Is there an association between a high monocyte/high-density lipoprotein cholesterol ratio and recurrence of urethral stricture after internal urethrotomy?

INTRODUCTION: Internal urethrotomy (IU) has been the most commonly used procedure for the treatment of urethral strictures (US) since it was described by Scahse in 1974. Although simple to perform and associated with a short recovery time, the main disadvantage is the high recurrence rate of stenosis. At present, there are no markers available for the prediction of recurrence after IU. The aim of this study was to evaluate the correlation between MHR and recurrence rates. METHODS: The data of a total of 250 male patients who underwent IU for the first time for bulbar urethral stricture less than 2cm in our hospital between January 2011 and January 2019 were retrospectively analysed. The MHR was calculated as the ratio of monocytes to HDL-C. RESULTS: In all, 78 patients experienced a recurrence while the remaining 177 did not. The stricture recurrence rate was recorded as 31.2% at the 3-year follow-up. There was a statistically significant difference in stricture length and MHR (P=0.015 and 0.001 respectively). MHR was high in the recurrent group. As a result of the Chi-square test, the positive predictive values (PPV) and negative predictive values (NPV) were 65.3% and 89.7%, respectively. ROC analysis was used to determine the optimal cut-off value. The cut-off value was found to be 1.72. CONCLUSION: In our opinion, a high MHR may indicate the presence of immune inflammation and it can be used as a prognostic factor for stricture recurrence after IU.

Efficacy of Aspiration-Assisted Ureteral Access Sheath (ClearPETRA) in Retrograde Intrarenal Surgery.

Backgrounds: In the renal intrarenal stone surgery (RIRS) procedure, ureteral access sheath (UAS) is still used in the majority of surgeries to both protect the flexible ureteroscope (FURS) and reduce intrarenal pressure. ClearPETRA is a new UAS that has an integrated aspiration port. We aimed to evaluate the clinical outcomes and effectiveness of Aspiration-Assisted UAS (ClearPETRA) in the RIRS procedure. Methods: One thousand six hundred twenty patients who underwent RIRS between January 2021 and January 2024 were evaluated retrospectively and 512 patients were included in the study. According to stone size, patients with stones less than 2 cm and those with stones between 2 and 3 cm were analyzed separately. Patient's demographic data, stone size, body mass index, Extracoporeal Shockwave Lithotripsy (ESWL) history, stone side, stone density (Hounsfield Unit), operation time, stone-free rate (SFR), and the number of patients with sepsis were recorded. SFR was evaluated with kidney urinary bladder 3 months after surgery for opaque calculi. Nonopaque calculi patients were evaluated with noncontrast computed tomography 3 months after surgery. In the postoperative evaluation, patients with stones less than 4 mm were evaluated as SFR. P value of <0.01 was considered statistically significant. Results: Patient's demographic data, stone characteristics, and history of ESWL were similar in the ClearPETRA and UAS groups (P > .05). A total of 328 patients who underwent RIRS for stones less than 2 cm were included (80 ClearPETRA, 248 UAS). Length of hospital stay, operation time, SFR, secondary intervention, or postoperative sepsis (P ≥ .01) were similar in both groups. The incidence of postoperative fever was statistically significantly lower in the ClearPETRA group (P = .006). A total of 184 patients who underwent RIRS for stones between 2 and 3 cm were included (42 ClearPETRA, 142 UAS). In the ClearPETRA group, operation time was statistically significantly shorter (P = .002), SFR was statistically significantly higher (P = .003), and the number of fever and sepsis were statistically significantly less (P = .003 and 0.002, respectively). Conclusion: We found that ClearPETRA reduces the likelihood of postoperative fever after RIRS surgeries. Moreover, we can say that the use of ClearPETRA in RIRS, especially for stones larger than 2 cm, reduces the operation time, increases the SFR, and also reduces sepsis rates.

Systemic Inflammatory Index: A Promising Non-Invasive Marker for the Prediction of Response to Neoadjuvant Chemotherapy prior to Cystectomy.

