Checking vesicourethral anastomosis for urinary extravasation during radical prostatectomy: is it still necessary in the robotic era? A prospective, randomized case-control study.

PURPOSE: This study aims to evaluate the role of intraoperative control of the watertightness of vesicourethral anastomosis extravasation control (VUAEC) in predicting vesicourethral anastomosis (VUA) healing and early postoperative outcomes in patients undergoing robot-assisted radical prostatectomy (RARP). METHODS: 100 patients who underwent RARP between October 2020 and May 2023 were consecutively included in the study. Preoperatively, the patients were randomized to undergo VUAEC (Group-A) or not (Group-B). Patients in Group-A were evaluated in 2 subgroups: those with no extravasation observed during VUAEC (Group-A1; n = 31 (62%)) and those with extravasation (Group-A2; n = 19 (38%)). On the 8th post-operative day, a gravity cystogram (GC) was performed on all patients to assess VUA healing. RESULTS: There was no statistically significant difference between the groups in terms of clinical features, drain removal time, length of hospital stay, extravasation on GC, catheter removal time and postoperative complications (p > 0.05, for each). There was also no statistically significant difference between the subgroups in terms of drain removal time, length of hospital stays, catheter removal time (p > 0.05, for each). In Group-A2, urinary extravasation on GC was found in a greater percentage, but the difference remained statistically insignificant (p = 0.082). CONCLUSIONS: Performing intraoperative VUAEC did not have a significant role in the prediction of VUA healing and early postoperative outcomes in patients undergoing RARP. The current study did not identify a substantial clinical benefit of routine intraoperative VUAEC.

Surgical reintervention requirements following GreenLight PVP: A single-center experience using three different laser device models.

Objective: To assess the incidence, risk factors, and timing of specific causes of reoperations following PVP. Material and Methods: A retrospective analysis of data on men who underwent GreenLight PVP between 2004 and 2019 in a single center and required surgical intervention for bladder neck contracture (BNC), urethral stricture (US), or persistent/recurrent prostate adenoma. Results: The overall rate of reoperations was 13.8% during a 61-month median follow-up of 377 patients. Reoperations were due to BNC, US, and adenoma in 7.7%, 5.6%, and 4.8% of cases, respectively. The median interval until reoperation for US (11 months) was significantly shorter. None of the risk factors had any relevance to US. In patients who underwent reoperation for BNC, lasing time and energy were significantly lower, and the prostate volume was smaller; however, the multivariate analysis only identified shorter lasing time as a predictor. In patients who had reoperation for persistent/recurrent adenoma, the PSA was increased, while the prostate volume was non-significantly high, and performance by less-experienced surgeons was associated with a higher rate of reoperations (p < 0.05). A longer lasing time predicted an increased risk of reoperation for adenoma in multivariate analysis. Conclusions: An unselective utilization of PVP may result in a relatively high rate of reoperations. The correlation of BNC with shorter lasing time may imply a higher risk after PVP of smaller prostates. A longer lasing time predicts an increased risk of reoperation due to persistent/recurrent adenoma, which may be related to higher prostate volumes and inefficient PVP by less-experienced surgeons.

Higher Serum Endothelial-Specific Molecule-1 (ESM-1/Endocan) Levels are Associated with Poor Pathological Outcomes in Primary Bladder Cancer: A Non-randomized, Prospective, Case-Control Study.

AIM: To compare serum endothelial-specific molecule-1 (ESM-1 or endocan) levels between individuals with primary bladder cancer (BC) who have various pathological features of BC and healthy volunteers. MATERIALS AND METHODS: 154 consecutive patients with primary BC (Group-1) and 52 healthy volunteers (Group-2) were accepted into this prospective, non-randomized, observational research between January 2017 and December 2018. Peripheral blood samples were obtained from each participant to measure serum ESM-1/endocan levels. Group-1 was further divided into subgroups as Group-1A (pTa), Group-1B (pT1) and Group-1C (pT2) based on the transurethral resection of bladder tumour (TURBT) histopathological results. In addition Group-1 was divided into other subgroups based on pathological features of BC including tumor grade, tumor volume and muscle-invasive status. Groups were compared statistically regarding ESM-1/endocan levels. RESULTS: Median age of the individuals was 63 (22) years in Group-1 and 66 (11) years in Group-2 (p = 0.051). There were 140 (90.9%) males and 14 (9.1%) females in Group-1 and 30 (57.7%) males and 22 (42.3%) females in Group-2 (p < 0.001). The serum ESM-1/endocan measurements were lower in Group-2 than in Group-1 (p = 0.018). Of the patients in Group-1, 62 (40.3%) had low-grade tumors and 92 (59.7%) had high-grade tumors. When Group-1 was further divided into other subgroups according to different pathological features of BC such as tumor stage, grade, muscle-invasive status and tumor volume it was detected that there was a statistically meaningful difference between all subgroups of Group-1 and Group-2 in terms of serum ESM-1/endocan levels (p < 0.05 for each). The serum ESM-1/endocan cut-off value (3.472 ng/mL) had a specificity of 57.7%, sensitivity of 59.1%, NPV (negative predictive value) of 32.3% and PPV (positive predictive value) of 80.5% for predicting the presence of BC with an AUC (Area Under the Curve) of 0.609 (95% confidence interval (CI) 0.524-0.694; p = 0.018). CONCLUSIONS: The serum ESM-1/endocan levels can be considered a potentially useful predictor for BC. Higher serum ESM-1/endocan levels are related with poor pathological outcomes in BC.

