Our experience on Fournier's gangrene in a tertiary-stage care center and analysis of its relationship with blood count parameters.

BACKGROUND: Fournier's gangrene (FG) is rapidly progressing and life-threatening necrotizing fasciitis of genital and perineal regions. The aim of the study was to share our experience with FG and to analyze the relationship of clinical data with whole blood count parameters, inflammation cells, and systemic inflammation markers. METHODS: The digital medical records of the adult patients followed-up and treated with diagnosis of FG between January 2016 to December 2020 were retrospectively analyzed. Data were as age, gender, total length of hospital stay, predisposing factors, etiological factors, total number of debridement's, surgical procedures, and antibiotherapy were collected. Serum glucose levels, complete blood count parameter levels, serum inflammation indicators and C-reactive protein (CRP) levels measured at the initial day of hospital admission, post-debridement 1st and 7th days were measured. RESULTS: Thirty-six male patients were included, with a mean age of 56.42 (22-86) years. The most common predisposing factor was diabetes mellitus (n=13; 36.1%). The most frequently seen etiological cause was scrotal abscess (n=19; 52.8%). A statistically significant decrease was found in White blood cell count, neutrophil level, neutrophil-to-lymphocyte ratio (NLR) value and CRP level measured before debridement, post-debridement 1st and 7th days (p<0.05). There was a positive correlation between the number of debridement's and age, NLR, platelet-to-lymphocyte ratio, and CRP values at the initial admission time (p<0.05). CONCLUSION: The infections of urogenital region are the essential etiological origin of FG. As a rare urological emergency, significant changes were observed in clinical data and blood count parameters during the course of FG.

Examination of clinical data and semen analysis results of patients undergoing orchiectomy for testicular tumor.

OBJECTIVE: Testicular tumor constitutes 1% of male neoplasms. Infertility can be determined in patients with testicular tumors before orchiectomy due to the deterioration of spermatogenesis. The aim of this study was to show the clinical, radiological, and pathological characteristics and spermiogram results of patients with testicular tumor and their relationship with each other. METHODS: The data of patients who underwent orchiectomy due to testicular tumor between 2016 and 2019 were reviewed retrospectively. These data included sociodemographic data of the patients, pretreatment spermiogram characteristics, level of serum tumor markers, characteristics of the ultrasonography, type of orchiectomy, and histopathological examination. RESULTS: This study included 53 male patients, with a mean age of 33.51±12.86 years. The mean levels of all tumor markers were above the reference levels. The mean tumor size was 34.68±23.32 mm. Multiple localizations and microlithiasis were detected in 11.3 and 13.2% of the tumors, respectively. The most common masses were hypoechoic (n=37; 69.8%) and hypervascular (n=47; 81%). Spermiogram and cryopreservation were performed in 29 (54.7%) of 53 patients preoperatively. The mean sperm concentration before orchiectomy was 24.21×106 /mL and group A sperm motility 0.79%, group B sperm motility 39.10%, group C sperm motility 9.83%, and group D sperm motility 22.69% in testicular tumors. CONCLUSION: Spermatogenesis adversely affected before the treatment due to local and systemic effects of testicular cancer. Fertility expectations can be increased in the subsequent years by semen analysis and referral to cryopreservation.

Examination of clinical data and semen analysis results of patients undergoing orchiectomy for testicular tumor

SUMMARY OBJECTIVE: Testicular tumor constitutes 1% of male neoplasms. Infertility can be determined in patients with testicular tumors before orchiectomy due to the deterioration of spermatogenesis. The aim of this study was to show the clinical, radiological, and pathological characteristics and spermiogram results of patients with testicular tumor and their relationship with each other. METHODS: The data of patients who underwent orchiectomy due to testicular tumor between 2016 and 2019 were reviewed retrospectively. These data included sociodemographic data of the patients, pretreatment spermiogram characteristics, level of serum tumor markers, characteristics of the ultrasonography, type of orchiectomy, and histopathological examination. RESULTS: This study included 53 male patients, with a mean age of 33.51±12.86 years. The mean levels of all tumor markers were above the reference levels. The mean tumor size was 34.68±23.32 mm. Multiple localizations and microlithiasis were detected in 11.3 and 13.2% of the tumors, respectively. The most common masses were hypoechoic (n=37; 69.8%) and hypervascular (n=47; 81%). Spermiogram and cryopreservation were performed in 29 (54.7%) of 53 patients preoperatively. The mean sperm concentration before orchiectomy was 24.21×106 /mL and group A sperm motility 0.79%, group B sperm motility 39.10%, group C sperm motility 9.83%, and group D sperm motility 22.69% in testicular tumors. CONCLUSION: Spermatogenesis adversely affected before the treatment due to local and systemic effects of testicular cancer. Fertility expectations can be increased in the subsequent years by semen analysis and referral to cryopreservation.

Ventral onlay buccal mucosa graft urethroplasty for female urethral stricture.

