Outcomes of ultraminipercutaneous nephrolithotomy in infants: our experiences at a single center in an endemic region.

OBJECTIVE: In this study, we aimed to contribute to the literature by sharing the perioperative and postoperative outcomes of infants (0-24 months) who underwent ultra-mini percutaneous nephrolithotomy (PNL) for kidney stones in our clinic. METHODS: Infants under 24 months old with kidney stones of 2 cm and larger, who applied to our clinic between January 2018 and May 2023, were included in the study. The patients' demographic and clinical characteristics were obtained from the medical records. The collected data were analyzed retrospectively. RESULTS: A total of 26 patients were included in the study. The mean age of the patients was 17.3 ± 3.90 (12-24) months. The mean operation time was 50.7 ± 6.43 min. The mean stone size was 2.66 ± 0.59 cm. Stone-free was achieved in 23 patients (88.5%). In one patient (3.8%) with residual fragments, SWL was performed, and in two patients (7.7%), RIRS was performed to achieve stone-free. Postoperatively, fever was observed in 3 patients (11.5%). There were no patients requiring blood transfusion. CONCLUSIONS: In experienced centers, ultra-mini-PNL performed by experienced surgeons is an effective and reliable treatment option for infants under 24 months of age with kidney stones larger than 2 cm. It provides high-stone clearance rates and low complication rates.

Comparing the Effects of 2D and 3D Imaging Systems on Laparoscopic Pyeloplasty Outcomes in the Treatment of Adult Ureteropelvic Junction Obstruction.

Background: The aim of this study was to compare the efficacy, safety, and the clinical and perioperative outcomes of two-dimensional (2D) and three-dimensional (3D) laparoscopic imaging systems in adult patients undergoing laparoscopic pyeloplasty in our clinics due to ureteropelvic junction (UPJ) obstruction. Methods: A total of 46 adult patients who had undergone laparoscopic pyeloplasty due to UPJ obstruction were included in the study. Cases that had undergone the operation before January 2019 were retrospectively evaluated with the 2D imaging systems. Cases after that date were evaluated by using the 3D imaging systems, and the operative, perioperative, and postoperative findings of these patients were recorded prospectively. Patients who had undergone laparoscopic pyeloplasty were classified into two groups as the "2D group" and the "3D group." To standardize the preoperative findings, the cases that were operated by a single surgeon experienced in both 2D and 3D imaging systems were included in the study. The demographic characteristics and the clinical findings of the patients were compared between the groups. Results: A total of 41 patients were included in the study. The mean age was 27.7 ± 9.17 years. Among the patients, 23 (56.1%) were in the 2D group and 18 (43.9%) were in the 3D group. No statistically significant difference was observed between groups with regard to the demographic characteristics of the patients. According to the perioperative and postoperative findings of the patients, the duration of the operation was significantly shorter in the 3D group. Conclusion: The duration of the operation was significantly reduced in the 3D image-guided laparoscopic pyeloplasty in the treatment of UPJ obstruction of the adult, compared with 2D image-guided operations. The 3D imaging systems provide a better image quality, an important convenience in intraoperative saturation, and low rates of complication in laparoscopic pyeloplasty, and they may be used safely and effectively.

Comparison of Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging in Patients with Prostate Biopsy Indications.

