A Retrospective Analysis of 83 Patients with Testicular Mass Who Underwent Testis-Sparing Surgery: The Eurasian Uro-oncology Association Multicenter Study.

INTRODUCTION: Herein, we analyzed the histopathological, oncological and functional outcomes of testis-sparing surgery (TSS) in patients with distinct risk for testicular cancer. METHODS: This is a multicenter retrospective study on consecutive patients who underwent TSS. Patients were categorized in high- or low-risk testicular germ cell tumor (TGCT) according to the presence/absence of features compatible with testicular dysgenesis syndrome. Histology was categorized per size and risk groups. RESULTS: TSS was performed in 83 patients (86 tumors) of them, 27 in the high-risk group. Fifty-nine patients had a non-tumoral contralateral testis present. Sixty masses and 26 masses were benign and TGCTs, respectively. No statistical differences were observed in mean age (30.9 ± 10.32 years), pathological tumor size (14.67 ± 6.7 mm) between risk groups or between benign and malignant tumors (p = 0.608). When categorized per risk groups, 22 (73.3%) and 4 (7.1%) of the TSS specimens were malignant in the high- and low-risk patient groups, respectively. Univariate analysis showed that the only independent variable significantly related to malignant outcome was previous history of TGCT. During a mean follow-up of 25.5 ± 22.7 months, no patient developed systemic disease. Local recurrence was detected in 5 patients and received radical orchiectomy. Postoperative testosterone levels remained normal in 88% of those patients with normal preoperative level. No erectile dysfunction was reported in patients with benign lesions. CONCLUSION: TSS is a safe and feasible approach with adequate cancer control, and preservation of sexual function is possible in 2/3 of patients harboring malignancy. Incidence of TGCT varies extremely between patients at high and low risk for TGCT requiring a careful consideration and counseling.

Making a case "against" focal therapy for intermediate-risk prostate cancer.

INTRODUCTION: Focal therapy (FT) for localized prostate cancer (PCa) is a promising treatment strategy. Although, according to guidelines, it should be regarded as an experimental option, its introduction into clinical practice has occurred at an accelerated speed. It is, thus, crucial for Urologists to understand FT limitations and potential drawbacks that may derive from its use. METHODS: We performed a literature search of peer-reviewed English language articles using Pubmed and the words "focal therapy" AND "prostate cancer" to identify relevant articles. Web search was complemented by manual search. RESULTS: From a biological perspective, in contrast with the index lesion theory, which still needs to be better supported, PCa is a multifocal and multiclonal entity. Also, the effects of FT on PCa microenvironment are unclear. From a clinical perspective, patient selection is still not precisely defined. Even when all variables potentially decreasing mpMRI and biopsy accuracy are optimized, up to one out of two men may be incorrectly selected for FT, leaving a significant proportion of clinically significant PCa (csPCa) untreated. Underestimation of PCa volume and variant histologies are other additional mpMRI potential limitations. No RCTs have been performed against the standard of care to support FT. There is absence of long-term results and FT series reaching medium-term follow-up have non-optimal oncological control with significant re-treatment needs. When PCa recurs/persists after FT, little is known about the appropriate management strategies and their outcomes. Finally, the optimal follow-up scheme post-FT remains unclear. CONCLUSIONS: Several arguments are present against the use of FT for localized PCa. Studies are needed to overcome current limitations and support FT before it can be included as part of the standard management of prostate cancer.

Preservation of antegrade ejaculation after surgical relief of benign prostatic obstruction is a valid endpoint.