OBJECTIVES: Female urethral stricture is a rare disease. Urethroplasty with different techniques using grafts or flaps are successful treatment options. The objective of this study was to present our experience with ventral onlay buccal mucosa graft urethroplasty for the treatment of female urethral stricture disease. METHODS: Eight female patients treated with ventral onlay buccal mucosa graft urethroplasty were identified retrospectively. Patient evaluation included physical examination, uroflowmetry with postvoid residual urine measurement, videourodynamics and urethrocystoscopy. Stricture was identified by videourethrography and/or urethrocystoscopy. Urodynamic evidence of stricture was considered as a persistent low maximum flow rate of <12 mL/s combined with detrusor pressure at maximum measured flow rate of >20 cmH2 O in the pressure flow study. RESULTS: The mean age was 50.5 ± 4.14 years. Stricture etiology was idiopathic (62.5%) or iatrogenic (37.5%). Two patients (25%) had undergone prior urethral dilations before buccal mucosa graft urethroplasty. Mean stricture length was 1.62 ± 0.44 cm. Stricture location was as follows: four distal urethra (50%), two mid-distal (25%) and two mid-urethra (25%). The mean postoperative follow-up period was 16.37 ± 5.75 months, and the during follow-up success rate was 100%. No complication, such as incontinence or vaginal fistula, was noted, except dyspareunia developed in one patient (12.5%). CONCLUSIONS: Ventral onlay buccal mucosa graft urethroplasty is a safe and effective treatment option for female urethral stricture. Unnecessary dilation should not be carried out and buccal mucosa graft urethroplasty in expert centers should be recommended to these patients.

Evaluation of depression, anxiety and quality of life in patients with non-obstructive azoospermia.

OBJECTIVE: The aim of this study was to determine the levels of depression, anxiety and quality of life in non-obstructive azoospermia (NOA) patients who attended our clinic. MATERIALS AND METHODS: A total of 40 male patients were included in the study troubled with non-obstructive azoospermia. An etiological classification was made according to the hormone levels of the patients. The semen specimen was obtained by masturbation from the patients. Three questionnaires, the Beck Depression Inventory, the Beck Anxiety Inventory, and the Short Form of the World Health Organization Quality of Life Questionnaire, were utilized in the study. RESULTS: The mean age of the patients in the study was 32.75±5.22 years. The patients were classified as follows: 26 (65%) patients were idiopathic, 11 (27.5%) patients were hyper-hypo and 3 (7.5%) patients could not be reached. In this cohort, 62.5% of patients had minimal depression, 27.5% of patients had mild depression and 10% of patients had moderate depression. In addition, 97.5% of patients had minimal anxiety and 2.5% of the patients had mild anxiety. Quality of life scores of the patients were 58.75% for general health status, 70.98% for physical health status, 72.92% for psychological status, 65% for social relations and 66.25% for environmental status. CONCLUSION: NOA particularly affects men in terms of biological, psychological and social aspects. In order to evaluate the quality of life and psychiatric conditions patients with azoospermia, various questionnaires may be applied before infertility treatment. Thus, patients who need psychiatric support can be identified.

Does biofeedback therapy improve quality of life in children with lower urinary tract dysfunction: parents' perspective.

INTRODUCTION: Lower urinary tract dysfunction (LUTD) is a situation that often disrupts the quality of life (QoL) of both the child and the family with daytime and nighttime incontinence. Although the first-line treatment option for children with LUTD is standard urotherapy, biofeedback therapy can be performed in children in which standard urotherapy failed. OBJECTIVE: We studied the biofeedback success in children with LUTD according to parents' expressions. METHODS: We retrospectively analyzed our hospital records of children who were diagnosed with LUTD between 2005 and 2017. In total, 281 patients, refractory to standard urotherapy were included into the study and directed to biofeedback treatment. Their parents completed the dysfunctional voiding symptom scores (DVSS) before and after biofeedback therapy. RESULTS: At the end of the six-month follow-up period, all voiding disorders and voiding patterns were evaluated. According to DVSS, QoL tools before biofeedback treatment 48 (17%) parents appraised that LUTD caused no effect in their children's daily life, 104 (37.8%) expressed little effect, 89 (31%) moderate effect, and 40 (14.2%) serious effect. And, 120 (43%) parents expressed no effect, 95 (34%) little effect, 51 (18%) moderate effect, and 15 (5%) serious effect (P = 0.001) after biofeedback therapy. Biofeedback therapy affected positively the daily life of LUTD's family. The less serious the effect of LUTD on these children's family, the more success rate of biofeedback therapy. The effect of biofeedback therapy was less successful in moderated and serious affected families. CONCLUSIONS: Biofeedback treatment is a non-invasive and effective treatment modality for improving the QoL for LUTD families who were less suffered from LUTD.

Does preoperative use of silodosin affect the stages of F-URS procedure? / ¿Afecta el uso de silodosin preoperatorio los pasos de la ureteroscopia flexible?