Should Targeted Biopsy be Performed in Patients Who Have Only Pi-rads 3 Lesions?

OBJECTIVE: To determine whether clinical or radiological parameters can predict clinically significant prostate cancer (csPC) in patients with the Prostate Imaging Reporting and Data System (PI-RADS) 3 lesions. PATIENTS AND METHODS: Data were obtained from 247 patients with PI-RADS 3 lesions on mpMRI and who had received a software guided transperineal/transrectal MRI/transrectal ultrasonography (MRI/TRUS) fusion prostate biopsy with concomitant standard systematic 12-core biopsy following mpMRI in the prostate cancer and prostate biopsy database of Turkish Urooncology Association, between 2016 and 2020. The cut-off values of clinical parameters were determined using receiver operating characteristic (ROC) curve analysis. Simple and multiple logistic regression analyses were performed to determine the clinical parameters in predicting csPC. RESULTS: A total of 56 patients (22.6%) had prostate cancer, 23 (9.3%) of whom had csPC. In the lesion- based analysis, cancer detection rates (CDRs) of each lesion in targeted biopsy were found to be 6% and 5% for ISUP GG 1 and ISUP GG ≥ 2, respectively. In the patient-based analysis, clinically insignificant CDRs were significantly higher in systematic biopsy compared with targeted biopsy, whereas no significant difference was found in terms of clinically significant CDRs (p = 0.020 and p=0.422, respectively). The cut-off values were determined as 48.3 mL (AUC [95% CI] = 0.68 [0.53-0.82]) for prostate volume, and 0.213 ng/mL/mL (AUC [95% CI] = 0.64 (0.51-0.77]) for PSAD in predicting csPC. In the multiple logistic regression analysis, only PSAD was found to be an independent risk factor in predicting csPC (OR [95% CI]: 3.56 [1.15-10.91], p = 0.024). CONCLUSION: Since PSAD > 0.20 ng/mL/mL was found to be positive independent risk factor in predicting csPC, in the absence of advanced radiological parameters, PSAD could be used for the biopsy decision in patients with PI-RADS 3 lesions.

Comparison of transperineal and transrectal targeted prostate biopsy using Mahalanobis distance matching within propensity score caliper method: A multicenter study of Turkish Urooncology Association.

OBJECTIVE: To compare the clinically significant prostate cancer (csPC)-detecting results of transperineal and transrectal targeted biopsy (TPTB and TRTB, respectively) by performing matching analysis. PATIENTS AND METHODS: This study has used the PC and prostate biopsy database from the Turkish Urooncology Association. A total of 1143 patients with Prostate Imaging-Reporting and Data System (PI-RADS) with ≥3 lesions on multiparametric magnetic resonance imaging (mpMRI) and who had received a software-guided transperineal/transrectal MRI/transrectal ultrasound (TRUS) fusion prostate biopsy with concomitant standard systematic 12-core biopsy were included in this study. csPC detection rates of the TP and TR approaches were compared following Mahalanobis distance matching within propensity score caliper method. The following four variables were selected as covariates for the matching procedure: age, digital rectal examination findings, PSA density, and the index lesion PI-RADS score. RESULTS: The matched sample included 508 TR and 276 TP patients. In both the TP and the TR groups, targeted biopsy was superior to systematic biopsy in detecting csPC (27.5% vs. 24.6%, p < 0.001 and 19.5% vs. 16.3%, p < 0.0001, respectively). Both TPTB and TP systematic biopsy was found to be superior to TRTB and TR systematic biopsy in terms of csPC detection (27.5% vs. 19.5%, p = 0.012 and 24.6% vs. 16.3%, p = 0.006). In patients with an anterior index lesion, an apical index lesion, and a larger prostate, the superiority of TPTB to TRTB was found to be more prominent in terms of csPC detection (37.8% vs. 18.3%, p = 0.044; 34.6% vs. 14.7%, p = 0.002; and 25% vs. 5.1%, p = 0.033, respectively). CONCLUSION: Targeted biopsy was found to be superior to systematic biopsy in detecting csPC in both the TP and the TR approaches. The TP approach is preferred because of its clear superiority in detecting csPC in targeted biopsy, especially in patients with anterior and apical lesions and with larger prostates.

The prostatic adenocarcinoma with mucinous features: A review of the literature with three case reports.