INTRODUCTION: The main challenge to the optimal use of neoadjuvant chemotherapy (NAC) is the difficulty in selecting patients who may or may not benefit from NAC. Our aim in this study was to investigate whether the Systemic Inflammatory Index (SII) predicts response to chemotherapy in patients who receive NAC prior to cystectomy. METHODS: We retrospectively analysed the data of patients who underwent NAC followed by cystectomy at our institution between January 2010 and September 2015 and whose 5-year follow-up was completed. All patients who underwent diagnostic biopsy with complete transurethral resection of bladder tumour at our hospital and whose pathology result was muscle-invasive transitional cell carcinoma were included in the study. At least 3 courses of gemcitabine/cisplatin NAC were given to all patients. A pathological response was defined as a reduction in cystectomy to a lower pathological stage after NAC. RESULTS: The SII was 320.8 ± 51 in the responders and 388.28 ± 50 in the non-responders. SII optimal cut-off of 350 was determined. The sensitivity and specificity of SII in predicting response were found to be 80% and 83%, respectively. Low SII (<350) was found to be a significant predictor of response compared with the other factors on multivariate analysis. The mean overall survival time was 55.4 months in patients with a low SII value and 40.3 months in the high SII group. CONCLUSION: SII, together with known clinicopathological factors and newer genetic and molecular markers, can be used to select patients for NAC.

Hybrid technique has lower stricture rates than Wallace and Bricker.

INTRODUCTION: A clear consensus has not yet been reached on the optimal ureteroenteric anastomosis technique for ileal conduit urinary diversion following radical cystectomy. This study aims to determine the incidence of strictures and their management associated with these anastomosis techniques. METHODS: We conducted a retrospective, single-center study of patients who underwent radical cystectomy and urinary diversion between March 2014 and August 2022. Patients were categorized based on the ureteroenteric anastomosis technique used: Wallace, Bricker, or Hybrid. Strictures were identified through antegrade pyelography following nephrostomy placement. RESULTS: A total of 141 patients were included in the study, with 60 patients in the Wallace group (42 %), 42 patients in the Bricker group (30 %), and 39 patients in the Hybrid group (28 %). The overall incidence of ureteroenteric strictures was 15 %, with 7 patients in the Wallace group, 11 patients in the Bricker group, and 3 patients in the Hybrid group experiencing strictures. There was no statistically significant difference in stricture rates between the Wallace and Bricker groups (11 % vs. 26 %, p = 0.09) or between the Wallace and Hybrid groups (11 % vs. 7 %, p = 0.73). However, a statistically significant difference was observed between the Bricker and Hybrid groups (26 % vs. 7 %, p = 0.03). The mean time to stricture development was 9.2 ± 3.3 months for the Wallace group, 9.5 ± 3.7 months for the Bricker group, and 12.6 ± 5 months for the Hybrid group (p = 0.407). CONCLUSION: The Hybrid ureteroenteric anastomosis technique exhibits a lower stricture rate compared to the Bricker and Wallace techniques. It represents a safe and feasible alternative technique.

Systemic Inflammatory Index: A Novel Biomarker for Predicting the Progression in Active Surveillance in Patients with Prostate Cancer.

OBJECTIVE: To investigate active surveillance (AS) for patients with prostate cancer to show the systemic inflammatory index (SII) progression and to evaluate whether SII will be an AS criterion in PCa patients. STUDY DESIGN: Descriptive study. Place and Duration of the Study: Department of Urology, University of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital, from February 2015 to December 2021. METHODOLOGY: For active surveillance follow-up criteria, patients with prostate cancer who underwent AS with PSA <10 ng/ml, GS ≤6, clinical stage t1c-t2b, ≤2 core positive, and for each positive core had ≤50% tumour cells, were inducted and SII was determined. RESULTS: As a result of the univariate analysis, high SII values, number of cores involved, and length of the tumour in one core significantly affected progression (in order of p = 0.009, B = 1.830, Exp(B) = 6.233, CI [1.58-24.497]; p = 0.018, B = 0.682, Exp(B) = 1.978, CI [1.123-3.482]; p=0.006, B = 1.835, Exp(B) = 6.263 CI [1.692-23.181]). High SII values (>443.42) had better explanations for progression than the number of core involvement but were similar to the length of the tumour in one core. As a result of the multivariate analysis, high SII values (>443.42) and the tumour 's length in one core had similar effects on progression (in order of p = 0.011, B = 1.978, Exp(B) = 7.227, CI [1.570-33.269]; p = 0.009, B = 1.958, Exp(B) = 7.084, CI [1.642-30.555]). CONCLUSION: Th use of SII early in the course of treatment can help to identify which prostate cancer patients can be selected for active treatment instead of active surveillance, and to assess the probability of progression. KEY WORDS: Prostate cancer, Active surveillance, Systemic inflammatory index, Biomarker.