PURPOSE: To review the current data on retrograde ejaculation (RE) and ejaculatory dysfunction (EjD) after endoscopic and minimally invasive surgical treatment of benign prostatic obstruction (BPO) and, their perceived impact in the quality of life (QoL) and sexual life of patients and their partners. METHODS: Narrative review of systematic reviews (SR) assessing comparative rates of RE, EjD or erectile dysfunction (EF) was carried out. Relevant articles on the prevalence of RE, EjD or EF and on their impact in the QoL or sexual life of patients and partners were manually selected based on relevance. RESULTS: Twelve SRs reporting on comparisons of different endoscopic/minimally invasive treatments of BPO were found. Data on outcomes varied widely. Overall, after conventional TURP or laser techniques 42-75% of patients present RE. Prostatic incision and ablative procedures present lowest rates of de novo RE or EjD whereas laser adenomectomy and ejaculation preservation procedures preserve antegrade ejaculation in 46-68% of patients. EjDs is associated to LUTS and present in 10% of sexualy active men before intervention. It modulates the QoL and sexual life of the couple. In spite of the scarce literature assessing patient's and partner's perception of postoperative EjD, it strongly suggests that both parties value the maintenance of the ejaculatory function. CONCLUSION: Ejaculation-preserving techniques and minimally invasive techniques successfully prevent BPO treatment-induced RE or EjD in 70-100% of the cases. While this is appealing to patients and spouses, technique selection and treatment durability are issues to be discussed with the couple.

COVID-19 and urology: A bibliometric analysis of the literature.

AIM: The aims of this research were to analyse the urological literature published during the COVID-19 pandemic and to guide future research. MATERIAL AND METHODS: Between 2019 and 2021, the Web of Science (WoS) All Databases collection was searched for publications related to COVID-19 and Urology. The keywords used during this search were coronavirus-19, COVID-19, SARS-CoV-2, novel coronavirus, 2019-nCoV, pandemic and/or urology. The top 50 cited (T50) publications were also identified and summarized. Exported Microsoft Excel files, Visualization of Similarities viewer (VOSviewer) software and descriptive assessment were used for bibliometric and statistical analyses of the publications. RESULTS: In total, 582 publications related to COVID-19 and urology were identified. In these publications, the most active author, journal, country and organisation were Francesco Porpiglia, European Urology, the United States of America (USA) and La Paz University Hospital, respectively. The most commonly used keywords were telemedicine-telehealth, SARS-CoV-2, coronavirus, pandemic, residency, testicle, semen, kidney transplantation, endourology and surgery. The most worrying issues in the articles are the negative impact of COVID-19 on resident training and permanent damage to urological organs. CONCLUSIONS: We analysed all the articles related to COVID-19 and urology published to date in the WoS All Databases collection. The most commonly published articles were based on clinical and outpatient practice, telemedicine, residency training, transplantation, and testicles. The long-term adverse effects of the pandemic on urology practice and especially urological organs will need to be assessed further in future research.

Cross-continental comparison of safety and protection measures amongst urologists during COVID-19.

OBJECTIVES: To determine the well-being of urologists worldwide during the coronavirus disease 2019 pandemic, and whether they have adequate personal protective equipment knowledge and supplies appropriate to their clinical setting. METHODS: Urologists worldwide completed a Société Internationale d'Urologie online survey from 16 April 2020 until 1 May 2020. Analysis was carried out to evaluate their knowledge about protecting themselves and others in the workplace, including their confidence in their ability to remain safe at work, and any regional differences. RESULTS: There were 3488 respondents from 109 countries. Urologists who stated they were moderately comfortable that their work environment offers good protection against coronavirus disease 2019 showed a total mean satisfaction level of 5.99 (on a "0 = not at all" to "10 = very" scale). A large majority (86.33%) were confident about protecting themselves from coronavirus disease 2019 at work. However, only about one-third reported their institution provided the required personal protective equipment (35.78%), and nearly half indicated their hospital has or had limited personal protective equipment availability (48.08%). Worldwide, a large majority of respondents answered affirmatively for testing the healthcare team (83.09%). Approximately half of the respondents (52.85%) across all regions indicated that all surgical team members face an equal risk of contracting coronavirus disease 2019 (52.85%). Nearly one-third of respondents reported that they had experienced social avoidance (28.97%). CONCLUSIONS: Our results show that urologists lack up-to-date knowledge of preferred protocols for personal protective equipment selection and use, social distancing, and coronavirus disease 2019 testing. These data can provide insights into functional domains from which other specialties could also benefit.

A review study to evaluate holmium:YAG laser lithotripsy with flexible ureteroscopy in patients on ongoing oral anticoagulant therapy.

