The effect of the first wave of COVID-19 pandemic on urology practice and anxiety scores of patients awaiting surgery.

OBJECTIVE: We aimed to determine the effect COVID-19 pandemic on the daily urology practice of the level 3 centre located in one of the most affected regions in Turkey. We also aimed to assess anxiety and depression levels of patients whose procedures and surgeries had to be postponed due to COVID-19-related restrictions. METHODS: The number of patients admitted to the outpatient clinic, outpatient procedures, emergency consultation requests, hospitalised patients and the total number of surgeries between March 10, 2020 and June 15, 2020 were evaluated. These numbers were compared with the same period of 2019. Subsequently, patients who could not be operated or whose elective surgeries were postponed between March 10, 2020 and June 15, 2020 were determined(n:96). These patients were asked to fill out Beck Depression Inventory(BDI) and State-Trait Anxiety Inventory(STAI). The presence of difference between the baseline anxiety levels and the anxiety levels during the COVID-19 pandemic was investigated. Afterwards, these patients were divided into two groups based on planned procedures as oncological group (group1) and non-oncological group (group2). The presence of a difference between the anxiety and depression levels between the groups was investigated. RESULTS: There was a drastic decline in number of patients in all assessed parameters. The least amount of change was seen in the number of emergency consultations. The evaluation of anxiety and depression scores of the patients showed a significant difference between their STAI-S and STAI-T scores (51.8 ± 9.3, 38.2 ± 7.5, respectively)(P < .001). STAI-S scores of the patients were found to be compatible with severe anxiety. The patients' mean BDI score was found to be 15 ± 8.9, which indicated mild depression. However, the age and STAI-S values were significantly higher in group1. CONCLUSION: We noted that anxiety and depression levels increased in patients whose operations were delayed because of pandemic-related restrictions, especially in oncological patients. We believe that an important contribution can be made to the protection of public health by planning advance psychosocial interventions for high-risk groups during pandemics.

Effect of seasonal variation on the success of micro-dissection testicular sperm extraction: A pilot study.

The aim of this study is to investigate the relationship between seasonal variation and the success of micro-dissection testicular sperm extraction (mTESE). A total of 395 patients who were diagnosed with non-obstructive azoospermia, who had undergone mTESE operation for the first time, and who did not have an obstructive pathology, were included in the study. The patients were divided into 12 groups according to the month of the operation and four groups according to the season. The groups were compared with regard to age, duration of infertility, BMI, hormone profile and sperm retrieval rate of mTESE. The maximum sperm retrieval rate was obtained in January (69.7%) and the minimum sperm retrieval rate was obtained in November (50.0%). No statistically significant difference was detected when the mTESE results were compared with regard to months (p = 0.638). The maximum sperm retrieval rate was obtained in the summer (62.8%) and the minimum was obtained in spring (57.0%). No statistically significant difference was determined between groups created according to seasons (p = 0.865). We did not observe a statistically significant relationship between the sperm retrieval rate and the seasons. Studies conducted in regions with different climate features could better reveal the relationship between seasonal variation and the success of mTESE.

Smartphone-based stent tracking application for prevention of forgotten ureteral double-J stents: a prospective study.

PURPOSE: Retained or forgotten ureteral stents (FUS) have a potential to cause significant morbidity as well as medico-legal issues and increased cost. We aimed to evaluate the efficacy and usefulness of smartphone-based Ureteral Stent Tracker (UST) application and compare the results with basic appointment card system to prevent FUS, prospectively. MATERIALS AND METHODS: A total of 90 patients who underwent ureteroscopic stone treatment procedure with indwelling DJ stents were equally distributed into two groups. In group-1, patients were followed using UST application. In group-2, only appointment cards were given to the patients. Two groups were compared in terms of stent overdue times and complete lost to follow up rates. RESULTS: Forty-four patients in group-1 and 43 patients in group-2 completed the study. Among patients, 22.7% in group-1 and 27.9% in group-2 did not return for the stent removal on the scheduled day. In group-1, these patients were identified using the UST and called for the stent removal on the same day. After 6 weeks of maximal waiting period, mean overdue times in group-1 and group-2 were 3.5 days and 20 days, respectively (p = 0.001) . In group-2, 3 patients (6.9%) were lost to follow up, while in group-1, it was none (p = 0.001). CONCLUSIONS: We found that the patients who were followed by the smartphone-based UST application has less overdue times and lost to follow up cases compared to the basic appointment card system. The UST application easily follows patients with indwelling ureteral stents and can identify patients when overdue.