Biopsy with Ureterorenoscopy Before Radical Nephroureterectomy is Associated with Increased Intravesical Recurrence in Urothelial Cancer Located in the Kidney.

OBJECTIVE: Diagnostic ureterorenoscopy is used to identify upper tract urothelial cancer before radical nephro ureterectomy, especially for uncertain lesions in imaging modalities or urine cytology. However, diagnostic ureterorenoscopy can potentially cause intravesical tumor spillage and can increase intravesical recurrence rates. We aimed to investigate the impact of diagnostic ureterorenoscopy before radical nephroureterectomy, with and without biopsy, on intravesical recurrence rates of patients with upper tract urothelial cancer. MATERIAL AND METHODS: Patients with localized upper tract urothelial cancer from 8 different tertiary referral centers, who underwent radical nephroureterectomy between 2001 and 2020, were included. Three groups were made: no URS (group 1); diagnostic ureterorenoscopy without biopsy (group 2); and diagnostic ure terorenoscopy with biopsy (group 3). Intravesical recurrence rates and survival outcomes were compared. Univariate and multivariate Cox regression analyses were performed to determine the factors that were asso ciated with intravesical recurrence-free survival. RESULTS: Twenty-two (20.8%), 10 (24.4%), and 23 (39%) patients experienced intravesical recurrence in groups 1, 2, and 3, respectively (P=.037) among 206 patients. The 2-year intravesical recurrence-free sur vival rate was 83.1%, 82.4%, and 69.2%, for groups 1, 2, and 3, respectively (P=.004). Cancer-specific survival and overall survival were comparable (P=.560 and P=.803, respectively). Diagnostic ureterore noscopy+biopsy (hazard ratio: 6.88, 95% CI: 2.41-19.65, P < .001) was the only independent predictor of intravesical recurrence in patients with upper tract urothelial cancer located in the kidney, according to tumor location. CONCLUSION: Diagnostic ureterorenoscopy+biopsy before radical nephroureterectomy significantly increased the rates of intravesical recurrence in tumors located in kidney. This result suggests tumor spillage with this type of biopsy, so further studies with different biopsy options or without biopsy can be designed.

The effect of vitamin D replacement in patients with lower urinary tract complaint/erectile dysfunction resistant to Tadalafil 5 mg treatment: A pilot clinical study.

The aim of this study was to evaluate the effect of vitamin D replacement in patients with lower urinary tract symptoms (LUTS)/erectile dysfunction (ED) who did not respond to tadalafil 5 mg treatment. Patients who applied to the Andrology Clinic with LUTS/ED between September 2017 and August 2020 and used 5 mg Tadalafil daily for treatment and did not benefit from treatment for 1 month were included in the study. Vitamin D levels of the patients were analysed and Vitamin D3 100,000 IU/week oral therapy was administered for a month to the patients with low levels of Vitamin D(<20 ng/ml).The values of the patients before and after Vitamin D replacement were compared. A total of 84 patients were included in the study. The mean age was 49.175 ± 11.63(28-70) years and the mean BMI was 25.93 ± 6.82(18.26-37.87). Testosterone levels of the examined patients were 3.45 ± 0.99 ng/ml. After 1 month of Vitamin D replacement + Tadalafil 5 mg/d treatment, the international index of erectile function-erectile function (IIEF-EF) (pre-treatment: 10.73 ± 6.12, post-treatment: 24.18 ± 4.87; p = 0.001) and International Prostate Symptom Score (pre-treatment: 9.12 ± 7.16, post-treatment: 3.11 ± 1.08; p = 0.003) scores of the patients improved significantly. Evaluation of Vitamin D levels is important to improve treatment response, especially in patients who do not respond to PDE-5 inhibitors.

Protective effect of oltipraz in testicular ischaemia/reperfusion injury: An experimental study.

