COVID-19 effect on perioperative findings of flexible/semi-rigid ureterorenoscopic lithotripsy: A match-pair analysis.

PURPOSE: If not treated on time with proper management options, urolithiasis cause serious morphologic and functional alterations in the involved renal units. Like many other pathologies, the diagnosis, treatment, and follow-up principles of patients with urinary stones have been negatively affected by the unestimated changes in the healthcare systems dealing intensively with COVID-19 patients. In this present study, we aimed to evaluate and present the possible effects of COVID-19 infection on the ureterorenoscopic stone treatment. MATERIALS AND METHODS: Clinical and procedural characteristics of 96 patients undergoing flexible and/or rigid ureterorenoscopy because of urolithiasis between March 2020 and January 2021 were evaluated in a retrospective manner. Obtained data were evaluated after match-pair analysis in a comparative manner between cases with a positive medical history of COVID-19 infection (Group 1, n: 48) and those without any COVID-19 infection (Group 2, n: 48). RESULTS: There was no statistically significant difference between the two groups of cases with respect to age, gender, associated comorbidities, and stone characteristics (p > 0.05). The mean serum creatinine level was determined to be higher in Group 1 than in Group 2 (1.15 ± 0.59 mg/dl, 0.83 ± 0.21 mg/dl, p = 0.007, respectively). Evaluation of the operative parameters revealed longer mean time from diagnosis to surgery (33.5 ± 14.27 vs 12.12 ± 6.33 days, p = 0.001), operating time, median length of stay in hospital along with higher additional intervention rates, and Clavien-Dindo complication scores again in Group 1 (p < 0.05). CONCLUSION: Our results indicate that the presence of COVID-19 infection anamnesis may affect the clinical and operative parameters of ureteroscopic stone management in cases with urolithiasis due to the possible effects of renal units damage and longer waiting time. Urologists may be aware of these unestimated problems during and after the intervention to take necessary measures for a safe and successful ureteroscopic stone removal.

Effect of hormonal therapy for volume reduction, lower urinary tract symptom relief and voiding symptoms in prostate cancer: leuprolide vs goserelin.

AIM: The complaints of lower urinary tract symptoms (LUTS) in cases with Prostate carcinoma (Pca) depend on coexisting benign prostate hyperplasia (BPH) or aging bladder. We aimed to investigate and compare the effect of goserelin acetate with leuprolide acetate on total prostate volume (TPV), post voiding residue (PVR), International Prostate Symptom Score (IPSS) and maximum flow rate (Qmax) reduction on cases of advanced Pca. METHODS: Patients with advanced Pca were treated with goserelin acetate (10.8 mg/3 months) or leuprolide acetate (22.5 mg/3 months) for 6 months. Changes in Prostate specific antigen (PSA), testesterone level, TPV, IPSS, PVR, and Qmax were assessed every 3 months. RESULTS: Fifty-one patients analyzed in this study. Mean percent decrease in PSA and testesterone from baseline to 6th month was not significantly difference between two groups (respectively; p = 0.9, p = 0.15) but TPV was reduced by -20.2 % ± 4.8 and -15.6 % ± 1.04,  the median total IPSS score was decreased by -34.77 % ± 8.8 and -19.77 % ± 6.1, median Qmax increased by 45.34 % ± 10.16 and 23.21 % ± 6.93, median PVR decreased by -31.54 % ± 8.4 and -19.23 % ± 5.5, respectively for two groups (all parameters (p < 0.05))Conclusion. In this study, we observed that the improvement of voiding parameters goserelin acetate was beter than leuprolide acetate. Especially it was detected the superiority of goserelin acetate group on the reduction of TPV, PVR and IPSS. Oncological outcomes were not different in both groups.

Is There a Relationship Between Pelvic Organ Prolapse and Tissue Fibrillin-1 Levels?

PURPOSE: Pelvic organ prolapse is a multifactorial disorder in which extracellular matrix defects are implicated. Fibrillin-1 level is reduced in stress urinary incontinence. In Marfan syndrome, which is associated with mutations in Fibrillin-1, pelvic floor disorders are commonly observed. We hypothesize that Fibrillin-1 gene expression is altered in pelvic organ prolapse. METHODS: Thirty women undergoing colporrhaphy or hysterectomy because of cystocele, rectocele, cystorectocele, or uterine prolapse were assigned to a pelvic prolapse study group, and thirty women undergone hysterectomy for nonpelvic prolapse conditions were assigned to a control group. Real-time polymerase chain reaction was conducted on vaginal tissue samples to measure the expression of Fibrillin-1. Expression levels were compared between study and control groups by Mann-Whitney U test with Bonferroni revision. RESULTS: Fibrillin-1 gene expression was not significantly lower in the study group than in the control group. Similarly, no significant correlation between Fibrillin-1 levels and grade of pelvic prolapse was found. Age over 40 years (P=0.018) and menopause (P=0.027) were both associated with reduced Fibrillin-1 levels in the pelvic prolapse group, whereas the delivery of babies weighing over 3,500 g at birth was associated with increased Fibrillin-1 expression (P=0.006). CONCLUSIONS: The results did not indicate a significant reduction in Fibrillin-1 gene expression in pelvic prolapse disorders; however, reduced Fibrillin-1 may contribute to increased pelvic organ prolapse risk with age and menopause. Increased Fibrillin-1 gene expression may be a compensatory mechanism in cases of delivery of babies with high birth weight. Further studies are needed for a better understanding of these observations.