The Role of Hematological Parameters in Predicting Fuhrman Grade and Tumor Stage in Renal Cell Carcinoma Patients Undergoing Nephrectomy.

Background and objective: We investigated the ability of preoperative serum values of red blood cell distribution width (RDW), neutrophil lymphocyte ratio (NLR) and plateletcrit (PCT) to predict Fuhrman grades (FG) and tumor stages of renal cell carcinoma in patients who underwent radical nephrectomy. Materials and methods: Records of 283 patients that underwent radical or partial nephrectomy of renal masses at our clinic between January 2010 and April 2018, whose pathology results indicated renal cell carcinoma (RCC), and who had their FG and T1-4 N0M0 identified were retrospectively evaluated. The patients were divided into two groups based on their FG as low (I-II) and high (III-IV) and their T stages were similarly grouped as limited to kidney (pT1-pT2) and not limited to kidney (pT3-pT4). Results: Mean RDW, NLR, PCT cut-off values of the patients for FG and T stage were 15.65%, 3.54, 0.28% and 14.35%, 2.69, 0.28%, respectively. The RDW and NLR were determined to be statistically significant predictors of a pathologically high FG, whereas the PCT value was not a statistically significant predictor of high FG (p = 0.003, p = 0.006, p = 0.075, respectively). The relationship of RDW, NLR and PCT values with a limited to the kidney pathological T stage revealed statistically significant correlations for all three values. Conclusions: We determined that only RDW and NLR were markers predicting FG, while PCT had no prognostic value. On the other hand, all three of these values were associated with a limited to the kidney pathological T stage in patients who underwent nephrectomy due to renal masses and whose pathologies suggested RCC.

The effectiveness of RENAL nephrometry score in ablated renal tumors via radiofrequency ablation or cryoablation

Background/aim: This study aimed to evaluate the clinical efficacy of radiofrequency ablation (RFA) and cryotherapy and to scrutinize the therapeutic success of the RENAL (radius, exophytic/endophytic, nearness to collecting system, anterior/posterior, and location) nephrometry score in terms of possible complications and the predictive status of oncological results. Materials and methods: Forty-five patients with biopsy-proven renal cell carcinomas (32 males, 13 females) treated with RFA and cryotherapy were included. Patients were 22­90 years old (average: 59.2 years). Statistical analyses were performed using SPSS for Windows. Results: A total of 79 lesions with dimensions varying between 0.9 and 4.5 cm (average: 2.2 cm) were ablated. Complete ablation was achieved for 72 (91.1%) lesions. Six repeat RFA sessions were applied for 4 (5%) lesions with residue/recurrence. The average RENAL nephrometry scores of lesions that underwent complete ablation and those that developed residue/recurrence were 6.3 and 7.7, respectively. The average recurrence-free survival time was 34.8 months (range: 3­55 months), while it was 44.6 months (range: 6­55 months) for cryotherapy and 28.6 months (range: 3­50 months) for RFA. Conclusion: Ablative therapies are minimally invasive and effective methods for treating small renal tumors. RENAL nephrometry scoring is a valuable system for standardizing renal tumors and evaluating the success of ablative therapies, possible complications, and oncological results.

Association between large prostate calculi and prostate cancer.

OBJECTIVE: We investigated the relationship between large prostate calculi and prostate cancer (PCa) risk. MATERIALS AND METHODS: The medical records of 340 patients who received a prostate biopsy at our institution between January 2015 and August 2016 were reviewed retrospectively. Of the patients, 82 had large prostatic calculi visualised by transrectal ultrasonography and 88 did not or had scarce prostatic calculi. We divided these patients into two groups: patients with large prostatic calculi (group 1) and patients without prostatic calculi (group 2). These groups were compared according to age, total prostate specific antigen (PSA) level, prostate volume, and final pathological diagnosis. RESULTS: The mean age of all patients was 61.4 ± 6.2 years, the mean total PSA was 12.3 ± 17.4 ng/mL, the mean prostate volume was 41.7 ± 17.6 mL, and the overall cancer detection rate was 31.5%. The cancer detection rates were 41.3% and 22.6% in groups 1 and 2, respectively (p = 0.018). No significant differences in mean age, mean total PSA, or mean prostate volume were observed between the groups. CONCLUSIONS: In the present study, large prostatic calculi were associated with PCa. However, more study is needed to examine the relationship between large prostatic calculi and PCa in more detail. The effects of particularly large prostate calculi in the development of PCa will be a necessary focus of future research.