Testicular torsion is an emergency urological disease, and the treatment is immediate surgery. Despite emergency surgery, testicular damage may occur due to reperfusion. Therefore, a medical treatment to prevent this damage may be a rational idea. We aimed to evaluate the protective effect of oltipraz in testicular ischaemia/reperfusion damage. Twenty-eight Wistar-Albino rats were randomly divided into four groups. In ischaemia/reperfusion group, testicular torsion was executed, and orchiectomy was done 4 hr after detorsion with no treatment. Second group performed torsion; intraperitoneal 50 mg/kg oltipraz was applied 30 min before detorsion, and orchiectomy was performed 4 hr after detorsion. Third group applied torsion; intraperitoneal 150 mg/kg oltipraz was applied 30 min before detorsion, and orchiectomy was performed 4 hr after detorsion. Last one was the sham group. We evaluated tissue malondialdehyde (MDA), transforming growth factor-ß1 (TGF-ß1), superoxide dismutase (SOD), reduced glutathione (GSH) and Johnsen testicular biopsy score. There was a significant decrease in TGF-ß1, GSH and MDA values in oltipraz treatment groups compared with ischaemia/reperfusion group. Oltipraz treatment has significant protective effect in testicular ischaemia/reperfusion damage. However, more clinical studies are needed to demonstrate appropriate dose and its effects.

Application of S.T.O.N.E. Nephrolithometry Score for Prediction of Stone-Free Status and Complication Rates in Patients Who Underwent Percutaneous Nephrolitotomy for Renal Stone.

Background: Renal stone disease is a common disorder in urology practice. Kidney stone has various treatment methods such as extracorporeal shock wave lithotripsy, retrograde intrarenal surgery, and percutaneous nephrolithotomy (PCNL). In this study, we aimed to determine the value of S.T.O.N.E. nephrolithometry score, which is considered as a new scoring system for predicting residual stone rate and complications in patients undergoing PCNL due to renal calculi. Materials and Methods: A total of 120 patients >18 years old who underwent PCNL were evaluated prospectively. Five parameters available from preoperative noncontrast-enhanced computed tomography were measured: stone size (S), tract length (T), obstruction (O), number of involved calices (N), and essence or stone density (E) and then S.T.O.N.E. nephrolithometry score was calculated. The prediction of the stone-free rates and complication rates of this scoring was evaluated statistically. Results: When the age, gender, body mass index, comorbidities, and American Society of Anesthesiologists scores of the patients were evaluated according to the patients' postoperative stone-free status, no statistical difference was found between the groups. Patients had a stone-free rate of 78%. Patients' mean neuropilitometry score was calculated to be 7.75 S.T.O.N.E. nephrolithometry score statistically significant (P = .001) for prediction of stone-free status. S.T.O.N.E. nephrolithometry score was significantly correlated with operation time, estimated blood loss, duration of fluoroscopy, duration of hospital stay, and number of punctures. Complications were seen in 13 patients. Conclusions: S.T.O.N.E. nephrolithometry score can be used as an objective criterion for predicting the complexity of the PCNL process. In addition, this scoring system is expected to provide more objective preoperative counseling and can provide standardization in academic studies.

Differentiating renal pelvic cancer from renal cell carcinoma with 18-fluorodeoxyglucose positron emission tomography-computed tomography.

BACKGROUND: The differential diagnosis of pelvis renalis cancer (PRC) from renal cell cancer (RCC) is difficult. Because of that, in this study, we compared the standardized uptake value (SUV) with positron emission tomography-computed tomography (PET-CT) of the RCC and PRC. METHODS: Twenty-one patients (12 males, 9 females; age range: 33-74 years; mean age ± standard deviation [SD]: 57.14 ± 17.6) with suspected primary renal cell cancer as Group 1 and 8 patients (6 male, 2 female; age range, 61-81; mean age ± SD, 71.5 ± 5.65) with suspected renal pelvis cancer as Group 2 detected by conventional imaging techniques (CT, magnetic resonance [MR] imaging, ultrasound, intravenous urogram, CT urography, MR urography) underwent fluorine-18-fluorodeoxyglucose (18F-FDG) PET/CT imaging between August 2010 and October 2012. RESULTS: Mean age is 57.14 (33-74) years in Group 1 and 71.5 (61-81) years in Group 2, respectively. The mean maximum SUV (SUVmax) value was 4.6 ± 2.1 in RCC group and 16.6 ± 6.9 in PRC group. At the 18-FDG PET/CT scanning, SUVmax value higher in patients with PRC than in the patients with RCC. It was statistically different (P < 0.001). CONCLUSION: We suggested that PET/CT can be used for the differential diagnosis of renal pelvis tumor and RCC. However, further studies with larger patient number are needed to confirm our suggestion. To clarify the mechanisms of underlying these differences, molecular advanced molecular studies are needed.