OBJECTIVES: To evaluate the effect of silodosin on stages of the flexible ureterorenoscopy (F-URS) procedures. METHODS: Between November 2015 and August 2017, a total of 76 patients suffering from 10-30 mm kidney stone were enrolled in this randomized prospective study. Patients were randomly divided into 2 groups for treatment: Group 1 had F-URS with preoperative daily uptake of 8 mg silodosin for 10 days, and group 2 had F-URS without silodosin uptake. None of the patients had preoperative JJ stenting. Stages of the F-URS was defined as entrance to bladder time (ETBT) with a semirigid ureterorenoscope (R-URS), entrance to ureteric orifice time (ETUOT) with R-URS using a guide wire and proceeding 2 cm inside the ureter, application of access sheath time (AAST) using the guide wire advanced through R-URS, F-URS time (FURST) + lithotripsy with laser time (LT), and total operation time (OT). We compared the time of each stage between two groups. RESULTS: There were 38 patients group1 and 2, respectively. There was one ureteral access sheath (UAS) application failure in group 1, and 3 failures in group 2 (p=0.307). The ETBT, ETUOT, and AAST were significantly short in group 1 than group 2 (p=0.001,0.007,0.002). CONCLUSIONS: Although preoperative use of silodosin facilitated only an insignificant positive effect on UAS placement failure, it eased the F-URS procedure by reducing the ETBT, ETUOT, and AAST in seconds. More studies are needed to make an exact conclusion.

OBJETIVOS: Evaluar el efecto de la silodosina en las etapas de los procedimientos de ureterorrenoscopia flexible (F-URS).MÉTODOS: Entre noviembre de 2015 y agosto de 2017, un total de 76 pacientes con cálculos renales de 10-30 mm se inscribieron en este estudio prospectivo aleatorizado. Los pacientes se dividieron aleatoriamente en 2 grupos para el tratamiento: el grupo 1 tenía F-URS con captación diaria preoperatoria de 8 mg de silodosina durante 10 días, y el grupo 2 tenía F-URS sin captación de silodosina. Ninguno de los pacientes tenía stent JJ preoperatorio. Las etapas del F-URS se definieron como entrada al tiempo de la vejiga (ETBT) con un ureterorrenoscopio semirrígido (R-URS), entrada al tiempo del orificio ureteral (ETUOT) con R-URS usando una guía y 2 cm dentro del uréter. Aplicación del tiempo de vaina de acceso (AAST) utilizando el cable de guía avanzado a través de R-URS, tiempo de F-URS (FURST) + litotricia con tiempo de láser (LT) y tiempo total de operación (OT). Comparamos el tiempo de cada etapa entre dos grupos. RESULTADOS: Hubo 38 pacientes grupo 1 y 2, respectivamente. Hubo una falla en la aplicación de la cubierta de acceso ureteral (UAS) en el grupo 1 y 3 fallas en el grupo 2 (p=0,307). ETBT, ETUOT y AAST fueron significativamente cortos en el grupo 1 que en el grupo 2 (p=0,001, 0,007, 0,002). CONCLUSIONES: Aunque el uso preoperatorio de silodosina facilitó solo un efecto positivo insignificante en la falla de colocación de UAS, alivió el procedimiento de F-URS al reducir el ETBT, ETUOT y AAST en segundos. Se necesitan más estudios para llegar a una conclusión exacta.

The cognitive fusion prostate biopsy using a smart phone in the diagnosis of prostate cancer. / Biopsia de próstata cognitiva utilizando un dispositivo móvil.

OBJECTIVES: In this research, we designed a cognitive fusion(CF) prostate biopsy(PB) (CFPB) technique by examining the multiparametric MRI of prostate (MP_MRI-P) images in a smart-phone near the trans-rectal ultrasound (TRUS) device, and examined the results. METHODS: Between January 2011 and January 2017, a total of 344 men who had PB enrolled in this study. Group 1 had a minimum of a 12-core standard TRUS PB (TRUSPB). Group 2 had CFPB while examining the MP_ MRI-P images in a smartphone near the TRUS device. A minimum 12 cores + cognitive targeted 1-3 biopsy were taken. The detection of Pca and significant Pca in group 1 and 2 were evaluated and compared. Then, the effect of MP_MRI-P findings on the detection of prostate cancer (Pca) and significant Pca were evaluated. RESULTS: Group 1 and 2 included 138 and 206 patients. After the PB, 45(32.8%) and 33(23%) patients ingroup 1, and 74(35.9%) and 60(29%) patients in-group 2 were detected to have Pca and significant Pca, respectively (p=0.001 for both). Higher PIRADS caused significant detection of Pca and significant Pca (p=0.004 and 0.002). Nodule in MP_MRI-P caused significant detection of Pca and significant Pca (p=0.001 and 0.001). Especially, when PSA was <10ng/ml, higher PIRADS and nodule in MP_MRI-P caused significant detection of Pca and significant Pca (p=0.02 and 0.019 for PIRADS, and p=0.01 and 0.042 for nodules). CONCLUSIONS: In the advanced hands with our new technique, the CFPB using prebiopsy MP_MRI-P seems to be an effective method to detect Pca and significant Pca.