Mucinous adenocarcinoma of the prostate is one of the rare variants of the prostatic carcinoma, and its incidence among all prostatic carcinomas is reported to be 0.3% in the literature. If the tumor variant containing extracellular mucin in <25% of the resected tumor mass, the histology is defined as adenocarcinoma with mucinous features. The mucinous adenocarcinoma of the prostate displays similar prognostic features with the classic adenocarcinoma. In this study, the treatment and surveillance processes of our three patients with prostatic adenocarcinoma with mucinous features were presented along with a literature review.

Renal pelvis urine Gram stain as a traditional, but new marker in predicting postoperative fever and stone culture positivity in percutaneous nephrolithotomy: an observational, prospective, non-randomized cohort study.

PURPOSE: The aim of this study was to evaluate the diagnostic value of renal pelvis urine Gram staining (RPUGS) in predicting postoperative fever and renal stone culture (RSC) positivity in percutaneous nephrolithotomy (PCNL). METHODS: Totally 141 consecutive patients undergoing PCNL for renal stone were included between January 2018 and December 2019. The RPUGS and renal pelvis urine culture (RPUC) were performed using urine sample from renal collecting system, while RSC was performed using stone fragments. Patients were divided into two groups as Group 1 (n = 119) without postoperative fever (< 38 °C) and Group 2 (n = 22) with postoperative fever (≥ 38 °C). Stone culture and Gram staining models were created for predicting postoperative fever using constant covariates of the presence of residual stone, hydronephrosis, and stone burden. RESULTS: A significantly higher number of patients in Group 2 had RPUGS, RSC, and RPUC positivity (p < 0.001, for each). The sensitivity, specificity, positive predictive value, and negative predictive value of RPUGS in predicting postoperative fever were 72.7%, 89.9%, 57.1%, and 94.7%, respectively. It was observed that both models had similar predictive values and diagnostic performances. Although RSC and RPUGS had a similar diagnostic value in predicting postoperative fever in univariable analysis, both were found to be independent predictors in multivariable analysis (OR: 10.6, 95% CI 4.07-27.9, p < 0.001 and OR: 15.0, 95% CI 5.4-41.2, p < 0.001, respectively). CONCLUSIONS: In conclusion, RPUGS is as effective as RSC in predicting fever after PCNL. We recommend RPUGS during PCNL to manage post-PCNL infectious complications.

Identifying the predictors of estimated glomerular filtration rate after partial nephrectomy with a nonlinear regression model.

PURPOSE: To evaluate the effect of partial nephrectomy on renal function and to identify predictors of estimated glomerular filtration rate (eGFR) at 6 months after partial nephrectomy. METHODS: Medical data of 154 consecutive patients who underwent partial nephrectomy for a renal mass between January 2015 and March 2020 were retrospectively analysed. The primary outcome measure was eGFR at 6 months postoperatively. An ordinary least regression analysis using a restricted cubic spline for continuous variables was performed to examine the association between primary outcome measure and candidate predictors. RESULTS: Of the patients, 66 (42.9%) were females and 88 (57.1%) were males with a median age of 60 (range, 50 to 67) years. The median baseline eGFR was 90.40 (range, 74.96 to 102.97) mL/min/1.73 m2 , while the median eGFR at 6 months was 77.12 (range, 61.06 to 91.93) mL/min/1.73 m2 (P < .001). Baseline eGFR (regression coefficient (ß) = 22.7, 95%CI: 18.8 to 26.5, P < .001) was found to be most significant predictor with the postoperative eGFR levels at 6 months. In addition, advanced tumour size (ß = -3.17, 95%CI: -5.33 to -1.01, P < .001) and presence of hypertension (ß = -3.48, 95%CI: -6.96 to -0.003, P = .049) were also found to be inversely associated with the postoperative eGFR levels at 6 months. CONCLUSION: Baseline eGFR values, tumour size, and presence of hypertension are significant predictors of eGFR values in the mid-term in patients undergoing partial nephrectomy.

Evaluation of the Sexual Functioning of Individuals Living in Turkey During the COVID-19 Pandemic: An Internet-Based Nationwide Survey Study.

INTRODUCTION: Although many countries in the world prioritize self-isolation measures during the corona virus disease 2019 (COVID-19) pandemic period, the effects of this process on sexual functioning are not yet known. AIM: To evaluate the effects of the COVID-19 pandemic on the sexual functioning of individuals who declared no medical history of the COVID-19 disease. METHODS: A total of 1,356 participants filled out an Internet-based survey between June 1 and June 20, 2020. The data from these participants were analyzed to determine sexual functioning in terms of sexual intercourse frequency and sexual desire during the COVID-19 pandemic. Subgroups analyses were also performed, wherein the subgroups were developed according to the population density of the cities in which the participants lived to examine whether population density has any effect on the sexual functions of the participants during the COVID-19 pandemic. MAIN OUTCOME MEASURE: The study outcomes were obtained using a study-specific questionnaire to assess the changes in people's sexual functioning. RESULTS: The mean age of the participants was 33.16 ± 8.31 years. There was a statistically significant difference between the participants according to the decrease in the number of weekly sexual intercourses when they were compared in terms of smoking status, alcohol consumption, marital and parental status, being a health-care worker, having a regular sexual partner, and the working status during the COVID-19 pandemic (P < .05, for each). In the subgroup analyses, it was observed that there was a statistically significant difference between the groups for change in the number of sexual intercourses, the number of masturbations, and sexual desire during the COVID-19 pandemic (P < .05, for each). CONCLUSION: A decline in sexual functioning was observed during the COVID-19 pandemic period. Living in a metropolitan area was associated with a decline in both sexual intercourse frequency and sexual desire during the COVID-19 pandemic. Karsiyakali N, Sahin Y, Ates HA, et al. Evaluation of the Sexual Functioning of Individuals Living in Turkey During the COVID-19 Pandemic: An Internet-Based Nationwide Survey Study. Sex Med 2021;9:100279.