Impact of delay in cystoscopic surveillance on recurrence and progression rates in patients with non-muscle-invasive bladder cancer during the COVID-19 pandemic.

PURPOSE: To evaluate the impact of delay in cystoscopic surveillance on recurrence and progression rates in non-muscle-invasive bladder cancer (NMIBC). MATERIALS AND METHODS: A total of 407 patients from four high-volume centres with NMIBC that applied for follow-up cystoscopy were included in our study prospectively. Patients' demographics and previous tumour characteristics, the presence of tumour in follow-up cystoscopy, the pathology results of the latest transurethral resection of bladder tumour (if tumour was detected) and the delay in cystoscopy time were recorded. Our primary outcomes were tumour recurrences detected by follow-up cystoscopy and progression. Multivariate logistic regression analysis was performed using the possible factors identified with univariate analyses (P values ≤ .2). RESULTS: A total of 105 patients (25.8%) had tumour recurrence in follow-up cystoscopy, and 20 (5.1%) of these patients had disease progression according to grade or stage. In multivariate analysis, the number of recurrences (OR: 1.307, P < .001) and the cystoscopy delay time (62-147 days, OR: 2.424, P = .002; >147 days, OR: 4.883, P < .001) were significant risk factors for tumour recurrence on follow-up cystoscopy; the number of recurrences (OR: 1.255, P = .024) and cystoscopy delay time (>90 days, OR: 6.704, P = .002) were significant risk factors for tumour progression. CONCLUSIONS: This study showed that a 2-5 months of delay in follow-up cystoscopy increases the risk of recurrence by 2.4-fold, and delay in cystoscopy for more than 3 months increases the probability of progression by 6.7-fold. We suggest that cystoscopic surveillance should be done during the COVID-19 pandemic according to the schedule set by relevant guidelines.

The efficacy and reliability of VI-RADS in determining candidates for repeated transurethral resection in patients with high-risk non-muscle invasive bladder cancer.

OBJECTIVE: Our study aims to evaluate the efficiency and reliability of Vesical Imaging Reporting Data System (VI-RADS) in prospectively identifying the patients to undergo RE-TURBT in the management of patients with high-risk non-muscle invasive Bladder Cancer(HR-NMIBC).The secondary objective was to evaluate the performance of the VI-RADS scoring system in differentiating between muscle-invasive bladder cancer (MIBC) and non-muscle invasive bladder cancer(NMIBC) prospectively. METHODS: The study included 330 patients who underwent transurethral resection of bladder tumour(TURBT) for Bladder Cancer (BC) in our clinic. All patients underwent multiparametric-magnetic resonance imaging (Mp-MRI) before the operation and VI-RADS scoring was administered. The cut-off value of VI-RADS was accepted as three and above. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for the differentiation between NMIBC and MIBC distinction in all patients. Receiver operating characteristic (ROC) analysis was performed to evaluate the performance of the VI-RADS scoring system. In the second phase of the study, patients with MIBC and low-risk NMIBC (LR-NMBIC) were excluded and 158 patients with HR-NMIBC were included, and their sensitivity, specificity, PPV and NPV values were measured. ROC analysis was performed. RESULTS: In all patients, sensitivity, specificity, PPV and NPV values of the VI-RADS scoring in the differentiation of MIBC and NMIBC were 91.3, 91.8, 81.7 and 96.3 respectively. The AUC value was 0.934 (95%CI: 0.903-0.964). Sensitivity, specificity, PPV and NPV values were found to be 87, 91.8, 74.1, 95.2 in the evaluation specifically made for patients with HR-NMIBC. The AUC value was 0.900 (95% CI:0.843-0.957). Inter-reader agreement was excellent (Ƙ = 0.90, 95% CI:0.71-0.95). CONCLUSIONS: The VI-RADS scoring system is an effective and reliable method in determining the patients who will undergo RE-TURBT and in differentiating MIBC and NMIBC.