The objective of this study was to evaluate the safety and efficacy of flexible ureteroscopy (FURS) and holmium:YAG laser lithotripsy for the treatment of upper urinary tract stones in patients on active oral anticoagulants. The records of 1081 patients who underwent flexible ureteroscopic holmium:YAG (Ho:YAG) laser lithotripsy for upper ureteral and renal calculi from 1999 to 2015 were retrospectively reviewed. A total of 84 patients on continuous oral anticoagulation or antiplatelet therapy (warfarin, aspirin, or clopidogrel) were identified. Of these patients, 40 were on warfarin, 25 on aspirin, 11 on clopidogrel, and 8 on both aspirin and clopidogrel. The drugs were not discontinued. The baseline characteristics, indications for anticoagulation therapy, perioperative data, stone-free rate, and complications were documented. Evaluation of outcomes was assessed at 1-, 3-, and 6-month follow-up postoperatively. Mean stone size was 19.7 ± 9.4 (range 8 to 31 mm). Twenty patients had upper ureteral and 64 patients had intrarenal calculi. Two patients had bilateral renal calculi. Mean operation time was 78.2 ± 23.8 min (range 17 to 144 min). Two procedures (2.3%) in warfarin group were terminated due to persistent bleeding causing visual impairment. No transfusions were required. The mean serum hemoglobin levels did not change significantly (12.9 ± 3.7 to 12.2 ± 3.3 g/dL). No thromboembolic or cardiac adverse events were observed perioperatively. The double-j (DJ) ureteral catheterization time was 29.6 ± 9.3 days (range 14 to 68 days) and the hospital stay was 1.6 ± 0.6 days (range 1 to 4). The stone-free rate was 95.2% (80 patients) at 6 months. Flexible ureteroscopic Ho:YAG laser lithotripsy in patients requiring long-term anticoagulation therapy seems to be a safe and effective procedure and should be considered as a first-line treatment option in such patients for the surgical management of upper urinary tract stones.

Metastasis of renal cell carcinoma to the thyroid gland 9 years after nephrectomy: A case report and literature review.

We report a case presenting with thyroid and lung metastases of renal cell carcinoma that was treated with molecular targeted therapy followed metastasectomy. A 52-year-old female underwent radical nephrectomy of right renal cell carcinoma in 2007. The patient presented 9 years after nephrectomy at the age of 61 years with sudden loss of vision on the left side and a mass on the neck. On magnetic resonance imagining, there was a mass on the midline of the neck, extending to the left, measuring 46 x 31 mm and containing central cystic-necrotic areas. Fine-needle aspiration biopsy was performed. The histopathological examination of the biopsy specimen revealed a lesion composed of malignant epithelial cells compatible with metastasis of renal carcinoma. Computed tomography showed multiple metastases in bilateral lungs. Metastasectomy and total tiroidectomy were performed. Thyroid and lung metastasis of renal cell carcinoma were pathologically confirmed. But on the first computed tomography after metastasectomy, there was residual tumor in the thyroid. Interferon-alpha therapy was given for 8 weeks. After that, pazopanib therapy started. Three months later, on computed tomography, residual metastatic foci were regressed. The patient was followed up for 1 year after metastasectomy. The patient is currently receiving a single dose of pazopanib per day (400 mg/day) and the general condition is good. Thyroid metastasis should be considered in patients with a thyroid nodule and positive history for renal cell carcinoma. Successful results can be obtained with metastasectomy and systemic targeted therapy.

Blood platelet activity in men with vasculogenic erectile dysfunction.