The effects of hypnotherapy during transrectal ultrasound-guided prostate needle biopsy for pain and anxiety.

INTRODUCTION: Several studies evaluating the tolerance of transrectal ultrasound (TRUS)-guided needle biopsies showed that moderate-to-severe pain was associated with the procedure. Additionally, prebiopsy anxiety or rebiopsy as a result of a prior biopsy procedure is mentioned as factors predisposing to higher pain intensity. Thus, in this study, we investigated the effects of hypnotherapy during transrectal ultrasound-guided prostate needle biopsy for pain and anxiety. MATERIALS AND METHODS: Sixty-four patients presenting for TRUS-guided prostate needle biopsy were randomly assigned to receive either 10-min presurgery hypnosis session (n = 32, mean age 63.5 ± 6.1, p = 0.289) or a presurgery control session (n = 32, mean age 61.8 ± 6.8, p = 0.289). The hypnosis session involved suggestions for increased relaxation and decreased anxiety. Presurgery pain and anxiety were measured using visual analog scales (VAS), Beck Anxiety Inventory (BAI), and Hamilton Anxiety Scale (HAS), respectively. In our statistics, p < 0.05 was considered statistically significant. RESULTS: Postintervention, and before surgery, patients in the hypnosis group had significantly lower mean values for presurgery VAS [mean 1 (0-8); p = 0.011], BAI (6.0 vs 2.0; p < 0.001), and HAS (11.0 vs 6.0; p < 0.001). CONCLUSION: The study results indicate that a brief presurgery hypnosis intervention can be an effective means of controlling presurgical anxiety, and therefore pain, in patients awaiting diagnostic prostate cancer surgery.

The relationship between histopathology and age factor in patients who were operated for renal masses.

OBJECTIVE: Renal neoplasms have a predilection to occur in older patients and they are often malignant. They may have different structural characteristics according to age groups. In our study, we have investigated age-related demographic characteristics of the patients who were operated because of suspected malignant renal masses. MATERIALS AND METHODS: Between 2010 and 2014, 129 patients were treated surgically for suspected malignant renal masses at our institution. These cases had undergone open radical, open partial, and laparoscopic radical nephrectomies. Patients were divided into two groups based on their ages and evaluated accordingly as Group 1 (≤50 years) and Group 2 (>50 years). Groups were compared based on their clinical and pathological features. RESULTS: Group 1 and Group 2 consisted of 29 (22.4%) and 91 (77.6%) patients, respectively. The mean age of younger patients was 43.1 years (23-49 years), with a male to female ratio of 19/10, while the average tumor size was 57.6 mm (20-120 mm). Twenty-four patients (83%) had a malignant pathology and five patients (17%) had a benign pathology. Clear cell carcinoma was diagnosed in 67% of the patients in both groups. There was no significant difference with respect to age and tumor size of male and female patients in the younger age group, while younger female adults tended to have a more benign pathology than their male counterparts (40% and 5%, respectively, p<0.05). CONCLUSION: There was no significant difference with respect to gender, tumor size, laterality, and surgical and pathologic features between younger and older patients. An organ- sparing approach should be strongly considered when treatment for renal tumors in young females is performed because of a potentially higher incidence of a benign pathology of renal masses.

Early diagnosis of testicular torsion in rats by measuring plasma d-dimer levels: comparative study with epididymitis.

PURPOSE: To evaluate the differential diagnosis of testicular torsion and acute epididymo-orchitis by measuring the acute increase in plasma d-dimer levels in an experimental rat model. METHODS: Thirty male Wistar rats were randomly divided into 5 groups, 1--sham operated group (acute term; 4 hours), 2--early torsion group (acute term; 4 hours), 3--late torsion group (long-term; 72 hours), 4--control of epididymitis group (vehicle injected; 0.1 ml physiologic saline injected into the left ductus deferens) (long term; 72 hours), 5--epididymitis group (0.1 ml Escherichia coli injected into the left ductus deferens), (n=6 for each group). RESULTS: Serum d-dimer levels were significantly higher compared with the sham operated group with early torsion (p=0.002). This elevation remained mildly in the late torsion group compared with the control group (p<0.001), but there was no difference between 4 and 72 hours of the testis torsions (p=0.794). On the other hand, d-dimer levels were significantly higher in the torsion groups compared to the epididymitis group (p=0.042). CONCLUSIONS: The present study demonstrated that testicular damage that occurs following testicular torsion shows a higher increase in d-dimer levels than epididymitis, suggesting that d-dimer level can be used as a diagnostic marker of testicular torsion.