Hypospadias surgery on YouTube: is it valid?

BACKGROUND: This study aims to evaluate video clips of hypospadias surgery on YouTube and to assess their competence for basic steps of hypospadias surgery. METHODS: The YouTube was screened for videos of hypospadias surgery between 1 December 2018 and 20 December 2018. Videos were divided into three groups based on the subjective utility checklist scores as follows: highly compatible (group 1; ≥7 points), moderately compatible (Group 2; 5-6 points), and less compatible (group 3; ≤4 points). Groups were compared statistically. RESULTS: A total of 100 videos were included in this study. The mean total score was 4.48±1.97. There were 15 (15%) videos in group 1, 42 (42%) in group 2, and 43 (43%) in group 3. There was a statistically significant difference in the total score, duration of videos, and like/dislike ratios among the groups (P<0.001, for all). There was a strong and significant correlation between the total scores and the step of glanuloplasty and skin closure (r: 0.805, P<0.001 and r: 0.770, P<0.001, respectively). CONCLUSIONS: Our study results suggest that the educational content of the videos of hypospadias surgery on YouTube is unsatisfactory. We believe that such videos must contain information regarding the surgical steps of glanuloplasty, skin closure, flap transposition, and urethroplasty and detailed information about the suture materials.

Suboptimal Prediction of Clinically Significant Prostate Cancer in Radical Prostatectomy Specimens by mpMRI-Targeted Biopsy.

OBJECTIVE: To investigate the correlation of multiparametric magnetic resonance imaging targeted (TBx) and/or systematic prostate biopsy (SBx) in predicting the presence of clinically significant (cs) prostate cancer (PCa) in radical prostatectomy (RP) specimens. Concordance of mpMRI and RP specimen lesions was also investigated in terms of tumor localization and histopathological features. METHODS: A total of 70 male patients with PCa and treated with robot-assisted RP were included in this study between January 2016 and December 2019. All patients underwent mpMRI-TBx and concomitant SBx. Suspicious lesions on mpMRI were scored according to Prostate Imaging-Reporting and Data System version 2 (PI-RADS) criteria. TBx was performed for all suspicious lesions with a PI-RADS score ≥3. RESULTS: The median age was 67 (43-77) years. Presence of csPCa in prostatectomy specimens was missed by TBx and SBx specimens in 25.4% and 19.4% of the cases, respectively (P<.001, for each). Combination of both biopsy (CBx) results improved detection by missing only 4.5% of csPCa (P = .250). International Society of Urologic Pathology grade group concordance with RP specimens were 50%, 54.3% and 67.1% for SBx, TBx, and CBx, respectively. There was a statistically significant correlation in terms of tumor localization and histopathological features between prostatectomy specimens and the first 3 lesions, particularly for the index lesions. CONCLUSIONS: CBx improved detection rate of csPCa. We propose TBx of 3 lesions with highest PI-RADS score(s) and a combination with SBx for the highest correlation with prostatectomy histopathology.

Shock wave lithotripsy deteriorates male sexual functions related to the treatment-driven anxiety: A prospective, non-randomized, self-controlled study. / La litotricia extracorporea deteriora la función sexual masculina en relación a la ansiedad por el tratamiento: un estudio prospectivo, no randomizado auto-controlado.