OBJECTIVE: The aim of this study was to investigate the platelet activity in patients with vasculogenic erectile dysfunction (ED). MATERIALS AND METHODS: The total blood count, including hemoglobin (Hgb), white blood cell (WBC), red blood cell (RBC), platelet (PLT) and mean platelet volume (MPV) parameters were measured in the patient (n = 70) and control groups (n = 50). RESULTS: The average age was 48.1 ± 11.7 and 47.6 ± 12.3 in the patient and control groups (p = 0.8217), respectively. MPV was higher in the patient group and there was a statistically significant difference between two groups (11.27 ± 0.56 and 9.8 ± 0.91, p < 0.0001). PLT counts were lower in the patient group but there was not a statistically significant difference (196.23 ± 37.01 and 209.07 ± 36.71, p = 0.0626). In terms of haemoglobin, WBC and RBC values, there was no difference in the patient and control groups. CONCLUSIONS: Finding high MPV, which reflects the platelet activity, in the patient group shows that platelets also have a role in the VED etiopathogenesis. In the case of the confirmation of this result with additional studies, the efficiency of anti-platelet therapy in the vasculogenic ED should also be researched.

Non sex-related subtotal rupture of the corpus cavernosum without urethral injury: A case report and literature review.

Although penile fracture is a rare case, it is a well-described urologic emergency. It results from the rupture of the tunica albuginea of corpora cavernosa by blunt strain that commonly mandates immediate surgical exploration. Urethral injury may also accompany penile fracture. An ideal anamnesis and a special physical examination were determinant to achieve a correct diagnosis. It is usually diagnosed based on clinical examination, but ultrasonography can be very helpful in diagnosis. The treatment is based on the presence of associated urethral injury. Early surgery is preferable to conservative management, because it is associated with better outcomes and fewer long-term complications. The surgical repair of cavernous body can produce good results, with a favorable prognosis and minimal rate of complications. We present a penile fracture case of 34-year-old with subtotal rupture of the right corpus cavernosum without urethral injury who treated by early surgery and good results.

A comparison of 120 W laser photoselective vaporization versus transurethral resection of the prostate for bladder outlet obstruction by prostate cancer.

OBJECTIVE: To compare the mid-term outcomes of photoselective vaporization of prostate (PVP) with GreenLight HPS 120 W laser and transurethral resection of the prostate (TURP) for obstructive lower urinary tract symptoms (LUTS) in men with prostate cancer (CaP). PATIENTS AND METHODS: Seventy four patients with locally advanced (T3/T4) CaP with severe LUTS or acute urinary retention (AUR) were allocated to TURP (n = 36) or PVP (n = 38). International Prostate Symptom Scores (IPSS), maximum flow rates (Qmax) and post-void residual volumes (Vres), PSA levels, prostate volumes, complications, catheter removal and hospitalization periods were recorded. Patients were reassessed at 3, 6, and 12 months. RESULTS: The catheter removal time was significantly longer in the TURP group (3.8 ± 1.1 vs. 1.2 ± 0.7 days, p = 0.02), whereas failure of initial voiding trial was higher in PVP (2.7 vs. 13.1%, p = 0.01). No significant difference in IPSS, Qmax and Vres values was observed within the follow-up period between two groups. A significant difference in urethral stricture rate (8.3 vs. 0%), catheter removal time (3.8 ± 11 vs. 1.2 ± 0.7 days) and hospital stay (2.9 ± 0.6 vs. 1.1 ± 0.5 days) was observed in favor of PVP. CONCLUSIONS: Palliative PVP is very safe and effective by means of symptomatic relief in patients with locally advanced CaP.

180-W XPS GreenLight laser vaporization for benign prostate hyperplasia: 12-month safety and efficacy results for glands larger than 80 mL.

The purpose of the current study was to evaluate the efficacy and safety of laser prostatectomy by using the latest 180-W XPS GreenLight laser with the new MoXy fiber in the surgical treatment of glands larger than 80 mL in a prospective study. From December 2011 to May 2013, 68 consecutive patients with a mean age of 71.1 ± 9.8 years (range 49 to 85) underwent 180-W XPS laser prostatectomy at our institution. The baseline characteristics, perioperative data, and complications were recorded. Evaluation of outcomes was assessed at 3, 6, and 12 months postoperatively comparing subjective (International Prostate Symptom Score [IPSS], International Index of Erectile Function-5 [IIEF-5]) and objective (Maximal flow rate [Qmax], postvoid residual urine [PVR], transrectal ultrasound [TRUS] volume) parameters to the preoperative data. Mean preoperative prostate volume was 104.3 ± 29.7 mL (range 81 to 185). Mean operation time was 65.5 ± 29.6 min (range 38 to 124), with a mean energy delivery of 398 ± 169 kJ (range 39 to 523). The catheterization time was 20.8 ± 1.9 h (range 6 to 92) and the hospital stay was 27.3 ± 8.7 h (range 12 to 80). No major intraoperative complications were observed. Improvement in IPSS, Qmax, and PVR was statistically significant (p < 0.001) at 3, 6, and 12 months. Urethral strictures were observed in two patients (2.9%). No patients required reintervention due to residual adenoma. The average volume reduction was 40.5% at 12 months. Photoselective vaporization of the prostate (PVP) using the new 180-W XPS GreenLight laser system seems to be a safe and effective procedure and could play an important role in the surgical treatment of symptomatic benign prostatic hyperplasia (BPH) patients with larger prostate volumes.