OBJETIVOS: En este estudio de investigación diseñamos una técnica de biopsia de próstata (BxP) con fusión cognitiva (FC) (BxPFC) mediante el examen de la RMN multiparamétrica (RMNmp) de la próstata en un dispositivo móvil cerca del aparato de ecografía transrectal (ETR) y examinamos los resultados.MÉTODOS: Entre enero de 2011 y enero del 2017 se incluyeron en el estudio un total de 344 varones sometidos a BxP. El Grupo 1 hizo una BxP guiada por ecografía transrectal estándar que tenía un mínimo de 12 muestras. El Grupo 2 fue sometido a BxPFC utilizando un dispositivo móvil para evaluar las imágenes de la RMNmp de próstata cerca del aparato de ecografía transrectal. Se tomaron un mínimo de 12 muestras + 1-3 dirigidas de forma cognitiva. Se evaluaron y compararon la detección de CaP y de CaP significativo entre los grupos. También se evaluó el efecto de los hallazgos de la RMNmp de próstata sobre la detección de cáncer de próstata y CaP significativo. RESULTADOS: Los grupos 1 y 2 incluyeron 138 y 206 pacientes respectivamente. Después de la BxP, se detectaron 45(32,8%) pacientes con CaP y 33(23%) con CaP significativo en el grupo 1, y 74(35,9%) y 60(29%) pacientes en el Grupo 2, respectivamente (p=0,001 para ambos). Los valores más altos de PIRADS se asociaron con una detección significativa de CaP y CaP significativo (p=0,004 y 0,002). La presencia de un nódulo en la RMNmp se asocia con una detección significativa de CaP y CaP significativo (p=0,001 y 0,001). Especialmente, cuando el valor del PSA era <10 ng/ml, el PIRADS más alto y existía un nódulo en la RMN mp el diagnóstico de CaP y CaP significativo era significativamente mayor (p=0,02 y 0,019 para PIRADS, y p=0,01 y 0,042 para nódulos). CONCLUSIONES: Con nuestra nueva técnica en manos expertas, la BxP con fusión cognitiva utilizando las imágenes de RMNmp previa parece ser un método efectivo para detectar CaP y CaP significativo.

Unusual intrascrotal lesions in adults in urological practice. / Lesiones intraescrotales inusuales en adultos en la práctica clínica urológica.

OBJECTIVE: Unusual intrascrotal lesions in adults generally have been described as case reports in the medical literature. We present two lesions observed in two clinics over more than 28 years, with their radiological, pathological and clinical characteristics. METHODS: Retrospective study preformed between 1989 and 2017 in 446 patients undergoing inguinal orchiectomy. Clinical data were obtained reviewing patient` s tables. All patients were evaluated with physical examination, medical history, serum tumor markers (alpha fetoprotein, beta human chorionic gonadotropin, LDH), and scrotal ultrasound in the perioperative period. RESULTS: In 396 cases (88,78%) the diagnosis was germ cell or non-germ cell tumor and the remainder 50 patients (11.2%) presented 15 different intrascrotal lesions. These lesions were rhabdomyosarcoma (1 patient), intrascrotal cavernous hemangioma (1 patient), dermoid cyst (2 cases), epidermoid cyst (4 patients), paratesticular mesothelioma (1 case), parietal testicular tunica vaginalis cyst (2 patients), spermatic granuloma (3 cases). The number of patients with tuberculosis orchitis was 6 and granulomatous orchitis 8. There were 8 patients with fibrous pseudotumor. 1 patient presented testicular plasmocytoma. Metastatic involvement secondary to lymphoma and leukemia appeared in 4 cases. Brucella epididymitis-orchitis 7 cases. 2 cases of adult pure yolk sac testicular tumors. Additional evaluations and treatments were performed depending on histologic diagnosis. CONCLUSIONS: The exact diagnosis of these lesions is difficult due to their rarity and they must always be considered for differential diagnosis.

OBJETIVO: Las lesiones intraescrotales adultas inusuales generalmente se han descrito como un informe de caso en la literatura. Estas lesiones que se observaron en dos clínicas durante más de 28 años se presentan aquí con características radiológicas, patológicas y clínicas.MÉTODOS: Este estudio retrospectivo se realizó entre 1989 y 2017 en 446 pacientes sometidos a orquiectomía inguinal. Los datos clínicos se obtuvieron mediante la revisión de tablas de pacientes. En el período preoperatorio, todos los pacientes evaluados con examen físico, historial de detalles, marcadores tumorales séricos (alfa-fetoproteína, beta-gonadotropina coriónica humana, lactato deshidrogenasa), ultrasonografía doppler escrotal. RESULTADOS: Se diagnosticaron tumores testiculares germinales y no germinales en 396 casos (88,78%) y los 50 pacientes restantes (11,22%) presentaron 15 lesiones intraescrotales diferentes. El tipo de estas diferentes lesiones intraescrotales fueron rabdomiosarcoma paratesticular (1 paciente), hemangioma cavernoso intraescrotal (1 caso), quiste dermoide (2 casos), quiste epidérmico (4 pacientes), mesotelioma paratesticular (1 caso), quiste de capa parietal de túnica testículo vaginal (2 pacientes), granuloma espermático (3 casos). El número de pacientes con orquitis tuberculosa y granulomatosa fue de 6 y 8 pacientes, respectivamente. Los pacientes con pseudotumor fibroso fueron 8 casos. Plasmacitoma del testículo se observó en 1 paciente. La afectación metastásica debida a linfoma y leucemia se observó en un total de 4 casos. Se observó epididimo- orquitis de Burucella en 7 casos. El número de tumores adultos en el testículo puro del saco vitelino fue de 2 casos. Se realizaron evaluaciones y tratamientos adicionales según el diagnóstico histológico. CONCLUSIONES: El diagnóstico exacto de estas lesiones es difícil debido a su rareza y siempre debe considerarse en el diagnóstico diferencial.