The sufficiency of 6 core sextant prostate biopsy in patients with prostate specific antigen (PSA) values over 20 ng/mL.

OBJECTIVE: In this study, we aimed to investigate sufficiency of 6 core prostate biopsy in patients with PSA levels elevated above 20 ng/mL. MATERIALS AND METHODS: The medical record of the patients who received prostate biopsy at our institution between August 2011 to August 2016 who had serum total PSA values above 20 ng/mL, were reviewed retrospectively. In this study, we included 40 patients who received 6 core prostate biopsy and 40 patients who received 12 core prostate biopsy. A total number of 80 patients were enrolled in this study. Patients were divided into two groups, a 6 core biopsy group and a 12 core biopsy group. These groups are compared according to age, total PSA, prostate volume and final pathological diagnosis. RESULTS: Based on final pathological diagnosis, 2 patients (5%) had benign pathology and 38 patients (95%) had PCa in both group 1 and 2. The cancer detection rate in both groups was 95%. Although there were higher values of mean age, mean total PSA, and mean prostate volume in group 1, there was no statistically significantly difference at this variables in both groups. CONCLUSION: Although taking 6 core biopsies is not recently recommended, we proved that 6 core biopsy is adequate for patients with PSA values above 20 ng/mL.

Predictive factors of successful salvage microdissection testicular sperm extraction (mTESE) after failed mTESE in patients with non-obstructive azoospermia: Long-term experience at a single institute.

OBJECTIVE: To observe the clinical practice of salvage microdissection testicular sperm extraction (mTESE) in patients with non-obstructive azoospermia (NOA) and to determine the factors that may predict the presence of spermatozoa in preoperative salvage mTESE. METHODS: We retrospectively reviewed the medical records of 445 patients with the diagnosis of NOA, who had undergone the mTESE operation consecutively in our institution between the dates of March 2008 and June 2017. The study included a total of 49 patients with failure to detect spermatozoa in the first mTESE and who had then undergone salvage mTESE. In order to investigate the factors that predict the result of salvage mTESE, the patients were classified into two groups according to the outcome of salvage mTESE, as those with and without spermatozoa retrieval. Patients in these two groups were compared with regard to age, body mass index, history of varicocele, history of cryptorchidism, duration of infertility, outcomes of genetic analysis, results of hormone profiles and the testicular histopathology results of the first mTESE. RESULTS: The sperm retrieval rate following salvage mTESE was observed to be 42.8%. Statistically a significant difference was determined between the mean follicle stimulating hormone (FSH) values of the groups (p = 0.013). No significant difference was observed between the groups with regard to the remaining parameters. CONCLUSION: It was observed that among the factors that predict the success of sperm retrieval in salvage mTESE in patients with NOA and previous unsuccessful sperm retrieval in mTESE operation, only the pre-operative FSH level was observed to significantly correlate with the success in salvage mTESE.

The effect of the American Society of Anesthesiology classification scores on complications associated with percutaneous nephrolithotomy.

OBJECTIVES: We aimed to evaluate the effect of American Society of Anesthesiology (ASA) classification scoring and age on complications and surgical outcomes during and after percutaneous nephrolithotomy (PCNL) operation. MATERIAL AND METHODS: The records of 263 patients, above the age of 18 years, that underwent PCNL surgery between October 2014 and May 2017 were evaluated retrospectively. The patients were divided into three groups based on their ASA risk scores (ASA 1, 2, 3) and into two groups based on their age (younger and older than 65 years). Postoperative complications were assessed according to the ASA groups and age and according to the Clavien classification system. RESULTS: The number of patients in the ASA 1, 2, and 3 groups were 97 (36.8%), 131 (49.8%) and 35 (13.3%), respectively. Four patients in ASA4 were not included in the study. There was no significant difference in ASA 1, 2, 3 groups in terms of changes in Hgb values, mean duration of operation, and mean hospital stay. When ASA1 was compared to ASA3 and ASA2 was compared to ASA3, there was no significant difference in the incidence of all complication rates. There were 159 (60.4%) patients in the young group and 104 (39.5%) patients in the elderly group. Postoperative PCNL complications of these 2 groups were compared according to Clavien classification system and no significant difference was found in incidence of complications. CONCLUSIONS: We believe that PCNL operation can be performed effectively and safely in both ASA3 patients and patients above the age of 65 years.