The Relationship between Urinary Incontinence, Osteoarthritis, and Musculoskeletal System Disorders.

Background/Objectives: Urinary incontinence diminishes quality of life, and its severity can be worsened by mobility impairments. This study explored the link between urinary incontinence, osteoarthritis, and back musculoskeletal system disorders, considering pain, mobility issues, and daily activity difficulties. Methods: This cross-sectional study included respondents aged ≥ 15 years from the 2008 Turkish Health Studies Survey (n = 13,976). We assessed self-reported urinary incontinence, daily activity, mobility impairment, pain, osteoarthritis, and musculoskeletal disorders to explore their association with urinary incontinence. Gender-specific logistic regression models included chronic conditions related to urinary incontinence. Results: The prevalence of urinary incontinence was higher in the participants with osteoarthritis and back musculoskeletal system problems. Among the patients with osteoarthritis, the prevalence was 25.84% in the mobility-impaired group and 10.03% in the non-impaired group. Similarly, 33.02% of those with activities of daily living (ADL) difficulties and 12.93% of those without difficulties had incontinence. The frequency of urinary incontinence increased with pain severity. According to the multivariable logistic regression analyses, the adjusted odds ratio (95% confidence interval) of urinary incontinence for osteoarthritis was 1.58 (95% CI 1.23-2.02, p < 0.01) for females and 2.38 (95% CI 1.62-3.49, p < 0.01) for males. Conclusions: Urinary incontinence was more common in females, increased with age, and was found to be associated with osteoarthritis and back musculoskeletal system disorders. Among the patients with osteoarthritis and back musculoskeletal system disorders, those with mobility impairment and daily activity difficulties had a higher prevalence of urinary incontinence. The patients with more severe pain had a higher frequency of urinary incontinence.

Reassessing Normal Voiding Standards: A Cross-Sectional Study Based on Medical Professionals' Evaluations with Portable Uroflowmetry and IPSS.

Background/Objectives: LUTS and voiding dysfunctions are prevalent in urology clinics, with uroflowmetry and IPSS as the prevailing diagnostic methods. Nevertheless, objective assessment can be constrained by age, gender, and variability in the test conditions. Portable (home) uroflowmetry addresses these limitations, allowing for more natural urinary flow recordings beyond clinic confines. This study aims to characterize spontaneous voiding patterns in healthcare professionals, exploring gender differences, variability in repeated measurements, and correlations among voiding parameters, IPSS, age, and BMI. Methods: This cross-sectional study was conducted during the SIU 43rd Congress in Istanbul using smart uroflow devices such as the Oruba Oruflow Uroflow Recorder, which were installed in public toilets. A total of 431 healthcare professionals participated by providing demographic information and completing the IPSS questionnaire. The data analysis included uroflowmetric parameters such as maximum flow rate (Qmax), average flow rate (Qave), and voided volume (VV), in addition to IPSS and demographic data to assess the possible associations with IPSS, age, BMI, and gender differences. Results: Of the participants, 76% were male and 24% female, with a higher prevalence of LUTS in women. Despite no significant gender difference in voided volume, men with lower volumes demonstrated more severe LUTS. Notably, women exhibited higher Qmax and Qave rates irrespective of their IPSS scores, contrasting with men whose flow rates declined with age and LUTS severity. In men, the total IPSS score was inversely associated with uroflowmetric performance, particularly impacting voiding symptoms over storage symptoms. Repeated measurements revealed noteworthy variability in Qmax and VV, without any influence from gender, BMI, age, or symptom severity. Conclusions: Our findings highlight the importance of gender-specific considerations in evaluating voiding complaints through uroflowmetry and IPSS. The significant variability observed in repeated uroflowmetry studies underlines the need for multiple measurements. Overall, this research emphasizes the significance of portable (home) uroflowmetry and calls for a reassessment of normal voiding standards in (non) clinical settings.