Application of ureteral access sheath under direct visualization: Description of a technique for difficult ureters. / Aplicación de la vaina de acceso ureteral bajo visión directa: Descripción de la técnica en uréteres difíciles.

OBJECTIVES: To introduce a new technique for the placement of ureteral access sheaths (UAS) when there is failure in standard UAS placement. MATERIALS AND METHODS: Between March 2014 and June 2016, a total of 25 patients had difficulty while UAS placement during F-URS procedures. The placement of UAS in these patients was accomplished by utilizing the technique outlined in this study. The causes of difficulty in UAS placement, kinds of UAS deformation, ureteric injuries, and operation time were recorded for all procedures conducted in this study. RESULTS: The pre-operative and post-operative mean stone sizes, Hgb, urea, and creatinine levels were 10.64 (5-19)mm and 1.8 (2-4)mm (p<0.000); 13.9 (10.50-16.73)g/dL and 12.81 (9.4-16.6)g/dL (p = 0.0001); 30.73 (15-48)mg/dL and 28.83 (16- 41)mg/dL (p = 0.067); 1.07 (0.74-1.79)mg/dL and 1.10 (0.77-1.75)mg/dL (p = 0.242), respectively. The causes of difficulty in UAS placement were mainly the failure of insertion at ureteric orifice due to orifice shape and angle (not stenosis) in 18 (72%), narrow ureter in 3 (12%), twisted ureter in 3 (12%) and duplex ureter in 1 (4%) of patients. Angulation deformity with kinking was observed in 10 (40%) of operations. No buckling or kinking due to external force was noted. Providing a smooth insertion force of the F-URS accomplished insertion in patients with angulation deformities without difficulties. Mild mucosal heamorragia was observed in 16 (64%) patients. Mean operation time was 57 minutes and each operation ended with success. CONCLUSIONS: Application of UAS under direct visualization provides a safer UAS placement, makes the F-URS more applicable, and we think this technique decreases the operation time when there is difficulty in UAS placement.

OBJETIVOS: Introducir una nueva técnica de inserción de las vainas de acceso ureteral (VAU) cuando fracasa la inserción estándar. MATERIAL Y MÉTODOS: Entre marzo 2014 y junio 2016 hubo dificultades durante la inserción de la VAU para la ureterorrenoscopia flexible (URS-F) en un total de 25 pacientes. La inserción de la VAU se consiguió utilizando la técnica descrita en este estudio. En todos los casos incluidos en el estudio se registraron las causas de dificultad de inserción de la VAU, tipo de deformación de la vaina, lesiones ureterales y tiempo de operación. RESULTADOS: Los valores pre y postoperatorios de tamaño medio de las litiasis, hemoglobina, urea, y creatinina fueron 10,64 mm (5-19 mm) y 1,8 mm (2-4) (p<0,000); 13,9 g/dL(10,50-16,73) y 12,81 g/dL(9,4-16,6) (p = 0,0001); 30,73 mg/dL(15-48) y 28,83 mg/dL(16- 41) (p = 0,067); 1,07(0,74-1,79) mg/dL y 1,10(0,77- 1,75) mg/dL(p = 0,242), respectivamente. Las causas de dificultad de inserción de la VAU fueron principalmente el fallo de inserción en el orificio ureteral debido a la forma y ángulo del orificio (no estenosis) en 18 pacientes (72%), uréter estrecho en 3 (12%) y duplicación ureteral en uno (4%). Se observó deformidad por angulación y el catéter retorcido en 10 operaciones (40%). No se observó deformidad o retorcimiento por fuerzas externas. Se consiguió una inserción sin dificultad en los pacientes con deformidades por angulación siempre que la fuerza de inserción del ureteroscopio flexible fuera suave. Se apreció una hemorragia mucosa leve en 16 pacientes (64%). El tiempo medio de operación fue de 57 minutos y en todos los casos la operación se terminó con éxito. CONCLUSIONES: La inserción de una VAU bajo visión directa ofrece una colocación más segura, hace la URS-F más aplicable, y nosotros pensamos que esta técnica disminuye el tiempo de operación cuando hay dificultades para la colocación de la VAU.

Retrograde intrarenal surgery or percutaneous nephrolithotomy: Which one is more effective for 1-2 cm renal stones in pediatric patients? / Cirugía intrarrenal retrógrada o nefrolitotomía percutánea: ¿Cuál es más efectiva para litiasis de 1-2 cm en pacientes pediátricos?

