rate of systemic inflammatory response syndrome?

OBJECTIVE: To identify the preoperative and intraoperative factors that might cause systemic inflammatory response syndrome (SIRS) after retrograde intrarenal surgery (RIRS), and to investigate the effect of time elapsed between the date of performing preoperative bladder urine culture (PBUC) and surgery date on postoperative SIRS. MATERIALS AND METHODS: Four hundred sixty-seven patients who had RIRS between January 2013 and June 2020 constituted the target population of this study. PBUC were obtained from all patients before undergoing surgery. Postoperatively, patients were closely monitored for fever and other signs of SIRS. Univariate and multivariate logistic regression analysis were performed to reveal the predictive factors for SIRS after RIRS. RESULTS: The entire study cohort consisted of 467 patients. The rate of SIRS was 5.6%. In univariate analysis, the rate of DM, recurrent urinary tract infection (UTI) history, surgical time, and stone burden were significant predictive factors for SIRS. In multivariate analysis, the rate of recurrent UTI history, surgical time and stone burden were observed to be statistically significant predictive factors. Time elapsed between the date of performing PBUC and surgery date was not different between the SIRS group and the normal group. CONCLUSION: We conclude that the time between the date of performing PBUC and surgery date is not an influential factor for SIRS. Clarifying this issue with prospective studies may be useful, as endourologists frequently encounter this situation in daily practice.