Withdraw of the ureteroscope causes fragmented ureter stones to disperse.

INTRODUCTION: Ureteroscopy has improved from the first use of ureteroscope in the 1970' s. Although the success rate increased in the last years, new treatment techniques are being developed for impacted and large proximal ureter stones (2). Pneumatic lithotripsy has high efficiency with low complication rates. However, in case of steinstrasse and large (> 1 cm) ureter stones, fragmented small stones may obstruct insertion of a ureteroscope after initial lithotripsy. In order to triumph over this issue, multiple ureteroscopic passages and manipulations needed for extraction of these small stones by forceps or basket catheters. The overall incidence of stricture was found upto 14.2% when the fragments were removed with a grasping forceps or a basket. We present our technique to disperse small fragmented stones in order to contact non-fragmented rest stone. MATERIALS AND METHODS: Ureteral lithotripsy was performed with an 8-9.8F semirigid ureteroscope using a pneumatic lithotripter (Swiss LithoClast, EMS, Nyon, Switzerland). The stone was fragmented into small pieces as small as 2-3 mm. by pneumatic lithotripter. Eventually, these fragmented stones interfered with vision and the lithotripter to get in touch with the rest stone. After fragmenting distal part of the large stone, the ureteroscope was pulled back out of ureter. While pulling back, the operating channel was closed and irrigation fluid was flowing in order not to decrease pressure behind the stones. Simultaneously, a person tilted the operating table to about 30 in reverse Trendelenburg position. When the ureteroscope was out of ureteral orifice, the operating channel was opened and irrigation fluid was stopped. This maneuver aided decreasing pressure in the bladder more rapidly in addition to feeding tube. Stone dust and antegrade fluid flow were easily seen out of the ureteral orifice. Ureteroscope was re-inserted after 30-60 seconds. While reaching the rest of the stone, small stone dust was seen at first. Bigger stones were approximately 3-5 cm distal to the original place of the stone. When the non-fragmented rest stone appeared, there were no blocking fragmented stones. Insertion of the ureteroscope was easy and we could go on with the lithotripsy procedure. CONCLUSIONS: In comparison to standard position, tilting and rapid decrease in pressure by pulling back the ureteroscope made gravity and negative pressure more effective.

When Bladder and Brain Collide: Is There a Gender Difference in the Relationship between Urinary Incontinence, Chronic Depression, and Anxiety?

In longitudinal and cross-sectional studies, depression and anxiety have been associated with urinary incontinence (UI) in women. However, this association has not been studied in men. Utilizing data from the 2008 Turkish Health Studies Survey conducted by the Turkish Statistical Institute, we analyzed 13,830 participants aged 15 years and above. We investigated the association of UI with psychological discomfort in both sexes using multivariable logistic regression. High psychological discomfort significantly correlated with UI in males (OR 2.30, 95% CI 1.43-3.71) and females (OR 2.78, 95% CI 1.80-4.29). Anxiety increased UI likelihood in females (OR 2.36, 95% CI 1.61-3.46) and males (OR 2.37, 95% CI 1.10-5.13). Depression related significantly to UI in females (OR 2.54, 95% CI 1.81-3.58) but not males (OR 1.63, 95% CI 0.71-3.76). Antidepressant and anxiolytic use was not significantly related to UI in either gender. Anxiety and psychological discomfort contribute to UI in both genders. While depression significantly correlates with UI in females, it does not show the same magnitude and significance in males. Antidepressant and anxiolytic use did not significantly influence the association. These findings underscore the psychological distress-UI link, advocating a holistic approach for managing UI in individuals with mental health conditions.