INTRODUCTION: Urinary stone diseaseis less common in pediatric age group and it has anincreasing incidence. In this study, our hypothesis is toevaluate if one of the techniques, PNL or RIRS is superiorthan the other in terms of stone free status (SFR), fluoroscopytime (FT), operation time (OT), complication rate(CR), JJ stent insertion rate, and hospitalization duration(HD) in children. METHODS: Between 2013 and 2016, 74 patients(under 18 years- old) were operated for the treatmentof renal stones between 1-2cm size. 37 patientswere male (50%) and 37 of them (50%) were female.The study shows the experience of a single center. Dataof the patients who underwent (surgery) were recorded. RESULTS: SFR was not different in both groups in shortand long terms follow up, but hgb drop, FT, OT, andHD were detected to be worse in PNL group. Therewas lower complication rates for RIRS group comparing to PCNL group according to Clavien classification butgrade I complications were higher in RIRS group. CONCLUSION: Although PNL is a cheaper treatmentmethod, RIRS has less creatinine change, less FT, lessOT, less CR, less HT with similar SFR for 1-2cm renalstones in children. Long term SFR were 83.8% for RIRSand 86.5% for PCNL. RIRS is a treatment of choice inchildren with 1-2 cm renal stones as it has more advantagesbut the costs must be considered.

INTRODUCCIÓN: La enfermedad litiásica es menos frecuente en el grupo de edad pediátrica y tiene una incidencia creciente. En este estudio, nuestra hipótesis es evaluar si una de las técnicas, NLP o CIR, es superior a la otra en términos de estatus libre de litiasis,tiempo de fluoroscopia, tiempo quirúrgico, tasa de complicaciones,tasa de inserción de catéter DJ, y duración de la hospitalización en niños.MÉTODOS: Entre 2013 y 2016, 74 pacientes (por debajo de 18 años de edad) fueron intervenidos para tratamiento de litiasis entre 1-2 cm. 37 pacientes eran varones (50%) y 37 mujeres (50%). El estudio muestra la experiencia de un único centro. Se recogieron los datosde los pacientes sometidos a cirugía.RESULTADOS: La tasa de pacientes libres de litiasis no fue diferente entre los grupos a corto y largo plazo, pero el descenso de la hemoglobina, tiempo de fluoroscopia, tiempo operatorio y de hospitalización fueron peores en el grupo de NLP. Hubo una menor tasa de complicaciones en el grupo de CIR en comparación con el de NLP de acuerdo con la clasificación de Clavien, aunque las complicaciones de Grado I fuero mayores en el grupo de CIR.CONCLUSIONES: Aunque la NLP es un tratamiento más barato, la CIR tiene menor cambio de la Creatinina, menor tiempo de fluoroscopia y menor hospitalización con una tasa de libres de litiasis similar paralitiasis de 1-2 cm en niños. Las tasas de libres de litiasis a largo plazo fueron 83,9% para CIR y 86,5% para NLP. La CIR es un tratamiento de elección en niños con litiasis renales de 1-2 cm porque tiene más ventajas, pero deben considerarse los costes.

Our experience with ureterocystoplasty in bilateral functional kidneys.

OBJECTIVE: We have reviewed the data of the patients in order to evaluate the effectiveness of our ureterocystoplasty technique in augmentation cystoplasty operation. MATERIAL AND METHODS: Data of a total of 16 patients with bilateral functional kidneys who had undergone augmentation ureterocystoplasty between January 1995 and June 2018 which were retrieved during the retrospective archive scanning were included in the study. Ultrasonography (USG), serum blood urea nitrogen and creatinine values and Technetium-99 DTPA (Tc-99 DTPA) scan were used to evaluate the renal function of the patients. Intravenous pyelography (IVP) and USG were used to evaluate the ureters before surgery. Magnetic resonance (MR) urographies were performed in our center. RESULTS: Of the total 16 patients, 10 were male and 6 were female, while ages ranged from 1 to 24 years. Among 16 patients, the most common cause of neurogenic bladder etiology was meningomyelocele. In the urodynamic studies performed before the operation, it was determined that the bladder capacities of the patients were between 40-180 mL and the bladder compliances were 1.0-4.0 cc/cmH2O. At postoperative 3rd months, it was determined that the bladder capacities of the patients were between 180-330 mL and the bladder compliances were between 6.0-24.0 cc/cmH2O. CONCLUSION: Augmentation ureterocystoplasty seems to be an appropriate technique in which successful results are obtained with appropriate patient selection. Besides, complications that may occur due to use of ileal segment are avoided.

Is retrograde intrarenal surgery replacing percutaneous nephrolithotomy as surgical treatment of stone disease: Our clinical experience.

OBJECTIVE: Urolithiasis prevalence is 2-20% according to different geographic characteristics in different populations. In this study, we aimed to present the distribution of operation numbers for both percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) in terms of age and stone size in order to reveal the changes over the years. METHOD: Between January 2010 and March 2016, 1814 patients were operated for the treatment of renal stones. Patients were directed to the two different operations according to the surgeons' choices: RIRS or PCNL. Prospectively collected data was retrospectively reviewed. RESULTS: In the years 2010, 2011, 2012, 2013, 2014, 2015, and 2016, the number of RIRS applied for the treatment of renal stones was 25, 87, 96, 147, 166, 174, and 66, respectively. RIRS was significantly preferred more than PCNL for stones <1.5cm. Examining the ages, there was no different data described as above for stone sizes. CONCLUSION: Despite RIRS is the new trend for treating stone disease, PCNL remains its important role for especially the larger stone sizes. RIRS is the raising trend for small sizes.

