Comparison of the Conventional PNL with Ecirs in the Treatment of Complete Staghorn Kidney Stones.

OBJECTIVE:  To analyse the results of conventional percutaneous nephrolithotomy (PNL) and endoscopic combined intrarenal surgery (ECIRS) in treating complete staghorn kidney calculi. STUDY DESIGN:  A comparative study. Place and Duration of the Study: Department of Urology, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey, between January 2007 and January 2022. METHODOLOGY:  Clinical data and surgical outcomes of the adult patients who underwent conventional PNL or ECIRS were retrospectively reviewed. Two patient groups were compared regarding the fluoroscopy time, the number of access, surgical time, duration of hospitalisation, haemoglobin (Hb) reduction, complication, and stone-free rates.  Results: There were 132 renal units in the conventional PNL (Group 1) and 45 renal units in the ECIRS group (Group 2). The comparative analysis revealed that fluoroscopy time, surgical time, duration of hospital stay, number of access, and the Hb drop were significantly lower in the ECIRS group compared to the conventional PNL group. Although stone-free rates were 48.5% in Group 1 and 64.4% in Group 2, p=0.064 and p>0.05 respectively). The median value of the complication grade was 1 (1-7) in Group 1 and 1 (1-5) in Group 2, (U=2446.5, p=0.026).  Conclusion: The ECIRS is a successful and more secure surgical method for treating complete staghorn stones than PNL. KEY WORDS:  PNL, ECIRS, Staghorn, Kidney, Stone.

Does Post-COVID-19 Erectile Dysfunction Improve over Time?

BACKGROUND: Some studies have shown that there may be an increase in the frequency of erectile dysfunction after COVID-19. However, no long-term study has investigated whether this is permanent or temporary. In this study, we aimed to examine whether there was an increase in the frequency of erectile dysfunction among individuals with a history of COVID-19, and, if there was, whether their condition improved over time. MATERIALS AND METHODS: In this study, a total of 125 healthy male healthcare workers, 95 with and 30 without a history of COVID-19, were evaluated in terms of erectile function. Four study groups were formed. The first three groups consisted of individuals with a history of COVID-19 confirmed by the polymerase chain reaction (PCR) test at different times, who recovered from the disease (time elapsed since COVID-19 positivity: <6 months for Group 1, 6 to 12 months for Group 2, and >12 months for Group 3). The individuals in Group 4 did not have a history of COVID-19 diagnosis. In order to evaluate the erectile function of the participants, they were asked to complete the five-item International Index of Erectile Function questionnaire (IIEF-5). Then, statistical analyses were performed to evaluate whether there was a difference between the groups in terms of the IIEF-5 scores. RESULTS: There was a statistically significant difference between the groups in terms of the IIEF-5 scores (p < 0.001), and this difference was determined to be caused by the significantly higher IIEF-5 scores of Groups 3 and 4 compared to Group 1 (p = 0.004 and p < 0.001, respectively). In addition, the IIEF-5 score of Group 4 was statistically significantly higher than that of Group 2 (p < 0.001). However, the IIEF-5 scores did not statistically significantly differ between Groups 1 and 2, Groups 2 and 3, and Groups 3 and 4 (p > 0.999, p = 0.204, and p = 0.592, respectively). CONCLUSION: There may be deterioration in erectile function after COVID-19; however, this tends to improve over time, especially from the first year after active infection. Given that vascular, hormonal, and/or psychogenic factors may lead to the development of erectile dysfunction after COVID-19, we consider that in order to easily manage this process, it is important to determine the underlying cause, initiate appropriate treatment, and inform couples that this situation can be temporary.

Effect of histopathologic characteristics on pseudocapsular invasion in the case of partial nephrectomy for renal tumours.