OBJECTIVE: This article aims to evaluate the efficacy of multiparametric magnetic resonance imaging before standard tru-cut biopsy in making prostate cancer diagnosis. MATERIALS AND METHODS: A total of 160 patients with prostate biopsy indications were prospectively evaluated between May 2017 and October 2018. Multiparametric magnetic resonance imaging was taken after obtaining a written informed consent from all patients. Cognitive transrectal ultrasound-guided biopsy was performed based on multiparametric magnetic resonance imaging results. Standard tru-cut biopsy was included to reduce false-negative rate. Statistical analysis was performed using the Statistical Package for Social Sciences version 20.0 software. RESULTS: The mean age of the patients was 65.94 ± 7.90 (48-84) years. Around 19.37% of the patients had a specificity in the digital rectal exam. The mean prostate-specific antigen value of the patients with adenocarcinoma was 42.1 ng/mL and it was 10.2 ng/mL in patients with benign prostate hyperplasia. It was observed that the prostate-specific antigen values in prostatic adenocarcinomas were significantly higher than those in benign prostate hyperplasia (P < .001). The results of multiparametric magnetic resonance imaging and the biopsy were 100% similar in terms of zones in patients with adenocarcinoma. All of the biopsy results of the patients who were evaluated to have normal prostate tissue in multiparametric magnetic resonance imaging were evaluated as benign prostate hyperplasia; on the other hand, 13.6% of PI-RADS 2 lesions, 14% of PI-RADS 3 lesions, 31.8% of PI-RADS 4 lesions, and 85.7% of PI-RADS 5 lesions were determined to be adenocarcinoma. It was observed that the prevalence of adenocarcinoma increased as the risk elevated in multiparametric magnetic resonance imaging (P < .001). CONCLUSION: Multiparametric magnetic resonance imaging evaluated by experienced radiologists may be instructive of urologists and reduce the need for unnecessary biopsies.

Variation of Serum PSA Levels in COVID-19 Infected Male Patients with Benign Prostatic Hyperplasia (BPH): A Prospective Cohort Studys.

OBJECTIVE: To investigate the effect of SARS CoV-2 on serum total PSA levels in men with BPH diagnosed with COVID-19. METHODS: The PSA (Kit: Immunoassay Program- Cycle 18, Siemens Atellica IM Analyzer) levels in patients who had had a PSA check at least 3 months, but no more than 6 months, prior to diagnosis of acute COVID-19 infection, were examined retrospectively. PSA levels were measured and recorded from these patients on the first day of diagnosis of COVID-19. These patients were called back for urology outpatient follow-up at the third month after the end of the COVID-19 treatment. PSA levels measured in the pre-COVID-19 period, during the period of active infection with COVID-19, and in the post-COVID-19 period were compared. RESULTS: In total, 91 patients had a serum PSA level of 1.58 ± 1.09 ng/mL in the pre-COVID-19 period, a serum PSA level of 4.34 ± 3.78 ng/mL measured in the COVID-19 period and 2.09 ± 2.70 ng/mL in the post-COVID-19 period. It was determined that the serum PSA level measured during active COVID-19 infection was statistically significantly higher than the PSA levels measured according to the pre-COVID-19 period and the post-COVID-19 period (P < .001, P < .001; respectively). CONCLUSION: SARS-CoV-2 infection in men diagnosed with BPH causes significant increases in PSA levels during the active period of the disease. Measurement of PSA values used in the diagnosis, differential diagnosis, and follow-up of prostate diseases in the acute period of infection and in the early period after infection treatment may cause false evaluations that may affect the diagnosis and treatment steps of prostate diseases in these patients.

Concurrent Inguinal Hernia Repair During Robot-Assisted Transperitoneal Radical Prostatectomy: Single Center Experience.

OBJECTIVE: To evaluate outcomes of concurrent inguinal hernia (IH) repair with mesh during transperitoneal robot-assisted radical prostatectomy (RARP). MATERIAL AND METHODS: Data of 26 patients (31 procedures) undergoing IH repair concurrently with RARP between January 2017 and January 2020 were evaluated retrospectively. Patients' demographics, intraoperative and postoperative variables were recorded. Patients were assessed based on prostate-specific antigen recurrence, IH recurrence, mesh infection, seroma formation and groin pain quarterly in the first year, and every six month thereafter. RESULTS: The median age was 64.5 years in our population. IH was detected preoperatively in 46.2% of patients (n = 12) and intraoperatively in 53.8% (n = 14). Twenty-one (80.8%) patients (11 of them had right IH and 10 of them had left IH) had unilateral hernias and 5 patients (19.2%) had bilateral hernias. Twenty-three (88.4%) IHs were direct, three (11.6%) were indirect. The median operative time and estimated blood loss were 192.5 (range: 140-250) min and 100 (range: 10-170) mL, respectively. The median duration of IH repair, time of drainage, length of hospitalization, and catheterization were 32.5 (range: 14-40) min. 2 (range: 2-6) days, 6 (range: 5-8) days and 7 (range: 5-7) days, respectively. No perioperative complication due to RARP or IH repair was observed. During a median follow-up time was 18 months, no scrotal hematoma, seroma formation or mesh infection was identified. CONCLUSION: IH repair performed during the same session at RARP is a safe and applicable procedure.