Flexible Ureterorenoscopy versus Mini-Percutaneous Nephrolithotomy for the Treatment of Renal Stones.

PURPOSE: To compare the pain status and stone free rates of flexible ureterorenoscopy (F-URS) versus mini-percutaneousnephrolithotomy (mini-PNL) for the treatment of 1-to 2-cm renal stones. MATERIALS AND METHODS: This study was retrospectively designed with match paired method. Between January 2013 and December 2016, 387 patients underwent stone surgery for renal stones, 45 patients underwent FURS and 45 patients underwent mini-PNL. 90 patients were divided into two groups according to the surgical procedures. Group 1 patients underwent F-URS, and Group 2 patients underwent mini-PNL. During the intraoperative andpostoperative periods, pain management for all patients was standardized. Pain scores were determined using a visual analogue scale (VAS) completed at 2, 6, 12 and 24 hours postoperatively. The stone free status, hemoglobin levels, fluoroscopy time (FT), operation time (OT), hospitalization time (HT), return to work time (RWT), and complications were noted for each patient. RESULTS: Of all patients, the mean age was 41.1 ± 12.1 years and the mean stone size was 13.9 ± 2.9 mm. The VAS scores were significantly higher in the mini-PNL group at 2, 6, 12 and 24 hours (P < .05). The stone-free status and complication rates were similar between the two groups (P > .05); however, the hemoglobin decreases and the fluoroscopy, operation, hospitalization and return to work times were higher in the mini-PNL group than in the F-URS group (P < .05). CONCLUSION: F-URS is less painful than mini-PNL for the treatment of 1- to 2-cm renal stones. However, the stone free rate is similar between the two procedures while mini-PNL is superior in terms of fluoroscopy, operation, hospitalization and return to work duration. We think that F-URS is more comfortable and less painful than mini-PNL and achieves a similar stone free rate for the treatment of 1- to 2-cm renal stones.

Shock wave lithotripsy or retrograde intrarenal surgery: which one is more effective for 10-20-mm renal stones in children.

OBJECTIVES: To compare shock wave lithotripsy and flexible ureteroscopy in children with renal stone's diameter of 10 to 20 mm. MATERIALS AND METHODS: This is a retrospective study including 79 children, who had renal stone and underwent either shock wave lithotripsy or flexible ureteroscopy between January 2007 and June 2017. Of those, 38 patients underwent shock wave lithotripsy assigned as group 1 and 41 patients underwent flexible ureteroscopy assigned as group 2. Stone-free rate, fluoroscopy time, procedure time, complication rates, hospitalization time, and cost-effectiveness were monitored and included in the analyses. RESULTS: The mean patient age was 4.4 ± 3.5 in group 1 and 4.9 ± 4.1 in group 2. Stone-free rate was not different in both groups in the first and third months of follow-up. The mean fluoroscopy time was statistically significantly longer in group 1 compared to group 2. Procedure and hospitalization times were longer in group 2 compared to group 1. No complications were seen in either groups. The expenditure was calculated as 135.23 and 869.41 Euro per patient for groups 1 and 2, respectively, which shows significant higher cost in group 2. CONCLUSIONS: In this present study, we have shown that shock wave lithotripsy is cheaper, has short hospitalization time and long fluoroscopy time and similar stone-free rate, and has the same efficiency compared to flexible ureteroscopy regarding pediatric renal stones with the diameter between 10 and 20 mm.

The outcome of percutaneous nephrolithotomy on ≥50 mm staghorn and multiple calyceal stones.

OBJECTIVE: To determine the success rate of percutaneous nephrolithotomy (PNL) in kidney stones over 50 milimeters. MATERIAL AND METHODS: Twenty-four patients with a renal stone size of >50 mm between January 2007 and December 2016 were enrolled. Stone-free and complication rates were investigated. RESULTS: Twenty-one (87.5%) patients were male and 3 (12.5%) were female. Fifteen (62.5%) stones were located in the right, and 9 (37.5%) in the left kidney. Twenty-one (87.5%) patients were operated using single-access, and three (12.5%) patients were double-access. Thirteen (54%) patients were found to have no stone after operation and 11 (46%) patients had residual stones. Extracorporal shock wave lithotripsy was applied to 5 of 11 patients with residual stones, while flexible ureteroscopy was applied to 6 of them. After additional treatments, 8 (33.5%) patients were observed to be stone free. The stone-free rate was 87.5%. The mean operation time was 135.43 (85-240) minutes. Hemoglobin levels before and after operation were 14.8 (12-16.7) and 12.6 (9.3-15.5), respectively (p=0.001). The hospital stay was 6.04 (4-8) days. Complications were observed in four patients (16.6%). CONCLUSION: PNL has high stone-free rate on staghorn type large stones compared with multiple calyceal scattered large stones.

Oxidative stress parameters in patients with prostate cancer, benign prostatic hyperplasia and asymptomatic inflammatory prostatitis: A prospective controlled study.