Pathology outcomes in patients with transurethral bladder tumour resection in a Turkish population: A retrospective analysis.

OBJECTIVES: Transurethral bladder tumour resection (TURBT) is the common surgical method used in the diagnosis, staging and treatment of patients with bladder tumour. Most of the rare tumours other than the urothelial carcinomas of the bladder are in advanced stage on diagnosis and necessitate aggressive treatment. In our study, we aimed to the histologic types of bladder cancer and to determine the regional incidence of rare bladder cancer types in our region. MATERIALS AND METHODS: We retrospectively evaluated 815 patients who underwent TURBT surgery between January 2010 and March 2016 in our clinic with a diagnosis of bladder cancer and at least 1 year follow-up. Patients with tumour histopathological examination including histological tumour type, grade and were reported. Thirty-nine patients with an unclear pathology report (neighboring organ invasion, cautery artifact, etc) and 17 patients whose data could not be accessed were excluded from the study. The patients who had received chemotherapy or radiotherapy due to any type of malignancy (23) were also excluded from the study. RESULTS: The outcomes of 736 patients operated in our clinics due to bladder tumour were evaluated. The mean age was 65.2 ± 8.4; 135 were female and 601 were male. Among them 711 patients with urothelial carcinoma were reported (94.2%). According to TNM classification, stage Ta was observed in 270 patients (37.9%), stage T1 in 297 (41.7%), and stage T2 in 144 (20.3%). Non-urothelial cancers were reported in 25 cases (3.3%). CONCLUSION: The incidence of bladder carcinoma varies between regions. The results of our study are similar to those of the western countries. Increased smoking and exposure to environmental carcinogenetic agents may lead to altered incidences and histological types of bladder tumours. Revision of regional tumour records may be useful to develop and evaluate future treatment strategies.

Investigation of the effect of body mass index (BMI) on semen parameters and male reproductive system hormones.

AIM: To evaluate the effects of body mass index (BMI) ratio on semen parameters and serum reproductive hormones. MATERIALS AND METHODS: The data of 454 patients who prsented to male infertility clinics in our hospital between 2014 and 2015 were analyzed retrospectively. Weight, height, serum hormone levels and semen analysis results of the patients were obtained. BMI values were calculated by using the weight and height values of the patients and they were classified as group 1 for BMI values ≤ 25 kg/m2, as group 2 for BMI values 25-30 kg/m2 and as group 3 for BMI values ≥ 30 kg/m2. RESULTS: The mean values of BMI, semen volume, concentration, total motility, progressive motility, total progressive motile sperm count (TPMSC), normal morphology according to Kruger, head abnormality, neck abnormality, tail abnormality, FSH, LH, prolactin, T/E2, total testosterone and estradiol parameters of the patients were considered. Patients were divided according to BMI values in Group 1 (n = 165), Group 2 (n = 222) and Group 3 (n = 56). There was no statistically significant difference in terms of all variables between the groups. CONCLUSIONS: We analyzed the relationship between BMI level and semen parameters and reproductive hormones, demonstrating no relationship between BMI and semen parameters. In our study, BMI does not affect semen parameters although it shows negative correlation with prolactin and testosterone levels.

Value of Ultrasound Elastography in the Differential Diagnosis of Cervical Lymph Nodes: A Comparative Study With B-mode and Color Doppler Sonography.

OBJECTIVES: The purpose of this study was to determine the usefulness of ultrasound elastography in the evaluation of enlarged cervical lymph nodes in comparison with B-mode and color Doppler sonography. METHODS: A total of 220 lymph nodes in 168 consecutive patients who were referred for sonography of the neck were included in this study. B-mode sonograms were evaluated according to short-axis diameter, long-to-short-axis ratio, hilum, echogenicity, and microcalcification. For color Doppler sonography, 5 different patterns were defined according to vascularity. Elastographic patterns of the lesions were categorized to 5 main types. The mean strain index values were calculated for all lymph nodes. Histopathologic findings, clinical and laboratory data, and imaging findings were used as reference standards for the diagnosis of benign and malignant lymph nodes. RESULTS: Of the 220 lymph nodes, 69.5% were diagnosed as benign, and 30.5% were diagnosed as malignant. The sensitivity, specificity, and accuracy of B-mode sonography were 97.0%, 31.4%, and 51.3%, respectively; the values were 76.1%, 82.4%, and 80.5% for color Doppler sonography and 82.1%, 56.2%, and 64.1% for elastography. The strain index cutoff value for the differentiation of benign and malignant lymph nodes was accepted as 1.7. The sensitivity, specificity, and accuracy of the strain index were 71.6%, 76.5%, and 75.0%. CONCLUSIONS: Ultrasound elastography adds no additional value to combined B-mode and color Doppler sonography for differentiation of benign and malignant cervical lymph nodes.