OBJECTIVE: It is aimed to define the existence of pseudocapsular structure on renal tumours, illuminate the relation between pseudocapsular invasion and Fuhrman grade histological type that are among histopathologic prognostic risk factors and determine the relation between surgical margin positivity and existence of pseudocapsular invasion. Sequential partial nephrectomy series and relevant pathological preparations were retrospectively reviewed in order to evaluate these issues. METHODS: The study includes 123 patients diagnosed with T1 renal tumour and treated with partial nephrectomy in between January 2007 and June 2016. Benign angiomyolipoma was excluded due to complete non-existence of pseudocapsule. 99 T1 patients diagnosed with renal cell cancer whose pathological slides can be duly analysed were included in the study. Clinical and pathological details were evaluated for all patients. Existence of pseudocapsule was revealed for all patients. Pseudocapsule invasion was classified by existence of expansive and infiltrative type and non-existence of pseudocapsule invasion. The groups have been assessed by their histopathologic characteristics. RESULTS: Compared to the group in which pseudocapsular invasion was not detected, clear-cell histological subtype was observed more frequently in a statistically significant way in the group with expansive pseudocapsular invasion and infiltrative pseudocapsular invasion respectively (p = 0.017 and p < 0.001). Pathological tumour sizes were found out to be statistically similar (p = 0.874). There was not a statistically significant difference in terms of Fuhrman grade (p = 0.220). There was not a statistically significant difference in terms of surgical positive margin (p = 0.609). CONCLUSION: It was indicated in our study that only the histological subtype affected pseudocapsular invasion in group of patients treated with partial nephrectomy but tumour size, tumour stage, tumour location as well as endophytic and exophytic character did not affect invasion. It has also been revealed that surgical margin positivity is not correlated with pseudocapsular invasion.

Do the etiological factors in artificial urinary sphincter reimplantation cases affect success and complications?

Background/aim: The artificial urinary sphincter (AUS) is still one of the best options for incontinence treatment. It may also have an advantage for revision or reimplantation in the management of complications. In this study we aimed to discuss the etiological factors for AUS reimplantation and effects of these etiological factors on success rates, patient satisfaction rates, time to reimplantation surgery, and complications Materials and methods: Data from 30 patients for whom AUS reimplantation was performed were analyzed retrospectively. Incontinence due to fluid loss from the cuff or reservoir balloon, inability of the cuff to adequately compress the urethra, and devices that were thought to have completed their lifespans were defined as mechanical reasons while incontinence caused by conditions such as cuff erosion and infection were defined as nonmechanical reasons. Patients who went through reimplantation due to mechanical and nonmechanical causes were included in Group 1 and Group 2, respectively. Success rates, patient satisfaction rates, time between the implantation of the first and second AUS, and complications were compared between the groups. Results: The mean follow-up period was 79 (3­308) months for patients who went through primary AUS implantation due to postprostatectomy incontinence. Our success rates were found as 75% and 66% in Group 1 and Group 2, respectively. The differences between the groups in terms of success and patient satisfaction rates were not statistically significant, while the time to reimplantation was longer in Group 1 and statistically significant. Conclusion: Reasons for AUS reimplantation may affect the success and patient satisfaction rates. Our success rates of AUS performed for nonmechanical reasons were slightly lower, but not statistically significantly so. AUS reimplantation may take a longer time if mechanical failure is detected.

Simultaneous Bilateral Quadriceps Tendon Rupture in a Patient with Diffuse Idiopathic Skeletal Hyperostosis after Minimal Trauma: Eight-Year Follow-Up.

INTRODUCTION: The purpose of this report was to describe a very rare case of simultaneous bilateral quadriceps tendon rupture seen in a patient who was diagnosed as having diffuse idiopathic skeletal hyperostosis. CASE PRESENTATION: A man aged 64 years presented to the emergency department with bilateral quadriceps tendon rupture. Surgical repair was performed with suture anchors and a stainless steel cable. His legs were immobilized in casts for six weeks. After removal of the casts, physiotherapy was started. Four months after surgery, he was able to walk with 0°-120° range of motion and active extension. He was followed up for 8 years without rerupture or other complications. CONCLUSION: Bilateral rupture of the quadriceps tendon is a rare condition and generally related to metabolic disorders. Diffuse idiopathic skeletal hyperostosis is a metabolic disorder that causes bilateral quadriceps tendon rupture, and it accounted for the differential diagnosis of the underlying condition.

Posttraumatic High-Flow Nonischemic Priapism.

Priapism is an uncommon disorder, and nonischemic priapism is seen less frequently in children, generally after trauma. Although it seems to be an advantage that urgent intervention is not required because of no cavernous ischemia, it is likely to be misdiagnosed because of the asymptomatic potential. We aimed to present a case of posttraumatic nonischemic priapism.

Comparison of Retrograde Intrarenal Surgery and Percutaneous Nephrolithotomy Methods in Treatment of Upper Calyceal Stones of 10-20 mm.