OBJECTIVES: This study aims to investigatel ongitudinal changes in sexual functions (SF), anxiety status, and health-related quality of life (HRQoL) after shock wave lithotripsy (SWL) in male urolithiasis patients. METHODS: Between February 2015 and April 2017, 85 consecutive male patients with kidney or ureter stones and treated with SWL were included. Patients were evaluated for SF, anxiety status, and HRQoL with questionnaire forms before and at the third month after SWL. Correlation between baseline and third-month scores of International Index of Erectile Function-15 (IIEF-15) subdomains and anxiety was evaluated. Uni- and multivariable linear regression analyses were used to identify changes in IIEF-15 subdomain scores at three months. RESULTS: Mean age was 42.80 ± 9.42 years. Significantly decreased IIEF-15 subdomain scores, increased anxiety and Short Form-36 (SF-36) subdomain scores were achieved at three months (p<0.05, for each). The baseline median values of erectile function (IIEFEF), orgasmic function (IIEF-OF), sexual desire (IIEF-SD), intercourse satisfaction (IIEF-IS), and overall satisfaction (IIEF-OS) were 26, 9, 8, 12, and 8, respectively. The same scores were 26, 9, 6, 9, and 8 at month 3, respectively. According to multivariable analysis, the difference in Beck Anxiety Inventory (BAI) scores was an independent risk factor for both changing in IIEF-SD and IIEF-IS (b= -0.094, 95%CI: -0.179 - -0.009, p=0.030 and b= -0.197, 95%CI: -0.350 - -0.044, p=0.012, respectively). The difference in the State Anxiety (STAISA) scores was an independent risk factor for changing in IIEF-IS (b= -0.075, 95%CI: -0.146 - -0.004,p=0.039). CONCLUSIONS: SWL may lead to impaired SF related to treatment-driven anxiety and significantly improve HRQoL of male patients in short term.

OBJETIVO: Este estudio tiene como objetivo investigar los cambios longitudinales en la función sexual, estado de ansiedad y calidad de vida después de la litotricia extracorpórea en pacientes varones conlitiasis. MÉTODOS: Entre febrero 2015 y abril 2017, 85 pacientes varones consecutivos con litiasis renales o ureterales tratados con litotricia extracorpórea fueron incluidos. Los pacientes fueron evaluados en relación a la función sexual, estado de ansiedad, y calidad de vida con cuestionarios de calidad de vida antes y a los 3 meses de la litotricia extracorpórea. Correlación entre los resultados de International Index of Erectile Function-15 (IIEF-15) iniciales y a los 3 meses en los dominios de ansiedad, fueron evaluados. Análisis de regresión univariada y multivariada fue utilizada para identificar cambios en IIEF-15 a los 3 meses. RESULTADOS: La edad media fue de 42,80 ± 9,42 años. Una caída significativa de los resultados de los subdominios de IIEF-15 con incremento de la ansiedad y Short Form-36 (SF-36) fueron conseguidos a los 3 meses (p<0,05, para cada uno). Los resultados medios en función eréctil (IIEF-EF), función orgásmica (IIEF-OF), deseo sexual (IIEF-SD), satisfacción en las relaciones (IIEF-IS), y satisfacción general (IIEF-OS) fueron 26, 9, 8, 12, y 8, respectivamente. Los mismos resultados fueron 26, 9, 6, 9, y 8 a los 3 meses, respectivamente. En el análisis multivariado, la diferencia en Beck Anxiety Inventory (BAI) fue un factor de riesgo independiente para ambos, cambiando en IIEF-SD y IIEF-IS (b= -0,094, 95%CI: -0,179 ­ -0,009, p=0,030 y b= -0,197, 95%CI: -0,350 ­ -0,044, p=0,012, respectivamente). La diferencia en el State Anxiety (STAI-SA) fue un factor de riesgo independiente para cambio en IIEF-IS (b= -0,075, 95%CI: -0,146 ­-0,004, p=0,039). CONCLUSIONES: La litotricia extracorpórea comporta cierto grado de disfunción sexual relacionada con la ansiedad del tratamiento y mejora significativamente la calidad de vida en los pacientes varones a corto plazo.

Neutrophil gelatinase-associated lipocalin is an early marker of renal damage in lower urinary tract obstruction in rats. / NGAL es un marcador precoz de daño renal en la obstrucción del tracto urinario inferior en ratas.

OBJECTIVES: To compare the urinary NGAL levels with serum creatinine levels as an early biomarker for renal injury in rats with bladder outlet obstruction (BOO). METHODS: Twenty male Wistar Albino rats dividedin to 4 groups. In each group basal serum creatinine and urinary NGAL levels were evaluated. In Group 1 (Sham/Control group) only laparotomy was performed.In Group 2 (14th day partial BOO) and Group 3 (28th day partial BOO) partial obstruction and in Group 4(Complete BOO) complete obstruction was performed. Serum creatinine levels and urinary NGAL levels were evaluated in Group 4 on the third day of the study, in Group 2 on the 14th day and in Group 3 and Group 1 on the 28th day. Urethra, ureters and kidneys were excracted by laparotomy and evaluated for histopathologic examination. RESULTS: The increase in plasma creatinine levels after obstruction was statistically significant in Group 4 ( p <0.005). There was significant difference between the groups in urinary NGAL levels after obstruction (p<0.005). Post-obstruction urinary NGAL level was highest in Group 4 and it was statistically significant when compared to beginning levels (p<0.005). In Group 3, increase in urinary NGAL levels were higher (p<0.005) with no increase in plasma creatinine level after obstruction. CONCLUSIONS: It can be concluded that urinary NGAL levels might be an early biomarker for renal dysfunction in partial bladder outlet obstruction which may cause renal impairment through upper urinary tract injury.Therefore, urinary NGAL may play role during the treatment choice and follow-up in BOO patients.