Effects of hydronephrosis on the surgical outcomes of fluoroscopically guided supine percutaneous nephrolithotomy.

PURPOSE: To evaluate the effect of hydronephrosis on operation success and the development of complications in supine percutaneous nephrolithotomy (PCNL). METHODS: A total 259 patients were included in the study who underwent supine PCNL in our clinic between September 2019 and November 2023. The patients were divided into four groups: normal, mild, moderate and severe, according to their preoperative hydronephrosis degrees. Demographic data, kidney stone characteristics, clinical aspects, surgical findings, and postoperative complications were compared across groups. RESULTS: In terms of American Society of Anesthesiologists score, stone-free rate, operation time, fluoroscopy time, and Clavien-Dindo classification grades, a statistically significant difference was found between the hydronephrosis groups. The stone-free rate in the normal, mild, moderate, and severe groups was 86.6, 82.5, 76.0, and 61.5, respectively. The severe hydronephrosis group varied statistically substantially from the other hydronephrosis groups in terms of stone-free rate, according to the post-hoc analysis. In terms of Clavien-Dindo classification grades, the severe hydronephrosis group varied statistically significantly from the normal and mild hydronephrosis groups (p values 0.04, 0.02, respectively). In terms of Clavien-Dindo classification grades, no statistically significant difference was seen between the severe and moderate hydronephrosis groups (p = 0.085). CONCLUSION: The findings of this study demonstrated that the existence of hydronephrosis was a predictive factor for the occurrence of complications and decreased the success rate of supine PCNL. Furthermore, univariate and multivariate analyses showed that the presence of hydronephrosis was a predictive factor for PCNL success and the development of complications.

Comparison of the Efficiency of Radiofrequency and Microwave Ablation Methods in the Treatment of Benign Thyroid Nodules.

RATIONALE AND OBJECTIVES: To compare the efficacy of two thermal ablation techniques (radiofrequency vs microwave ablation) in the treatment of benign thyroid nodules. MATERIALS AND METHODS: A total of 80 patients with 80 nodules underwent thermal ablation of thyroid nodules with either radiofrequency ablation (RFA) (23 females and 14 males; mean age 41 ± 9years) or microwave ablation (MWA) (28 females and 15 males; mean age 45 ± 11years). Ultrasound assessments were made at the 1st, 3rd, 6th, and 12th months after the ablation procedure. RESULTS: The mean initial volume of the nodules (RFA: 15.6 mL [min 2.5-max 74]; MWA: 40 mL [min 2-max 205]) was statistically significantly different (P < .001). The following were the volume reduction rates of nodules at 1, 3, 6, and 12months, respectively: after RFA: 46.8 ± 13.5%, 62.9 ± 13.6%, 71.6 ± 11.9%, and 77.9 ± 10.3%. After MWA: 38.7 ± 12.5%, 54 ± 15.3%, 59.6 ± 12.5%, and 65 ± 11.3%. For all months, volume reduction rates in the RFA group were significantly higher than those in the MWA group (P < .05). One patient treated by RFA reported an abscess formation and another patient treated by RFA had a self-limiting hematoma, who recovered without any further treatment. Also, in the MWA group, one patient had abscess formation and another patient had transient recurrent nerve paralysis, who recovered with appropriate treatment. CONCLUSION: Both methods are effective in treating benign thyroid nodules; however, RFA provides a better volume reduction.

Evaluation of Diaphragm Thickness and Stiffness Using Ultrasound and Shear-Wave Elastography.