OBJECTIVE: To compare the success and complication rates and advantages and disadvantages of retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PNL) methods for the upper calyceal renal stones between 10 and 20 mm. MATERIALS AND METHODS: The files of 124 patients who had upper calyceal renal stones in diameter 10-20 mm were analyzed retrospectively. Sixty-one patients were randomized as Group 1 and 63 as Group 2. The parameters as success and complication rates, fluoroscopy and operation times, preoperative and postoperative hemogram (Hb) levels, and need of blood transfusion were saved and then groups compared. Complication rates and need of second procedure numbers between groups were evaluated according to modified Clavien classification. RESULTS: Demographic features and success and complication rates between groups were similar. Hospitalization time was 1.0 ± 0.1 day for Group 1 and 2.3 ± 1.4 days for Group 2. When preoperative and postoperative Hb difference was evaluated, 0.1 ± 0.3 mg/dL decrease was noticed for Group 1 and 1.6 ± 0.8 mg/dL decrease for Group 2. Mean operation time for Group 1 was 53.6 ± 15.1 minutes and mean fluoroscopy time was 20.1 ± 8.9 seconds for Group 1; for Group 2, these values were 67.8 ± 16.2 minutes and 53 ± 15.0 seconds, respectively. As a result, mean operation time and fluoroscopy time, hospitalization time, and Hb decrease levels were found less and as statistically significant for Group 1. CONCLUSION: RIRS and PNL methods both have the same success and complication rates for upper calyceal renal stones between 10 and 20 mm. However, we think that RIRS method should be preferred for suitable patients because it is a more noninvasive method and has advantages of some operation parameters over PNL.

Intraneural ganglion cyst of the ulnar nerve in an unusual location: A case report.

INTRODUCTION: Intraneural ganglion cysts are benign, mucinous, non-neoplastic lesions of the peripheral nerves. While the most common location of intraneural ganglion cysts is the ulnar nerve and its branches, intraneural ganglion cyst involving the superficial branch of the ulnar nerve has not yet been reported. PRESENTATION OF CASE: A-25-year-old woman presented with pain and a palpable mass in the hypothenar region of the volar side of her right hand. Her neuromuscular examination was normal. The pain was unresponsive to nonsurgical treatments. After confirming with imaging modalities, the initial diagnosis was considered as an intraneural ganglion cyst arising from superficial ulnar nerve. Excision of the ganglion and exploration of the articular branch (if seen in operation) decision was undertaken by the senior author. Whether MRI or intraoperative exploration, not identified an articular branch. DISCUSSION: Intraneural ganglion cysts of peripheral nerves may be seen in miscellaneous locations in the body. However, to our knowledge, an intraneural ganglion cyst involving the superficial branch of the ulnar nerve is unique. While a variety of theories have been proposed to enlighten the etiopathogenesis of intraneural ganglia, the latest and most affirmed is the unifying articular (synovial) theory. CONCLUSION: Intraneural ganglion cysts may be seen on the hypothenar side of the palm. The etiology and treatment of choice are closely associated with each other in this rare disorder. It is important to realize a related articular branch, otherwise the origin of cyst formation remains, and this may cause other para-articular cysts.

Factors affecting complication rates of retrograde flexible ureterorenoscopy: analysis of 1571 procedures-a single-center experience.

PURPOSE: To evaluate the factors affecting complication rates of flexible ureteroscopy and laser lithotripsy (FURSL). MATERIALS AND METHODS: Data on a total of 1395 patients, with 1411 renal units underwent 1571 procedures with FURSL for renal and/or proximal ureteral stones between April 2012 and January 2016, were retrospectively analyzed. Complications were assessed using the Satava and modified Clavien systems. Univariate and multivariate analyses were done to determine predictive factors affecting complication rates. RESULTS: The mean patient age in the total procedures was 45.68 ± 14.00 years (range 2-86 years), and the mean stone size was 15.15 ± 8.32 mm (range 5-75 mm). The overall success rate was 95.6 %. A total of 209 (13.3 %) cases suffered from complications with intraoperative complications rates of 5.9 % and postoperative complication rates of 7.3 %. Univariate analysis revealed no significant difference in complication rates in respect of age, gender, body mass index, use of ureteral access sheath, operation time, bleeding disorder, solitary kidney, preoperative stenting, American Society of Anesthesiologists score, repeated procedure or location of stones (all p value >0.05). Complication rates were determined to be significantly affected by stone size (p = 0.026), multiplicity (p = 0.028) and the presence of congenital renal abnormality (p < 0.01). The only significant factor in multivariate analysis was the presence of congenital renal abnormalities (p = 0.02). CONCLUSIONS: The results of the current study indicated that stone size, stone number and the presence of congenital renal abnormalities were factors affecting complication rates after FURSL, although congenital renal abnormality was the only independent predictor among these risk factors.