Questionnaire-guided evaluation of the effectiveness of long-term intravesical 0.2% chondroitin sulfate therapy in interstitial cystitis.

INTRODUCTION AND HYPOTHESIS: To investigate the long-term feasibility, safety and effectiveness of intravesical chondroitin sulfate therapy in patients with one or more forms of chronic cystitis. METHODS: The study included 62 female patients with interstitial cystitis/painful bladder syndrome (IC/PBS) who received intravesical chondroitin sulfate (40 ml/80 mg) therapy between 2014 and 2018. A total of 15 doses of intravesical treatment were applied, once weekly in the first month and once monthly from the second month onward. A 3-day voiding diary, a visual analog scale (VAS), the O'Leary Sant Indexes (ICSI/ICPI), the Pelvic Pain and Urgency/Frequency Symptom (PPUFS) Scale and PPUF Bother scores were recorded and evaluated through prospective comparison before treatment and at the first month and first year. Patients were also assessed using the Global Response Assessment (GRA) at the end of the first month and first year to assess the effectiveness of responses to treatment. RESULTS: In the first month of treatment, 0.2% chondroitin sulfate was ineffective in 22.5% of patients, with mild improvement observed in 40.0% and moderate-good improvement in 37.0%. Evaluation at the end of the first year revealed mild improvement in 21.0% of patients and moderate-good improvement in 79.0%. Statistically significant improvements were observed in all scoring systems at 1 and 12 months compared with pre-treatment values (p < 0.001). CONCLUSION: Long-term intravesical chondroitin sulfate therapy is a safe and highly successful therapeutic modality that produces significant improvement in patients' quality of life and symptoms in the treatment of IC/PBS.

Surgical results in penile fracture: Our single center experience.

INTRODUCTION: Penile fracture arises as a result of a unilateral or bilateral rupture of the tunica albuginea of the corpus cavernosum. It is a rare condition that requires urgent surgical intervention. In this study, we aimed to determine the effectiveness of surgical treatment in penile fracture and its effect on complications. METHODS: The data of 21 patients who were admitted to the emergency department of our clinic between 2012 and 2019 and underwent emergency surgical repair with the diagnosis of penile fracture were collected retrospectively. The diagnosis of penile fracture was established by anamnesis and physical examination. Age, etiology, duration from trauma to surgery, physical examination findings,length and localization of the tunica albuginea defect, length of hospital stay, and postoperative first-, third- and sixth-month follow-up results were analyzed. Erectile function was evaluated using the International Index of Erectile Function (IIEF-5). Complications such as penile curvature, penile nodule and painful erection were evaluated. RESULTS: The mean age of the patients was 36.8 ± 8.3 years. The most common reason of penile fracture was manually bending the penis for detumescence. All patients underwent surgery. The mean duration from trauma to surgery was 7.6 ± 3.1 h. The mean length of the tunica albuginea defect was 11 ± 2.5 mm. The mean length of hospital stay was 2.5 ± 0.5 days. The mean IIEF-5 scores in the postoperative first, third and sixth months were 20.5 ± 2.6, 22 ± 2.2, 22.1 ± 1.7, respectively. CONCLUSION: Penile fracture is a urological emergency, and timely surgery is an effective treatment method for preventing postoperative complications.

The effect of desloratadine on ischemia reperfusion induced oxidative and inflammatory renal injury in rats.