OBJETIVOS: Comparar los niveles urinariosde NGAL con la creatinina sérica como marcador precoz de daño renal en ratas con obstrucción del tracto urinario inferior. MÉTODOS: 20 ratas Wistar Albino masculinas fueron divididas en 4 grupos. En cada grupo se midió el nivel basal de creatinina en suero así como los niveles urinarios de NGAL. En el grupo 1 (Sham/Grupo Control) solo se realizó laparotomía. En el grupo 2 (14 días después de una obstrucción tracto urinario inferior parcial) y el grupo 3 (28 días después de una obstrucción tracto urinario inferior parcial) se realizó una obstrucción parcial y en el grupo 4 (obstrucción completa) una obstrucción completa. Los niveles de creatinina sérica y NGAL urinario fueron evaluados en el grupo 4 en el 3er día del estudio; en el grupo 2 en el día 14 del estudio y en el grupo 1 en el día 28. Uretra, uréteres y riñones se quitaron por laparotomía y se hizo un análisis histológico. RESULTADOS: El incremento en la creatinina sérica después de la obstrucción fue estadísticamente significativo en el grupo 4 (p<0,05). Hubo suficiente diferecia entre los grupos en términos de NGAL urinario después de la obstrucción (p<0,005). Los niveles de NGA post-obstructivos fueron superiores en el grupo 4 y fue estadísticamente significativo en comparación con los niveles iniciales. En el grupo 3, el incremento en los niveles de NGAL urinario fue superior (p<0,005) sin incrementeo en los niveles de creatinina en plasma después de la obstrucción. CONCLUSIONES: Se puede concluir que los niveles de NGAL urinarios podrían ser un marcador de lesión renal en caso de obstrucción parcial del tracto urinario inferior. Por tanto, NGAL urinario debe jugar un papel durante la elección de tratamiento y seguimiento de pacientes con obstrucción del tracto urinario inferior.

Evaluation of sexual functions in female rosacea patients: a prospective, case-control study.

Patients with rosacea have a higher incidence of depression, embarrassment, social phobia, stress, subjective disease perception and decreased quality of life. Sexual dysfunction is one of the main factors contributing to impaired life quality. The aim of this study is to evaluate the presence of sexual dysfunction in women with rosacea. A prospective case-control study was planned to investigate female sexual dysfunction in patients utilizing the Female Sexual Function Index (FSFI). A total of 85 patients with rosacea and 80 healthy control subjects were included in the study. The total FSFI scores were significantly lower in the rosacea group than in the control group (26.6 vs. 27.6, p < 0.001, respectively). According to the total FSFI scores, 49.4% of the rosacea patients had sexual dysfunction compared with 30.0% of the healthy controls (p = 0.011). The total FSFI scores were negatively correlated with the values of the Dermatologic Life Quality Index (DLQI) (r: -0.251, p = 0.001), disease duration (r: -0.416, p < 0.001), age (r: -0.632, p < 0.001) and body mass index (r: -0.329, p < 0.001). Sexual dysfunction in female rosacea patients was demonstrated in this study. We believe that the recognition of sexual dysfunction in women with rosacea will provide improvements in the life quality of such patients.

Predictive value of prognostic nutritional index on tumor stage in patients with primary bladder cancer. / Valor predictivo del índice nutricional pronóstico en el estadiaje tumoral en paciente con cáncer de vejiga primario.

OBJECTIVES:  The aim of this study was to evaluate relationship between preoperative Prognostic Nutritional Index (PNI) values and tumor stage and to identify predictive value of PNI in patients with primary bladder cancer (BC). METHODS:  A total of 164 patients with primary bladder cancer were retrospectively analyzed using institutional bladder cancer database between January 2008 and January 2018. The PNI was calculated using preoperative blood sample results. According to pathological results, the patients were divided into groups as pTa (n=94), pT1 (n=54), and pT2 (n=16) and further into subgroups as Group 1 (pTa patients, n=94) and Group2 (pT1 + pT2 patients, n=70). Subgroups were compared statistically in terms of PNI values and independent risk factors were evaluated using Backward Step wise multivariate logistic regression analysis. RESULTS:  Of patients, 145 (88.4%) were males and 19 (11.6%) were females with a mean age of 66.46±10.57 (range, 36 to 93) years. Mean total peripheral lymphocyte count was 2.11±0.71 (×109/L), mean serum albumin was 4.11±0.53 (gr/dL), and mean PNI score was 51.66±6.36. There was a statistically significant difference in serum albumin levels and PNI scores according to tumor stages (p=0.008 and p=0.003, respectively). There was a statistically significant difference in mean serum total protein, albumin, and PNI scores (p<0.01, for all). Tumor size, tumor grade, PNI, carcinoma in situ,and atypical variant status were independent risk factors for predicting tumor stage. CONCLUSIONS:  Our study results demonstrate that PNI is a potential preoperative predictor of tumor stage and is an independent risk factor for predicting tumor stage in patients with primary bladder cancer. Lower PNI levels are associated with high stage disease.