Comparison of Flexible Ureterorenoscopy and Laparoscopic Ureterolithotomy Methods for Proximal Ureteric Stones Greater Than 10 mm.

OBJECTIVE: To examine the outcomes and to compare the effectiveness of laparoscopic ureterolithotomy and flexible URS in patients with proximal ureteral stones greater than 10 mm in diameter. MATERIAL AND METHODS: A total of 150 patients who were performed laparoscopic ureterolithotomy and flexible URS because of uretral stones in our urology clinic between January 2010 and June 2015, were analyzed retrospectively. We constituted two groups; 70 patients who were performed laparoscopic ureterolithotomy were included in group I while flexible URS-performed 80 patients in group II. Success rates and complications of the group I and II were compared. RESULTS: Success rates were 95.7% and 90% in group I and II respectively. There was no significant difference between the groups in terms of "success-rates". No statistically and clinically significant complications occurred in both groups. CONCLUSION: Laparoscopic ureterolithotomy and flexible URS methods are effective and reliable with proper indications in treatment of proximal ureteral stones. However, when considered short operational and hospitalization times and the management of the situations that require secondary interventions, we suggest that flexible URS is a minimally invasive method and it may be the first choice in the treatment of proximal ureteral stones.

Comparison of Dilation Methods in Percutaneous Nephrolithotomy: Which One Is More Successful?

OBJECTIVE: Creation of the access tract is an important step in percutaneous nephrolithotomy (PNL). In this study, we compared the efficiency and safety of Amplatz, Alken, and balloon dilation methods in the creation of the access tract. MATERIALS AND METHODS: Data from 487 PNL patients admitted to 517 renal units in 3 centers were analyzed. The Amplatz (280 patients), Alken (142 patients), and balloon (95 patients) dilation methods were compared for their success, duration of the dilation, injury to the collecting system, durations of fluoroscopy and surgery, stone-free and complication rates, pre- and postoperative hematocrit levels, and need for blood transfusion. RESULTS: The dilation methods did not significantly differ with respect to patient demographic data, mean stone area, decrease in hematocrit, need for blood transfusion, unsuccessful tract dilation, injury to the collecting system, stone-free rate, and rate of postoperative complications. The mean fluoroscopy times during Amplatz, Alken, and balloon dilation were 288.52 ± 164.67, 287.34 ± 164.99, and 169.23 ± 21 seconds, respectively. The mean duration of surgery was 96.48 ± 46.07, 94.72 ± 42.25, and 78 ± 25.96 minutes, respectively. The duration of tract creation was 328.67 ± 172.99, 325.14 ± 175.70, and 203.50 ± 32.76 seconds, respectively. The durations of surgery and tract creation were significantly shorter in the balloon dilation group. CONCLUSION: None of the dilation methods was significantly superior in terms of surgical success, efficiency, or safety. Although balloon dilation was advantageous with respect to time parameters, the role of surgical experience should not be ignored.

Standard percutaneous nephrolithotomy alone versus in combination with intraoperative anterograde flexible nephroscopy for staghorn stones: A retrospective study.

This study aimed to compare the outcomes of standard percutaneous nephrolithotomy (PCNL) to PCNL with intraoperative antegrade flexible nephroscopy (IAFN) for treating stones of staghorn nature. We retrospectively analyzed patients treated using PCNL between January 2007 and July 2013. A total of 1250 patients were treated using PCNL, and 166 patients had staghorn stones. All patients had been subjected to a complete blood count, routine biochemical analyses, coagulation tests, a complete urine analysis, and urine cultures. Patients with a positive urine culture had been treated with appropriate antibiotics until the urine culture became negative. After purchasing a flexible renoscope in March 2012, we routinely used this tool to improve the stone-free (SF) rate. The 105 patients who underwent standard PCNL prior to March 2012 were classified as Group 1, and the 61 patients who underwent PCNL + IAFN after that date were classified as Group 2. The two groups had similar and homogeneous demographic data. The fluoroscopy and total operative times were significantly higher in Group 2 than in Group 1 (p < 0.01). Additionally, the hospitalization time (p < 0.01) and the mean hematocrit decrease (p < 0.01) were significantly lower in Group 1. In both groups, the SF rates were higher than 85%, similar to those reported in the literature. Although Group 2 had a slightly better SF rates, this difference was not statistically significant. For staghorn calculi, PCNL combined with IAFN yields excellent outcomes. However, similar prospective studies on larger cohorts should be performed to support our findings.