The clinical impact of the COVID-19 pandemic on daily urological practice: first 3-month multicenter results from Istanbul

Background/aim: The aim of this paper was to determine the general tendencies of urology patients and effect of COVID-19 pandemic on daily urological practice at tertiary centers located in the most affected area in Turkey. Materials and methods: We retrospectively analyzed the data of 39,677 patients (group 1) that applied to 6 different large-volume tertiary centers in Istanbul for outpatient consultation, surgery, or other procedures in the 3-month period between March 16 and June 14, 2020. The distribution of the number of patients who applied to subspecialty sections of urology outpatient clinics and inpatient services were recorded by weeks. That data was compared to data obtained from 145,247 patients that applied to the same centers in the same period of the previous year (group 2). The reflection of worldwide and Turkish COVID-19 case distribution on the daily urological practice was analyzed. Results: There was a decrease in the number of patients in all subspecialty sections the in group 1 compared to group 2; however, there was a significant proportional increase in urooncology and general urology admissions. A decrease of approximately 75% was observed in the total number of surgeries (p < 0.001). We detected a negative correlation between the numbers of admission to all outpatient clinics and COVID-19 cases or deaths in Turkey (p < 0.05). The same negative correlation was present for all surgical procedures and consultations (p < 0.05). The multivariate linear regression analysis revealed that the number of cases in Turkey, and the number of deaths worldwide affect the number of outpatient clinic admissions (R2 = 0.38, p = 0.028) and urological surgery (R2 = 0.33, p = 0.020) in Turkey negatively. Conclusion: This novel pandemic has implications even for urology practice. Urological surgical procedures were more affected by COVID-19-related deaths in Turkey and worldwide. Outpatient admissions and urological surgeries decreased significantly by increasing COVID-19 case numbers in Turkey and worldwide deaths.

The relationship between erectile dysfunction severity, mean platelet volume and vitamin D levels.

Background: The aim of this study was to evaluate the relationship between mean platelet volume (MPV) and vitamin D levels according to ED severity.Methods: Between October 2015 and September 2017, patients who applied to the andrology outpatient clinic with an ED complaint were retrospectively reviewed. Patients with diabetes, hypertension, hyperlipidemia, malignancy, late-onset hypogonadism and smokers were not included in the study. The International Erectile Function Index-Erectile Function (IIEF-EF) questionnaire was used to assess the levels of erectile function. According to this scoring system, patients were divided into two groups. IIEF score: between 17 and 25 = mild ED (Group 1) and IIEF score between 16 and 0 = moderate-severe ED (Group 2). Blood samples of the patients were taken from antecubital vein and MPV and 25-hydroxyvitamin D [25(OH)D] levels were evaluated.Results: Ninety patients were included in the study (Group 1: n = 41, Group 2: n = 49). The mean age of the patients was 41.07 ± 8.56 and the mean body mass index (BMI) was 27.59 ± 3.91. 25(OH)D levels were found to be statistically lower in Group 2 (18.85 ± 6.09; 13.98 ± 7.10; p = .001). MPV levels were found to be statistically higher in Group 2 (10.05 ± 0.81; 10.78 ± 1.16; p = .001). Correlation between IIEF-EF scores and 25(OH)D levels was positive (p = .03, r = 0.22). There was negative correlation between IIEF-EF scores and MPV and between 25(OH)D levels and MPV levels [p = .003 for IIEF-EF/MPV, p = .04, r = -0.23 for 25(OH)D/MPV].Conclusion: There is a significant positive correlation between ED severity and 25(OH)D levels and there is a significant negative correlation between ED severity and MPV levels.

Statins are effective in the treatment of benign prostatic hyperplasia with metabolic syndrome.

OBJECTIVE: To compare the efficacy of statins and ɑ blockers drug therapies for benign prostatic hyperplasia (BPH) in patients with metabolic syndrome (MetS). MATERIALS AND METHOD: A total of three hundred patients were randomly distributed into three groups of one hundred patients each. Group 1 received only ɑ-adrenoceptor antagonist (ɑ-blocker, AB) (Tamsulosin), group 2 received only statin (atorvastatin), and group 3 received AB plus statin (Tamsulosin + Atorvastatin). The efficacy measurement was assessed by analyzing the changes from baseline in the total International Prostate Symptom Score (IPSS), disease-specific QoL question score and maximum urinary flow rate at the end of 6 months in each group and between the three groups. RESULTS: Pre-treatment and post-treatment value of triglycerides (TG), high-density lipoprotein (HDL), and prostate volüme (PV) were not significantly different in AB group, while TG and PV were significantly lower in patients taking statin and combined therapy. The significant decrease was demonstrated in maximum urinary flow rate (Qmax) in three groups. However, the most significant decrease was observed in the combination therapy group. IPSS, postvoid residual urine volüme (PVR), and Quality of Life score (QoL) significantly changed in three groups. CONCLUSION: We recommend of the use of statins in those men with BPH accompanied by MetS in which AB is ineffective alone.