BACKGROUND: The imbalance between oxidant and reductant mechanisms creates a nidus for the etiopathogenesis of several diseases. In this study, we aimed to compare the oxidative stress (OS) parameters in patients who were diagnosed with prostate cancer (pCa), benign prostatic hyperplasia (BPH) or asymptomatic inflammatory prostatitis (AIP), according to the histopathologic examination of transrectal ultrasonographic prostate biopsy and transurethral prostate resection specimens. OBJECTIVES: In this study, we aimed to compare oxidative stress between histologically proven prostate cancer, hyperplasia and prostatitis. MATERIAL AND METHODS: According to histopathologic examinations, 97 patients were divided into 3 study groups: group 1: pCa (n = 30), group 2: BPH (n = 41), and group 3: AIP (n = 26). Finally, 30 patients were enrolled in a control group. MDA levels, CuZn-SOD, Se-GPx, CAT activities, and trace element levels were evaluated. RESULTS: A statistically significant difference between prostate cancer and other groups were documented in terms of MDA activity. Contrary to AIP, a statistically significant difference has also been encountered between BPH and the control group. Decreased CuZn-SOD enzyme levels were found in PCa and BPH patients without statistical significance. Increased CAT activity was also documented in PCa, BPH and AIP patients. No significant difference in GPX activity was documented between the groups, except BPH and control group. Trace element levels were low in the patients with prostate cancer and BPH when compared with the control group. CONCLUSIONS: Despite the data regarding OS in PCa patients, there is a paucity of data regarding BPH and especially AIP patients. Our study revealed obvious oxidative stress in BPH and PCa patients as opposed to AIP. Assessing the oxidative stress in these patients may assist in the future prevention, diagnosis and also treatment. However, the question whether the presence of OS-related parameters and drugs could be used for the diagnosis or management of prostatic diseases, needs to be addressed in future larger and better studies with a more rational basis.

The histopathological effects of intracavernosal mitomycin-C injection in a rat Peyronie's disease model.

INTRODUCTION: We aimed to evaluate whether or not mitomycin-C (MMC) has an antifibrotic effect on transforming growth factor-beta (TGF-ß)-induced Peyronie's disease (PD) in a rat model. METHODS: Eighteen 12-week-old male Sprague-Dawley rats were divided into three groups: Group 1=TGF-ß1 (n=7); Group 2=TGF-ß1+MMC (n=7); and Group 3=Sham group (0.25 ml bovine serum albumin injected) (n=4). All groups were sacrificed on the sixth week of the procedure and their penises were excised. All penis specimens were evaluated semi-quantitatively and quantitatively with histochemical, immunohistochemistry, and image analysis. RESULTS: Both Group 1 and Group 2 had significantly higher fibrosis scores and lower elastic fibers in both outer surface of tunica albuginea (TA) and subsinusoidal area compared with Group 3. When compared with Group 1, the amount of collagen was significantly decreased in Group 2. Intracavernosal MMC injection (Group 2) ended up with lower elastic fibers when compared with Group 1. According to the quantitative analyses, when compared with Groups 1 and 3, lower dorsal, ventral, and trabecular thickening values were seen in Group 2. These parameters were only statistically significant when compared with Group 1, suggesting the antifibrotic effect of TGF-ß1-induced fibrosis. Both Groups 1 and 2 showed lower decorin staining levels in subsinusoidal areas of tunica albuginea (SATA) and subsinusoidal areas of trabecular wall (SATW) when compared with Group 3. The statistically significant difference was only detected between Group 1 and Group 3. CONCLUSIONS: Our study demonstrates the antifibrotic effects of MMC on PD. Further clinical studies are necessary to make inferences regarding its clinical use.

Our experiences with robot- assisted laparoscopic surgery in pediatric patients: the first case series from Turkey.

OBJECTIVE: Robotic surgery is a leading treatment option for minimally invasive surgery and has an increasing popularity in pediatric population, as well. In this article, we reported our case series of robot-assisted laparoscopic surgery in pediatric population. MATERIAL AND METHODS: We retrospectively reviewed 29 consecutive pediatric patients who underwent robot- assisted procedures between May 2014 and October 2016. Patient demographics, hospitalization time, estimated blood loss, robotic time and total operative and peri-, and post-operative complications were evaluated. RESULTS: A total of 24 ureter units (18 patients) with grade 1-5 vesicoureteral reflux in 13 female and 5 male, 1 male patient with vesicoureteral stenosis were underwent robot- assisted laparoscopic ureteral reimplantation (RALUR). All patients had complete resolution after surgery. Robot-assisted laparoscopic pyeloplasty (RALP) was performed in 6 patients with ureteropelvic junction obstruction. All patients had complete resolution after surgery. Completely intracorporeal robotic assisted laparoscopic augmentation ileocystoplasty (RLAIC) was applied to two patients with neurogenic bladder. The symptoms and preoperative hydronephrosis were regressed on the first month of follow-up. Robot-assisted laparoscopic reduction cystoplasty (RALRC) was performed in 14-year-old boy with a bladder diverticula and recurrent urinary tract infection. The last case was eleven- year-old female patient with non-functioning kidney. She had recurrent urinary tract infections and was treated with robotic assisted laparoscopic nephrectomy (RALN). CONCLUSION: Robot-assisted laparoscopic surgery is safe and efficient in pediatric population. Although open surgery is still the gold standard for many pediatric diseases, inherent reconstructive advantages of robotic assisted laparoscopy have a chance to change this view.