OBJETIVOS:  El objetivo de este studio fue evaluar la relación entre el índice pronóstico nutricional (IPN) y el estadio tumor para identificar el valor predictivo de IPN en paciente con cáncer vesical primario.MÉTODOS: 164 pacientes fueron incluidos con cáncer vesical primario fueron retrospectivamente evaluados utilizando una base de datos institucional entre enero de 2008 y enero 2018. El IPN fue calculado utilizando la analítica preoperatoria. De acuerdo con los resultadosde la anatomía patológica, los pacientes se repartieron en varios grupos: pTa (n=94), pT1 (n=54) y pT2 (n=16) y después en subgrupos como Grupo 1 (pTa n=94),Grupo 2 (pT1+pT2, n=70). Los subgrupos se compararon en términos de IPN y factores independientes de riesgo se calcularon utilizando Regresión Logística. RESULTADOS:  145 pacientes (88%) fueron hombres y 19 (11%) fueron mujeres con una mediana de edad de 66+/- 11 años (rango 36-93). El recuento total de linfocitos fue de 2,1+/- 0,71 (x109/L, al albumina sérica fue de 4,1+/-0,53 (gr/dL), y la mediana IPN fuede 51. Se observaron diferencias estadísticamente significativas en los niveles de albumina sérica y proteína total y IPN scores (p<0,01) tumoral, IPNm Cis, variantes atípicas fueron factores de riesgo independientes para la predicción del estadio tumoral. CONCLUSIONES:  Nuestro estudio demuestra que IPN es un factor predictor potencial del estadio tumoral y un factor independiente de riesgo para la predicción del estadio tumoral en pacientes con cáncer de vejiga.Niveles bajos de IPN se asocian con estadios mas avanzados.

Change in Frequency and Predictors of Erectile Dysfunction With Changes in the International Index of Erectile Function-Erectile Function Domain Score in Patients With ST-Elevation Myocardial Infarction: A Prospective, Longitudinal Study.

BACKGROUND: Erectile dysfunction (ED) has been proposed as an early indicator for future coronary and peripheral vascular disease. AIM: We aimed to investigate the longitudinal change in proportion and predictors for ED with changes in erectile function domain (EFD) of the International Index of Erectile Function-15 (IIEF-15) in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PPCI). METHODS: Between December 2018 and June 2019, 286 male patients aged between 40 and 70 years who were treated with PPCI for STEMI were included. The patients were asked to complete the IIEF-EFD form 3 days after the procedure for the evaluation of baseline erectile functions. During follow-up 3 months after the index procedure, the patients were asked to refill the IIEF-EFD form. Both baseline and third-month IIEF-EFD scores were calculated, and the patients were classified into ED severity groups as per the IIEF-EFD scores. A linear mixed model was used to identify predictors of ED at 3 months. OUTCOMES: This study identifies the prevalence and predictors of ED with STEMI who underwent PPCI. RESULTS: The median age was 54 (range 48-61) years. The median IIEF-EFD scores at 3 days and 3 months were 25.5 (range 20.0-27.0) and 22.00 (range 18.25-25.00), respectively. Half of the patients were found to have ED with varying severity as per baseline IIEF-EFD scores. This rate increased to 79% at the 3-month follow-up visit. The IIEF-EFD scores of the patients decreased over time (P < .001). Advanced age (ß = -0.603, se = 0.192, P = .002), presence of three-vessel coronary artery disease (ß = -3.828, se = 0.783, P < .001), and diabetes (ß = -2.934, se = 0.685, P < .001) were found to be inversely associated with the IIEF-EFD scores. CLINICAL IMPLICATIONS: Advanced age, presence of three-vessel disease, and diabetes mellitus are the indicators of sexual rehabilitation needs in patients after STEMI. STRENGTHS & LIMITATIONS: This is the first study investigating the predictor variables for the development of ED after coronary artery disease treatment. The limitations include the lack of evaluation of anxiety and depression and the measurements of testosterone levels. CONCLUSION: The prevalence of ED was high among patients with coronary artery disease, and the frequency of ED increased during 3-month follow-up. Advanced age, three-vessel disease, and diabetes were significant predictors of ED with changes in IIEF-EFD score in patients with STEMI who underwent PPCI. Karabay E, Karsiyakali N, Cinier G, et al. Change in Frequency and Predictors of Erectile Dysfunction With Changes in the International Index of Erectile Function-Erectile Function Domain Score in Patients With ST-Elevation Myocardial Infarction: A Prospective, Longitudinal Study. J Sex Med 2020;17:1101-1108.

Evaluation of Nephrolithometric Scoring Systems to Predict Outcomes of Retrograde Intrarenal Surgery.