Metabolic syndrome is associated worsened erectile function in patients undergoing TURP due to benign prostatic hyperplasia.

INTRODUCTION: Transurethral resection of the prostate (TURP) is the gold standard method for surgical treatment of benign prostatic hyperplasia (BPH). So, the complications of TURP is important, in which erectile dysfunction is the most important. The aim of the present study is to evaluate erectile dysfunction in patients undergoing TURP treatment for BPH and investigate the correlation between metabolic syndrome and erectile dysfunction. MATERIALS AND METHODS: This study included 120 patients who underwent surgery for BPH at Beylikdüzü State Hospital and Okmeydani Training and Research Hospital. IIEF-5 form was administered to the patients before the surgery and six months after the surgery. The Student's t-test, Wilcoxon, and chi-square test were used in the statistical analysis. RESULTS: The patients were investigated by IIEF-5 scoring into three groups (severe, moderate, and non-ED (erectyl disfunction)-mild). The statistical analysis of IIEF-5 form administered to 120 patients who underwent surgery did not show any significant difference before surgery and six months after surgery (p > 0.05). Metabolic syndrome and erectile dysfunction correlation were examined, and a significant correlation was obtained between metabolic syndrome and severe erectile dysfunction (p < 0.05). CONCLUSIONS: IIEF-5 results administered before and after surgery showed no significant difference. The study showed that patients with metabolic syndrome have a higher probability of having erectile dysfunction after TURP compared to patients without metabolic syndrome. Moreover, post-surgery, patients with metabolic syndrome seemed to be affected negatively regarding erectile dysfunction compared to patients with no metabolic syndrome.

Procalcitonin as an early indicator of urosepsis following prostate biopsy.

BACKGROUND: To investigate the usefulness of serum procalcitonin (PCT) in the early diagnosis of urinary tract infection (UTI) and urosepsis following transrectal prostate biopsy. METHODS: In this prospective observational study, 227 patients who underwent transrectal ultrasound-guided prostate biopsy were evaluated. The relationship between urosepsis and age, serum PCT, C-reactive protein, prostate-specific antigen (PSA), prostate volume, PSA density and pathologic results following biopsy was assessed. Serum PCT level was measured in all patients immediately before the biopsy and at the post-biopsy day 2. RESULTS: Of the 227 patients, 11 (4.8%) developed UTI with positive urine culture without urosepsis and 5 (2.2%) developed urosepsis within 30 days after biopsy. The concentration of PCT was within the normal range before the biopsy. Procalcitonin concentration at post-biopsy day 2 was significantly higher in patients who developed urosepsis (1.91 ± 2.99 ng/ml vs. 0.05 ± 0.08 ng/ml; p = .004) compared with non-UTI patients. Only elevated PCT level at post-biopsy day 2 was a statistically significant independent predictor of post-biopsy urosepsis. The area under the ROC curve for the prediction of urosepsis was 0.976 (95%CI: 0.941-1.000) and a cut-off 0.095 ng/ml in the level of PCT at post-biopsy day 2 yielded a sensitivity of 100% and specificity of 93.8% in detecting urosepsis following biopsy. CONCLUSIONS: Procalcitonin appears to be a useful early biomarker to predict the urosepsis following prostate biopsy. Patients with elevated PCT value should be closely monitored after the biopsy.

Factors affecting fluoroscopy time during percutaneous nephrolithotomy: Impact of stone volume distribution in renal collecting system.