Novel approach for pain control in patients undergoing prostate biopsy: iliohypogastric nerve block with or without topical application of prilocaine-lidocaine: a randomized controlled trial.

PURPOSE: To investigate the efficacy of a novel anesthetic technique called iliohypogastric nerve block (INB) for pain control in patients undergoing prostate biopsy. MATERIALS AND METHODS: A total of 59 consecutive patients who underwent transrectal ultrasound guided prostates biopsies were included in the study. Patients were randomized into four groups: (1) control, no method of anesthesia was administered, (2) intrarectal prilocaine-lidocaine cream application, (3) INB and (4) INB + intrarectal prilocaine-lidocaine cream application (combined group). Patients were asked to use a scale of 0-10 in a Visual Analogue Scale (VAS) questionnaire about pain during probe insertion (VAS 1) and prostate biopsy (VAS 2). RESULTS: The mean VAS 1 and VAS 2 scores were 0.7 and 4.9 for controls, 0.5 and 1.8 for INB, 0.5 and 2.6 for the intrarectal cream group, and 0.4 and 1.8 for the combined group. The mean VAS 1 scores were not different between groups. However, the mean VAS 2 scores were significantly lower in INB, prilocaine-lidocaine cream and combined groups compared to the control group (P < .001). In addition, the INB group had significantly lower VAS 2 scores compared to the cream application group (P = .03). On the other hand, there was no difference between the INB and combined groups (P = .8). CONCLUSION: Any form of anesthesia was superior to none. However, INB alone seemed to be superior to prilocaine-lidocaine cream application in patients undergoing prostate biopsy. Addition of prilocaine-lidocaine cream application to INB may not provide better analgesia. 

Management of calyceal diverticular calculi: a comparison of percutaneous nephrolithotomy and flexible ureterorenoscopy.

To compare the outcomes in patients who have been treated with flexible ureterorenoscopy (f-URS) and percutaneous nephrolithotomy (PNL) in managing stone-bearing caliceal diverticula. Between April 2007 and October 2013, we performed a retrospective analysis of 54 evaluable patients (28 women and 26 men) with symptomatic stone-bearing caliceal diverticula, who underwent PNL (n = 29) or F-URS (n = 25) in four referral hospitals in Turkey. The groups were compared with respect to demographics, stone location/size, success rate, stone-free status, symptom-free status, complication rates, and hospital stay. The average stone burden preoperatively was significantly larger in patients who were treated with PNL, with the average size for f-URS being 154 ± 77 mm(2) and that for PNL being 211 ± 97 mm(2) (p = 0.023). Symptom-free rates, success rates, stone-free rates and clinically insignificant residual fragments were similar between the groups (p = 0.880 vs. p = 0.537 vs. p = 0.539, and p = 0.877, respectively). There was no statistical difference between the groups for minor complications (p = 0.521) but no major complication (Clavien III-V) occured in the f-URS group; although there were three major complications (10.3 %) (Clavien III) in the PNL group (p < 0.001). Hospitalization time per patient was 1.04 ± 0.20 days in the f-URS group, while it was 3.86 ± 1.94 days in the PNL group (p < 0.001). Even though this study clearly shows that both techniques have high overall success and symptom-free rates with similar complication rates for stone-bearing calyceal diverticulum, major complication rates may suggest consideration of the invasiveness of PNL. The f-URS procedure is advantageous with respect to a shorter hospital stay and absence of major complications. Therefore, it should be emphasized that the location of the stone and diverticula is an important factor for the selection of the procedure.

Metachronous bilateral granulocytic sarcoma of the testis in a young adult: a report of an unusual entity.

Granulocytic sarcomas are rare tumors composed of neoplastic blood cells, typically occurring during the course of acute nonlymphoblastic leukemia or before its onset. We present a case of a 23-year-old young adult man with metachronous granulocytic sarcoma of the testis without hematologic manifestations who was diagnosed with granulocytic sarcoma (GS). The patient was treated with right orchiectomy but relapsed with a left testicular mass 16 months later when a left orchiectomy was performed. The patient has been free of disease for 13 months following the left orchiectomy. This case highlights a rare hematologic cancer that urologists and pathologists should be aware of since it can present as a testicular mass. Only 3 cases of testicular GS without an associated hematologic disorder have been described. To the best of our knowledge, our patient is the first reported case in the English literature of metachronous GS of the testis with no evidence of hematologic disorder.