The Effect of Metabolic Syndrome on the Success and Complications of Percutaneous Nephrolitotomy.

BACKGROUND: The aim of this study was to investigate the effect of Metabolic syndrome (MetS) on the success and complications of percutaneous nephrolithotomy (PNL). METHODS: Two hundred ten patients who had undergone PNL for kidney stones in our clinic between May 2012 and May 2014 were retrospectively analyzed. The patients were divided into two groups based on whether they had diagnostic criteria for MetS. All patients had lower pole kidney stones between 15 and 20 mm. Complication rates between groups were evaluated using a modified Clavien grading system. RESULTS: Group1 was a standard PNL group and group 2 consisted of patients with MetS. Mean stone size was 293.25 ± 102.4 mm(2) for group 1 and 301.10 ± 169.5 mm(2) for group 2 (p < 0.05). Mean hospitalization days, fluoroscopy duration, and mean hematocrit loss were significantly higher in group 2. Mean operative time and need for blood transfusions were higher in group 2 but statistically insignificant. One hundred twenty five patients in group 1 (96.1%) and 72 patients in group 2 (90%) obtained stone-free state. CONCLUSIONS: Our study results reveal an increase in complications and morbidity for patients with MetS during PNL.

A comparison of standard PCNL and staged retrograde FURS in pelvis stones over 2 cm in diameter: a prospective randomized study.

The aim of the study was to compare percutaneous nephrolithotomy (PCNL) and staged retrograde flexible ureteroscopy (FURS) methods used in the treatment of kidney stones of 2 cm or more in diameter. The study comprised a total of 60 patients with a diagnosis of kidney pelvic stones more than 2 cm in diameter, for whom surgery was planned between January 2013 and January 2014. The patients were randomly allocated to two groups as staged retrograde FURS (Group A) and PCNL (Group B). Comparison of the groups was made with respect to operating time, number of procedures, total treatment time, length of hospital stay, stone-free rates and complications according to the Clavien-Dindo classification. In Group A, the total operating time of multiple sessions was 114.46 min. In Group B, a single session of PCNL was applied to all patients and the mean operating time was 86.8 min (p = 0.014). Mean total treatment time was 2.01 weeks in Group A and 1 week in Group B (p < 0.01). The mean total hospitalization time was 3.66 days in Group A and 3.13 days in Group B (p = 0.037). At the end of the sessions, clinically insignificant residual fragments were observed in ten patients of Group A and one patient of Group B (p = 0.03). No statistically significant difference was determined between the groups in terms of stone-free rates or complications. Although current technology with FURS is effective on large kidney stones, it has no superiority to PCNL due to the need for multiple sessions and long treatment time.

Asymptomatic lower pole small renal stones: shock wave lithotripsy, flexible ureteroscopy, or observation? A prospective randomized trial.

OBJECTIVE: To present the outcomes of flexible ureteroscopy (F-URS), shock wave lithotripsy (SWL), and observation in the management of asymptomatic lower calyceal stones. METHODS: A total of 150 patients with asymptomatic lower calyceal stones were randomized into F-URS (group 1), SWL (group 2), and observation (group 3) groups. The main criteria for patient enrollment were having asymptomatic single lower pole stones <1 cm. RESULTS: In F-URS, the mean stone-free rate was 92% (46 of 50). The mean number of sessions for the SWL group was 1.48 ± 0.65. Stone-free rate was 90% (45 of 50). In the observation group, patients were followed up for a mean of 21.02 ± 3.65 months. Three stones passed spontaneously without any symptoms. Pain developed in 3 patients during follow-up, and 2 of them passed a stone and responded to analgesics without further treatment. Complication rates for groups 1 and 2 were similar, but group 2 had higher Clavien grades. CONCLUSION: For asymptomatic small-sized lower calyceal stones, SWL and F-URS are established treatment modalities. However, with low auxiliary treatment rates, observation may be an option for the management of nonsymptomatic small-sized lower pole kidney stones.

The impact of metabolic syndrome on the outcomes of transurethral resection of the prostate.