ABSTRACT: The purposes of this study are to measure the thickness and stiffness of diaphragm in association with the respiratory cyclus and to assess the reproducibility of these measurements. Forty individuals who are volunteered for participating diaphragm evaluation were included in the study. Two radiologists with 14 and 15 years of experiences in abdominal ultrasound performed all examinations independently. Furthermore, 8 chronic obstructive pulmonary disease (COPD) patients were examined by only the first radiologist. Gray scale and shear-wave elastography imaging of only the right hemidiaphragm of all participants were performed. Thickness and stiffness of diaphragm were measured at the peak inspiration and end expiration phases. Intraclass correlation coefficients test was used to assess the interobserver agreement. The thickness and stiffness of diaphragm significantly increased with inspiration (P < 0.001). The mean ± SD stiffness of diaphragm in peak inspiration and end expiration phases was 51.84 ± 16.83 kPa and 38.49 ± 9.42 kPa, respectively, for the first radiologist and 49.61 ± 13.83 kPa and 37.52 ± 10.71 kPa, respectively, for the second radiologist. Intraclass correlation coefficient values for diaphragm stiffness were 0.667 and 0.736 in peak inspiration and end expiration phases, respectively. In COPD patients, there was no significant difference between stiffness measurements of respiratory phases. In conclusion, the current study revealed that diaphragm thickness and stiffness increase at inspiration, and these measurements are slightly more reproducible at the end of expiration. However, diaphragm stiffness changes between respiratory phases may not be valid for COPD patients, and this may be related to loss of force-generating capacity of diaphragm in COPD patients.

Effects of severe hydronephrosis on the outcomes of percutaneous nephrolithotomy with one-shot dilation method.

OBJECTIVE: To investigate the effect of the presence of severe hydronephrosis on percutaneous nephrolithotomy (PNL) outcome in patients who underwent PNL operation with one-shot dilatation technique. MATERIALS AND METHODS: Medical data of 989 patients underwent PNL operation in our clinic between 2012 and 2018 were retrospectively reviewed. We included 373 of the patients underwent PNL operation due to renal pelvic stone, who were older than 18 years of age, who did not have any urinary tract abnormality, and had no previous history of open renal stone operation. Patients were divided into two groups according to the presence of severe hydronephrosis and absence of hydronephrosis. These two groups were compared in terms of age, gender, body mass index (BMI), number of stones, stone burden, operation duration, fluoroscopy time, hospitalization time, hemoglobin and creatinine change, complications, and stone free rate. RESULTS: There was no statistically significant difference between the groups in terms of age, gender, BMI, stone number, stone size, stone density, operation duration, fluoroscopy time, and hospitalization duration. The mean change in hemoglobin was 1.5 g/dL in group 1 and 1.1 g/dL in group 2. This difference was statistically significant (p = 0.006). Postoperative blood transfusion was required for 3 patients (2.1%) in group 1 and 12 patients (5.1%) in group 2. This difference was statistically significant (p < 0.001). CONCLUSION: Only the presence of severe hydronephrosis was found to be associated with the change in hemoglobin and postoperative blood transfusion.

Vaginocutaneous fistula: A rare long-term complication of transobturator tape procedure for stress urinary incontinence.

INTRODUCTION: Synthetic mid-urethral slings are currently the most common performed surgical procedure for the treatment of female stress urinary incontinence. The transobturator mid-urethral sling technique has been widely accepted owing to its high success and low complication rates. Although complications are rarely seen, it may cause significant morbidity. CASE PRESENTATION: We report a case of vaginocutaneous fistula following transobturator mid-urethral sling procedure and a successful reconstruction with transvaginal sling excision and fistula closure. CONCLUSION: Vaginocutaneous fistula is a known but rarely seen long-term complication of transobturator tape. With an increased use of mesh, various delayed complications can be seen in the long-term follow-up. This case showed us the need for longer and detailed studies that evaluate the effectiveness and safety of the transobturator tape procedure.

Relationship between testicular histopathology and the success of testicular sperm extraction in patients with non-mosaic Klinefelter syndrome.