PURPOSE: To identify the factors increased fluoroscopy time during percutaneous nephrolithotomy and investigate the relationship between the 3D segmentation volume ratio of stone to renal collecting system and fluoroscopy time. MATERIALS AND METHODS: Data from 102 patients who underwent percutaneous nephrolithotomy were analyzed retrospectively. Volume segmentation of both the renal collecting system and stones were obtained from 3D segmentation software with the images on CT data. Analyzed stone volume (ASV), renal collecting system volume (RCSV) measured and the ASV-to-RCSV ratio was calculated. Several parameters were evaluated for their predictive ability with regard to fl uoroscopy time. RESULTS: The stone-free rate was 55.9% after the percutaneous nephrolithotomy. Complications occurred in 31(30.4%) patients. The mean fluoroscopy time was 199.4±151.1 seconds. The fl uoroscopy time was significantly associated with the ASV-to-RCSV ratio (p<0.001, r=0.614). The single tract was used in 77 ( 75.5%) cases while multiple tracts were used in 25 (24.5%) cases. Fluoroscopy time was significantly associated with multiple access (p<0.001, r=0.689). On univariate linear regression analysis, longer fluoroscopy time was related with increased stone size, increased stone volume, increased number of access, increased calyx number with stone, increased ASV-to-RCSV, increased operative time and decreased stone essence. On multivariate linear regression analysis, the number of access and the ASV-to-RCSV were independent predictors of fluoroscopy time during percutaneous nephrolithotomy. CONCLUSIONS: The distribution of the stone burden volume in the pelvicalyceal system is a significant predictor for prolonged fluoroscopy time during percutaneous nephrolithotomy. Measures to decrease FT could be benefi cial in patients with a high ASV-to-RCSV ratio for precise preoperative planning.

Factors affecting fluoroscopy time during percutaneous nephrolithotomy: Impact of stone volume distribution in renal collecting system

ABSTRACT Purpose: To identify the factors increased fluoroscopy time during percutaneous nephrolithotomy and investigate the relationship between the 3D segmentation volume ratio of stone to renal collecting system and fluoroscopy time. Materials and Methods: Data from 102 patients who underwent percutaneous nephrolithotomy were analyzed retrospectively. Volume segmentation of both the renal collecting system and stones were obtained from 3D segmentation software with the images on CT data. Analyzed stone volume (ASV), renal collecting system volume (RCSV) measured and the ASV-to-RCSV ratio was calculated. Several parameters were evaluated for their predictive ability with regard to fluoroscopy time. Results: The stone-free rate was 55.9% after the percutaneous nephrolithotomy. Complications occurred in 31(30.4%) patients. The mean fluoroscopy time was 199.4±151.1 seconds. The fluoroscopy time was significantly associated with the ASV-to-RCSV ratio (p<0.001, r=0.614). The single tract was used in 77 (75.5%) cases while multiple tracts were used in 25 (24.5%) cases. Fluoroscopy time was significantly associated with multiple access (p<0.001, r=0.689). On univariate linear regression analysis, longer fluoroscopy time was related with increased stone size, increased stone volume, increased number of access, increased calyx number with stone, increased ASV-to-RCSV, increased operative time and decreased stone essence. On multivariate linear regression analysis, the number of access and the ASV-to-RCSV were independent predictors of fluoroscopy time during percutaneous nephrolithotomy. Conclusions: The distribution of the stone burden volume in the pelvicalyceal system is a significant predictor for prolonged fluoroscopy time during percutaneous nephrolithotomy. Measures to decrease FT could be beneficial in patients with a high ASV-to-RCSV ratio for precise preoperative planning.

Is Cardiometabolic Index a Predictive Marker for Renal Cell Cancer Aggressiveness?

Studies show that metabolic syndrome is a factor for developing renal cell cancer (RCC) and tumour aggressiveness. In our study, we evaluated the association between renal cell cancer and cardiometabolic index (CMI) which meets the main components of the metabolic syndrome. We retrospectively reviewed the records of 310 consecutive patients with RCC who underwent radical nephrectomy at our institution. We evaluated the tumour size, histologic subtype, Fuhrman nuclear grade. CMI was calculated as the product of waist circumference (WC) to waist-to-height ratio (WHtR) and triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-c). CMI were statistically higher in patients with tumour size ≥ 7 cm than those < 7 cm (p<0.05). Mean CMI level was 2.34 ± 0.84 in patients with high tumour size; and 1.18 ± 0.74 in the other group. The patients with high tumour size had higher TG levels, higher WC and lower HDL-c levels. Similarly, CMI levels were statistically higher in patients with Fuhrman grade 3 and 4 than patients with Fuhrman grade 1 and 2 (p<0.001). The patients with high Fuhrman grade had higher TG levels, higher WC and lower HDL-c levels. The simplicity of WC and height measurement and TG and HDL assessment make CMI an easily applicable index for the evaluation of cardiovascular dysfunction. The components of CMI may have effect on tumour carcinogenesis in similar pathways. In this context, CMI which meets the main components of the metabolic syndrome, can be a useful index for the evaluation and calculation of renal cell cancer aggressiveness.