Fragmentation without extraction in ureteral stones: outcomes of 238 cases.

We aimed to evaluate the success rates, auxiliary procedures and complications after ureteroscopic lithotripsy (URS) during which the fragments left in situ for spontaneous passage after complete disintegration into a acceptable (<4 mm) size. 238 patients with ureteral stones were treated with URS between 2005 and 2011, and disintegrated fragments (<4 mm) were left in situ for spontaneous passage. Patients were followed with radiography for 3 months and evaluated with respect to the success rates (stone-free), auxiliary procedures, complication rates and additional analgesic requirement. The median age was 42.2 ± 13.7 years, and overall stone size was 8.79 ± 2.94 mm. Significantly lower rate of stone-free status was achieved in proximal stones (p < 0.05). A second URS was necessary in 5% (n = 12) of the patients. Double-J catheter placement during initial URS did not cause any change in the rate of secondary URS (p = 0.620). Additional oral or intramuscular analgesia was required in 41% (n = 97) and 25% (n = 59) of the patients, respectively, after discharge. The overall stone-free rate was 95% and mean time to complete clearance was 5 days. Severe colic pain within 24 h was noted in 21 (9%), and transient hydro-ureteronephrosis in 31 (13%) patients, as minor complications. Leaving the fragments (<4 mm) in place for spontaneous passage following a successful disintegration in URS could be a reasonable approach with acceptable and comparable stone-free rates, and this approach appears to give chance of shortening the duration of operation and also avoiding from the potential morbidity of repeated manipulations during the both further disintegration and extraction.

Evaluating ESWL-induced renal injury based on urinary TNF-α, IL-1α, and IL-6 levels.

Extracorporeal shockwave lithotripsy (ESWL) has dramatically changed the treatment of urinary lithiasis and has been the first treatment option for the majority of patients for more than two decades. Despite its significant benefits, it induces acute renal injury that extends from the papilla to the outer cortex. We evaluated the severity of the inflammatory response to ESWL by measuring the urinary excretion of the cytokines TNF-α, IL-1α, and IL-6. The study included 21 selected patients and 14 control subjects. All patients underwent the same ESWL procedure (2,500 shockwaves at 100 shockwaves/min and 0.039 J from the lithotripter). Urine TNF-α, IL-1α, and IL-6 levels were measured using standard ELISA kits. In the study population (patients and controls), we did not detect TNF-α in the urine samples. The levels of both IL-1α (2.5 pg/ml) and IL-6 (3.8 pg/ml) measured before ESWL were not significantly different from the control group (2.5 and 5.2 pg/ml, respectively; p > 0.05). Twenty-four hours after ESWL, in contrast to IL-1α (4 pg/ml), urine IL-6 (19.7 pg/ml) increased significantly (p < 0.05). Fourteen days after ESWL, IL-1α increased to 5 pg/ml, while IL-6 (7 pg/ml) decreased to the control level. Urine cytokine levels may be used to evaluate the inflammatory response to ESWL. After ESWL, IL-6 levels increased in the early phase, while IL-1α levels increased later. These two markers may be used to measure the severity of inflammation. In contrast to IL-1α and IL-6, urine TNF-α excretion was not increased by ESWL. We believe that the inflammatory response to ESWL can be detected by the urinary excretion of IL-1α for up to 14 days.

Rectal injury during radical prostatectomy.

BACKGROUND: We evaluated the data of our patients who experienced rectal injury during radical prostatectomy (RP). METHODS: We analyzed the data for the 7 patients (6 perineal, 1 retropubic) with iatrogenic rectal injury who were selected from 451 patients with RP (218 retropubic, 233 perineal) operated in our clinic between 2003 and 2011. RESULTS: The mean age of the 7 patients was 64.4 years. Rectal injury occurred during prostatic apical dissection in 4 patients, during dissection of Denonvilliers fascia in 1 patient, during transection of the rectourethral muscles in 1 patient, and during dissection of the rectal region proximal to the anal sphincter in 1 patient. The mean size of the lesions was 2 (1-4) cm. All of the rectal injuries were recognized during the operation, and double-layered sutures were used for the primary repair. None of the cases required colostomy procedure. No postoperative complications were encountered in 6 of the patients; however, 1 patient underwent a second operation on the following day due to detachment at the injury site. None of the patients displayed urethrorectal fistula, urinary incontinence or urethral stricture. CONCLUSION: Primary repair with double-layered suturing is sufficient for the treatment of rectal injuries that occur during RP if they are recognized intraoperatively.