PURPOSE: The aim of the study was to evaluate the predictive value of nephrolithometric scoring systems used to predict the complexity of renal stones for the outcomes of retrograde intrarenal surgery (RIRS). MATERIALS AND METHODS: A total of 81 patients who underwent RIRS for nephrolithiasis between January 2013 and October 2017 were reviewed in this retrospective study. Guy's Stone Score (GSS), the S.T.O.N.E., Clinical Research Office of the Endourologic Society (CROES), and Seoul National University Renal Stone Complexity (S-ReSC) nephrolithometry scores were assessed by same researcher for each patient from preoperative non-contrast enhanced computed tomography scans. These nephrolithometric scores, stone characteristics and complications were compared in patients with/without residual stone. RESULTS: The median (IQR) age of patients (37 female/44 male) was 45 (20) years. The median (IQR) stone burden was 139.4 (125.4) mm2 and the mean Hounsfield unit (HU) value was 1034.46 ± 239.56. The stone burden, S.T.O.N.E. and S-ReSC scores were statistically significantly higher and the CROES score was significantly lower in patients with a residual stone (p < 0.001, for all). The incidence of residual stones was statistically significantly higher in patients with Grade 3 GSS (p = 0.018). While S.T.O.N.E., S-ReSC and CROES were significantly correlated with stone-free rates, GSS failed to correlate with stone-free status. According to the receiver operating characteristic (ROC) curve analysis, the predictive value of stone burden was higher for residual stones, compared to S-ReSC scoring (p < 0.05). CONCLUSION: Nephrolithometric scoring systems nomograms used to predict the PCNL success were not superior to stone burden in predicting the RIRS success.

Open radical cystectomy is a reliable surgery with acceptable complication rates in elderly male patients: a retrospective, tertiary hospital-based study.

Objective: This study aims to evaluate safety of radical cystectomy (RS)+pelvic lymph node dissection (PLND)+ileal conduit urinary diversion (ICUD) in male patients aged >65 years versus ≤65 years.Materials and Methods: Eighty-five male patients who underwent RS + PLND + ICUD for bladder cancer were retrospectively analyzed. The patients were divided into two groups according to age: ≤65 years (Group 1, n = 40) versus >65 years (Group 2, n = 45). Data including baseline demographic and clinical characteristics of the patients, length of hospital stay, and complications within 90 days of surgery, and Grade ≤ II and Grade ≥ III complications according to the Clavien-Dindo (C-D) classification were recorded. Groups were compared in terms of demographic features and development of complications within 90 day after surgery statistically.Results: The median length of hospital stay was statistically significantly longer in Group 2 than Group 1 [10 (7-17) days vs. 9 (6-14) days, respectively; p < .05]. There was no statistically significant difference in the rehospitalization rate within 90 days of surgery between the groups (p > .05).Conclusion: Our study results suggest that RS + PLND + ICUD is a safe procedure in male patients aged ≥65 years.

Relationship between plasma Atherogenic index and final pathology of Bosniak III-IV renal masses: a retrospective, single-center study.

BACKGROUND: There is an increased incidence of renal cell carcinoma (RCC) in patients with metabolic syndrome who usually have high levels of serum triglyceride (TG) and low high-density lipoprotein-cholesterol (HDL-C). Plasma atherogenic index (PAI) is the logarithmic ratio of serum TG level to HDL-C and related to cardiovascular diseases. In this study, we aimed to determine the accuracy of PAI in determining renal malignancy in localized renal masses preoperatively. METHODS: Totally 169 patients who were diagnosed with Bosniak III-IV lesions by imaging modalities and treated in our hospital with partial or radical nephrectomy were retrospectively analyzed using institutional renal cancer database between 2013 and 2018. Preoperative images were evaluated by two experienced radiologists. The patients were divided into two groups according to their postoperative pathological diagnosis as malignant or benign tumors. The PAI of each patient was calculated and the statistical significance of PAI in predicting malignancy for renal masses was analyzed using uni- and multivariable analyses. RESULTS: Of patients, 109 (64.5%) were males and 60 (35.5%) were females with a median age of 61 (33-84) years. Median tumor size was 6.5 (2-18) cm. Pathological diagnosis was malignant in 145 (85.8%) and benign in 24 (14.2%) patients. There was no statistically significant difference in serum TG levels between malignant and benign cases (p > 0.05). The HDL-C levels were significantly lower in malignant cases (p = 0.001). Median PAI value was 0.63 (0.34-1.58) and significantly higher in malignant cases (p = 0.003). The PAI cut-off value for malignancy was ≥0.34. The sensitivity was calculated as 88.2% and specificity as 45.8%, the positive predictive value as 90.8, negative predictive value as 39.3, and odds ratio as 6.37 (95% CI: 2.466-16.458). In multivariable analysis, gender, smoking status, and hypertension had no effect on malignancy, whereas PAI and HDL-C were independent risk factors (p = 0.003 and p = 0.003, respectively). The risk of malignancy was 5.019 times higher, when PAI was > 0.34 (95% CI: 1.744-14.445) in multivariable logistic regression analysis. CONCLUSIONS: The PAI can be used as a predictive tool in suspicion of malignant renal masses. In case of a benign pathology, PAI levels may be encouraging for surgeons for nephron-sparing surgery.