OBJECTIVE: To investigate the effect of testicular histopathology on the success of microscopic testicular sperm extraction (mTESE) and the factors that could predict the success of mTESE in patients with non-mosaic Klinefelter syndrome (KS). MATERIAL AND METHODS: Forty-one KS patients diagnosed with non-obstructive azoospermia (NOA) who had undergone mTESE at our clinic were included in the study. The patients were divided into 5 groups according to the histopathology results: hyalinisation of tubules (HT), sertoli cell only (SCO), early maturation arrest (EMA), late maturation arrest (LMA), and hypospermatogenesis (HS). The groups were compared with regard to age, duration of infertility, hormone profile, testicular volume, and sperm retriveal rate. The clinical features of the patients with mTESE from whom sperm could or could not be obtained were also compared with the aim of investigating the predictive value of testicular histopathology and the other variables for prediction of the success of mTESE. RESULTS: Sperm could be obtained through mTESE in 13 out of 41 patients (31.7%). A statistically significant difference was determined between the groups with regard to the rate of sperm collection. No significant difference was determined between the histopathology groups with regard to the other variables. A statistically significant difference was determined between the groups from whic sperm could be collected or not with regard to age, Johnsen criteria, SCO, EMA and LMA variables. Multi-variate analysis revealed that age and Johnsen score were the independent variables predictive for success of mTESE. CONCLUSION: The present study has revealed that impairment in testicular histopathology negatively affects the success of mTESE and that it is a predictive factor for the success of mTESE in patients with KS. Increased patient age was also determined to negatively affect the success of mTESE and the operation was demonstrated to be more successful before 34 years of age.

Comparison of uroflowmetry tests performed with a sensation of normal desire to void versus urgency and correlation of test results with IPSS.

OBJECTIVE: The objective of this study was to evaluate the uroflowmetry test results performed for normal and urgent desire to void and their correlation with International Prostate Symptom Score (IPSS) values in adult male patients having lower urinary tract symptoms (LUTS) complaints. MATERIAL AND METHODS: In this prospective study, a total of 83 patients were included. With a normal desire to void, maximum flowrate (Qmax)-normal, average flowrate (Qaverage)-normal, and void volume (VV)-normal values were obtained. Residual urine volume was examined by suprapubic ultrasound within 5 minutes following uroflowmetry, and calculated. The maximum bladder volume (MBV)-normal value was calculated by adding the residual-normal volume and VV-normal values. The same procedures were repeated the next day with the sensation of urgency, Qmax-urgency, Qaverage-urgency, VV-urgency, residue-urgency, MBV-urgency values were obtained. RESULTS: Statistically significant difference was determined for all parameters, and higher values were obtained in the urgency group for all parameters (p<0.05). A correlation analysis was performed for the Qmax-normal and Qmax-urgency values and the IPSS. Both parameters were not statistically significantly correlated with IPSS, but the correlation coefficient of Qmax-urgency was found to be higher than Qmax-normal (p=0.85, Correlation Coefficient=-0.022 for Qmax-normal and IPSS; and p=0.069, Correlation Coefficient=-0.214 for Qmax-urgency and IPSS, respectively). CONCLUSION: Our study is the first study examining the effect of bladder sensitivity on uroflowmetry parameters in male patients having LUTS. More reliable results might be obtained in adult male patients with LUTS complaints when the uroflowmetry test is performed with a feeling of urgency to void. Our results need to be supported by more objective criteria, rather than subjective criteria such as IPSS.

Comparison of penile prosthesis types' complications: A retrospective analysis of single center.

OBJECTIVES: The aim of this study was to compare clinical outcomes and complication rates associated with semirigid (malleable) and inflatable penile prostheses (PPs) and investigate the factors that influence these complications. MATERIAL AND METHODS: The records of 131 patients who had undergone penile prosthesis implantation (PPI) in our clinic due to erectile dysfunction (ED) between January 2010 and March 2019 were retrospectively reviewed. The initial surgery included 116 primary implants and 15 men had two revision operations. Patients were assigned to two groups as semirigid (malleable) PPI (group 1) and inflatable PPI (group 2) patients, and obtained data were compared across these two groups. RESULTS: Group 1 included 93 patients, while Group 2 included 38 patients. Postoperative complication rates of Group 1 were 8.6% (n = 8), and Group 2 were 21% (n = 8), and the comparison of postoperative complication rates revealed a statistically significant difference between the two groups (p = 0.025). The majority of these complications (50%) was constituted by mechanical failure associated with inflatable PPs. When patients were further segregated as those with and without diabetes type 2 (DM) and those who had and had not undergone radical pelvic surgery (RPS), the comparison of complication rates across these subgroups did not yield any significant difference. CONCLUSIONS: We determined in this study that semirigid (malleable) PPs were associated with lower complication rates compared to the inflatable group, particularly with regard to mechanic failure, and that DM and history of RPS did not make a difference in complication rates in patients planned to undergo PPI.