Turkish Validation of the User Version of the Mobile Application Rating Scale.

OBJECTIVE: As the number of mobile health applications increases, quality assessment becomes a capital feature of any mobile application design. Besides the professional evaluation conducted before marketing the app, the perceptions of the subjects to whom is intended will determine the successful widespread dis- semination. Hence, the implementation of a given app may be impaired by the lack of a validated transla- tion and cross-cultural adaptation. We aimed to validate in the Turkish language the User Version of the Mobile Application Rating Scale, an English original scale designed to assess the quality of mobile health applications. MATERIALS AND METHODS: A well-established and predefined process of cross-cultural adaptation and transla- tion to Turkish of the User Version of the Mobile Application Rating Scale according to the World Health Organization guidelines was performed using a common, readily available, free-of-charge application. Internal consistency and reliability were tested in a population sample by Cronbach's α and rWG index, respectively. RESULTS: The total User Version of the Mobile Application Rating Scale score had good internal consistency (Cronbach's α = 0.87). Internal consistencies of its subscales were also acceptable: with Cronbach's α of 0.71, 0.78, 0.71, and 0.73 for engagement, functionality, aesthetics, and information, respectively. Cronbach's α of the satisfaction subscale was 0.46. The User Version of the Mobile Application Rating Scale total and sub- scales scores had a strong within-group agreement, all of them with rwg indexes between 0.78 and 0.87 over baseline to 1 month. CONCLUSION: The Turkish version of the User Version of the Mobile Application Rating Scale is consistent with the English original version and is a reliable and valid tool to assess the quality of mobile applications by Turkish users.

The effect of cardiopulmonary bypass in coronary artery bypass surgeries (on-pump versus off-pump) on erectile function and endothelium-derived nitric oxide levels.

PURPOSE: To investigate the effects of on-pump and off-pump coronary artery bypass grafting (CABG) on the erectile function and endothelium-derived nitric oxide (eNO) levels. MATERIALS AND METHODS: Twenty-eight consecutive patients were randomized into two groups depending on use of cardiopulmonary bypass in CABG surgery. The erectile function was evaluated by using the IIEF-5 questionnaire. The plasma eNO levels were determined at baseline and after reactive hyperemia before and after surgery. Blood was collected in one minute after cuff deflation from the radial artery on the same side. RESULTS: After CABG surgery the mean IIEF-5 score increased insignificantly over baseline from 14.8 to 15.8 (p = 0.29) and 12.4 to 14.3 (p = 0.11) after on-pump and off-pump CABG surgeries, respectively. The baseline plasma NO levels before surgery were 18.16 ± 7.63 nmol/L in on-pump and 21.76 ± 11.08 nmol/L in off-pump CABG. After reactive hyperemia the plasma NO levels were 22.14 ± 10.52 nmol/L in on-pump and 21.49 ± 9.13 nmol/L in off-pump CABG before the surgery. The difference in the plasma NO levels before surgery was not significant (p = 0.51). Two hours after surgery, the difference of the plasma NO levels at baseline (24.44 ± 12.31 on -pump and 20.58 ± 6.74 nmol/L off-pump CABG) and after reactive hyperemia (35.55 ± 23.54 nmol/L on-pump and 23.00 ± 15.40 nmol/L off-pump CABG) were not significantly different from each other (p = 0.11). CONCLUSIONS: Patients who had on-pump or off-pump CABG surgeries had higher IIEF-5 scores. Nevertheless, the improvement was insignificant in both groups. Meanwhile, on-pump or off-pump CABG surgeries did not have significant effect on plasma eNO levels.