Purpose: To examine the effect of desloratadine on kidney ischemia-reperfusion (I/R) injury in albino Wistar male rats using biochemical and histopathological methods.Methods: The treated with ischemia-reperfusion + 5 mg/kg desloratadine (IRD) group (n-6) was given 5 mg/kg desloratadine by gavage orally, and applied renal ischemia-reperfusion (BIR) group (n-6) and control (SG) group undergoing Sham operation (n-6) rats were given distilled water as solvent one hour before ketamine anesthesia. During the anesthesia period, ischemia was induced for 2 h unilaterally in the left kidney of all rats followed by reperfusion for 6 h. The kidneys of the SG group had sham operation without any intervention.Results: Our biochemical test results showed that malondialdehyde (MDA), nuclear factor kappa (NF-κB), tumor necrosis factor alpha (TNF-α), interleukin one beta (IL-1ß), creatinine, and blood urea nitrogen (BUN) levels were significantly increased in the BIR group compared to the healthy control and IRD groups treated with desloratadine. Histopathological results were revealed tubular dilatation, tubular necrosis, loss of brushy margins, cast formation, and apoptotic bodies in tubular epithelial cells in the BIR group. There were no histopathological findings except for the swelling of tubule epithelial cells and the accumulation of proteinous material in some tubule lumens in renal tissue of desloratadine-treated rats.Conclusions: Experimental results suggested that desloratadine may be useful in the treatment of renal I/R injury.

Serum paraoxonase 1 and 3 activities in benign and malignant diseases of the prostate and changes in levels following robotic-assisted laparoscopic radical prostatectomy

Background/aim: This study aimed to examine serum paraoxonase 1 and 3 (PON1 and PON3) activities in benign and malignant diseases of the prostate, to determine lipid profile and malondialdehyde (MDA) levels, and to investigate changes in levels following robotic-assisted laparoscopic radical prostatectomy (RALRP). Materials and methods: A total of 137 patients, including a control group, were enrolled in the study and assigned into four groups. Group 1 (n = 33) consisted of patients previously undergoing RALRP with no recurrence, group 2 (n = 36) consisted of patients diagnosed with prostate cancer (PCa) and undergoing RALRP, and group 3 (n = 34) consisted of patients diagnosed with benign prostatic hyperplasia. The control group (n = 34) consisted of healthy individuals. Serum low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglyceride, cholesterol, prostate-specific antigen (PSA), PON1, PON3, and MDA values were measured. In addition, group 2 MDA, PON1, PON3, and PON1/HDL levels were investigated preoperatively and at the first month postoperatively. Results: Significant changes were found in PON1, PON3, and MDA levels. PON1 and PON3 levels decreased significantly in patients with PCa, while MDA levels increased. PON1 and PON3 increased postoperatively in the PCa group, while MDA decreased. BPH group PON1, PON3, and MDA levels were higher than those of the control group. Conclusion: An increase in free oxygen radicals in the body or a decrease in endogenous antioxidant enzyme levels can result in malignant and benign diseases of the prostate. Surgical excision of malignant tissue in PCa causes a decrease in oxidative stress.

Posterior Urethral Polyp: First Holmium-YAG Laser Ablation on a 3-Month-Old Infant.

BACKGROUND: Urethral polyps are rare benign pathologies seen in the male posterior urethra, more frequently originating from verumontanum. In this article, we aimed to discuss diagnosis and treatment of a urethral polyp causing hematuria and urinary infection in a 3-month-old male infant. This is the first case in the literature in which a urethral polyp is treated with Holmium yttrium-aluminum-garnet (YAG) laser. CASE PRESENTATION: The patient was a 3-month-old male infant, and complains were hematuria and crying during micturition. Ultrasonography and voiding cystourethrogram were used for diagnosis. Urethral polyp was observed on urethrocystoscopy. Ablation was performed with a newborn cystoscope. CONCLUSION: Urethral polyp can cause hematuria and urinary obstruction and should be considered in the differential diagnosis of pathologies such as posterior urethral valve and cecoureterocele that could cause infravesical obstruction. Holmium-YAG laser is a good choice of treatment with easy application possibilities using a newborn cystoscope, especially for newborns and infants who have thin urethra.