PURPOSE: To investigate the effect of metabolic syndrome (MS) and its components on the outcomes of transurethral resection of the prostate (TURP). PATIENTS AND METHODS: Fifty patients with MS and 50 without MS were enrolled for the study. Patients without MS were assigned to Group 1 and patients with MS were in Group 2. Patients were evaluated by the International Prostate Symptom Score (IPSS), Quality of Life index (QoL), maximum urine flow rate (Qmax), prostate-specific antigen level, and urinary ultrasonography. Six months after surgery, patients were again evaluated by IPSS and uroflowmetry; then comparison was made between the groups with respect to IPSS, QoL, and Qmax. RESULTS: Postoperative IPSS was determined as 11.2±0.87 in Group 1 and 12.9±0.88 in Group 2 (P<0.05). Postoperative Qmax values were determined as 18.2±0.81 and 13.9±1.12 for the two groups, respectively (P<0.05). After multivariate analyses, elevated fasting glucose (EFG) and dyslipidemia were determined to have a significant correlation with IPSS improvement. EFG and hypertension had a significant negative impact on Qmax, and hypertension and abdominal obesity had a significant correlation with QoL improvement. CONCLUSIONS: MS as a comorbidity seems to diminish the effects of TURP. Further well-designed prospective, randomized studies with larger cohorts are needed to confirm the findings of this study.

Do lubricants with 2% lidocaine gel have an effect on patient comfort in diagnostic cystoscopy?

BACKGROUND: Patients undergoing both rigid and flexible cystoscopic evaluation suffer from a great deal of pain and discomfort. In this study, we aimed to investigate the effect of lidocaine gel anestesia on patient comfort on diagnostic rigid cystoscopy. MATERIAL AND METHODS: 11 mL of lubricant gel applied to each patient via the external meatus in 10 s. Patients were randomized into three groups. In group 1, liquid glycerine was applied and cystoscopy was immediately performed, in group 2 lidocaine gel (Aqua Touch™: Istem Tibbi Cihaz Ve Sanayi Ltd.Sti, Ostim, Ankara, Türkiye) was applied and the procedure undergone immediately and in group 3, lidocaine gel was applied and penis was clemped for 10 minutes before the procedure. VAS forms were filled to determine the discomfort and pain during cystoscopy and the first micturation after. RESULTS: After the evaluation between groups, VAS scores were significantly lower in Group II and III than Group I and in Group III than in Group II (p < 0.05). When post micturation VAS scores were evaluated, VAS scores were significantly lower in Group II than Group I and in Group III than in Group II (p < 0.05). CONCLUSIONS: The application of local anesthetic lidocaine gel in rigid cystoscopy, is a practical, safe and efficient method to improve patient comfort when applied in appropriate dose and waiting duration.

Evaluation of frozen section results in patients who have suspected testicular masses: a preliminary report.

PURPOSE: To report our experience with patients who have suspected testicular masses (STM) managed by ex vivo technique of testicular sparing surgery (TSS) after radical orchiectomy. MATERIALS AND METHODS: Between 2007-2011 years, 10 patients with STM were evaluated by history, physical examination, testicular ultrasound and serum tumor markers. STM were defined as; no paratesticular lesions, size of the lesion smaller than 20 mm, and no known presence of elevated tumor markers or metastatic disease. The principles of TSS followed by radical orchiectomy were applied to the removed surgical specimen. Excised mass, multiple biopsies of the adjacent parenchyma and the remaining testis were sent for frozen-section analysis (FSA). Histopathologic sections were re-reviewed for definitive pathologic diagnosis. RESULTS: The mean patient age, mean size and mean length of history of STM were 37 years (25-64), 17.5 mm (10-20) and 6 months (2-12). All STM were palpable and painless. Tumor markers were negative in all patients. Six tumors were benign (2 adenomatoid tumor, 1 epididymitis nodosa, 1 leydig cell tumor, 1 sertoli cell tumor, 1 fibrous pseudotumor) and 4 tumors were malignant (3 seminoma, 1 embryonal carcinoma) on definitive pathologic diagnosis. Excluding one benign lesion, FSA correctly determined 9 lesions and all malignant lesions. Three patients had testicular intraepithelial neoplasia (ones seminoma, ones embryonal carcinoma, ones adenomatoid tumor). CONCLUSION: Our preliminary report reveals that STM tend to be benign rather than malignant in nature. Also, a careful patient selection and an accurate FSA are crucial points for TSS and it has the potential to become the primary option in selected patients who have testicular lesions instead of the traditional method.