Antiadhesive role of human amniotic fluid on peritoneal adhesion formation in a rat model. Experimental study.

OBJECTIVE: To determine the role of human amniotic fluid (HAF) in preventing or reducing postoperative adhesions. STUDY DESIGN: Uterine horn adhesion model was carried out in 24 female Wistar rats. The animals were randomized into 4 groups: (1) control, (2) Ringer's lactate, (3) whole HAF, and (4) HAF depleted from cells and proteins. Adhesion grade and histologic findings of adhesion-carrying tissues were evaluated and groups were compared according to these parameters. RESULTS: Rats treated with whole HAF had less adhesion grade when compared to the control group, but the difference was not statistically significant. On the other hand, centrifuged amniotic fluid treatment significantly reduced peritoneal adhesion grade, fibrosis and inflammation (p < 0.05). CONCLUSION: Whole HAF seems to have no beneficial effect on peritoneal adhesion formation, but HAF depleted of protein and cells does have a positive effect on reducing adhesion formation.

Effect of vitamin D on postoperative adhesion formation in a rat uterine horn adhesion model.

OBJECTIVE: To determine the role of vitamin D for preventing or reducing postoperative adhesions. STUDY DESIGN: The uterine horn adhesion model was carried out in 24 female Wistar rats. The animals were randomized into 4 groups: (1) control, (2) Ringer's lactate, (3) olive oil, and (4) vitamin D. Adhesion grade and histologic findings of adhesion-carrying tissues were evaluated, and groups were compared according to these parameters. RESULTS: Rats treated with vitamin D had less adhesion and lower inflammation grade when compared to the control and Ringer's lactate groups, and the results were statistically significant (p < 0.05). On the other hand, no difference was detected between the groups according to the fibrosis score. CONCLUSION: Vitamin D decreased postsurgical adhesion scores by both visual scores and histologic analyses in a rat model. Further experimental and clinical trials are required to confirm these results.

A giant bladder struvite stone in an adolescent boy.

A 14-year-old adolescent boy with a history of recurrent lower urinary tract infection presented with a complaint of lower abdominal pain. Renal ultrasonography revealed bilateral hydronephrosis and X-ray film revealed a huge pelvic mass measuring 10 × 8 × 6 cm which filled the whole bladder. Open cystolithotomy was performed and magnesium ammonium phosphate (struvite) stone weighing 420 g was removed. Although a bladder stone is not rare, in the present report, the composition and the huge size of the stone determined in an adolescent patient is an interesting clinical entity. To the best of our knowledge, this is the largest struvite stone reported in an adolescent patient.

Urinary incontinence in a young girl due to ectopic ureter: the importance of history in a diagnostic challenge.

In girls who are otherwise well and whose history is that of continuous wetting day and night, despite successful toilet training, for a lifelong history, an extravesical infrasphincteric ectopic ureteral orifice should be strongly suspected and imaging should be vigorously pursued. Here, delayed diagnosis of vaginal ectopic ureter in a young girl with a lifelong history of urinary incontinence is presented. The importance of history and imaging procedures are also discussed.

Abeta(25-35) attenuated SREBP level in nuclear extracts of serum-deprived human neuroblastoma cells.

Disturbance in cholesterol homeostasis appears to be an important factor in the pathogenesis of neurodegenerative disorders. The aim of the present study was to investigate sterol regulatory element binding protein (SREBP) levels in the nuclear extracts of human neuroblastoma cells and the possible interaction of beta-amyloid peptide (Abeta) and cholesterol with this transcription factor. In this study, cultured human neuroblastoma cells (SHSY-5Y) were incubated in serum-deprived media in the presence or absence of Abeta((25-35)) (1 microM) or cholesterol (300 microM) for 24 h. Nuclear extracts were subjected to SDS-PAGE, and SREBP cleavage product (68 kDa) was detected by immunoblotting. SREBP levels were elevated in the cells incubated 24 h in serum-deprived experimental media and were attenuated by Abeta or cholesterol-supplementation. It is likely that the ability of Abeta to release cholesterol into the medium and downregulate SREBP is due to a feedback mechanism.

What is the best predictor of postoperative erectile function in patients who will undergo coronary artery bypass surgery?

PURPOSE: The aim of this prospective study was to evaluate the impact of extracorporeal circulation and cross clamping period on erectile function in patients undergoing coronary artery bypass surgery (CABS). MATERIALS AND METHODS: A total of 50 patients undergoing CABS were evaluated in this prospective study. Before and 6-12 months after the CABS, patients were interviewed for erectile dysfunction (ED) using the International Index of Erectile Function (IIEF). Scoring the IIEF domain of erectile function allowed the classification of each patient as having no (26-30), mild (17-25), moderate (11-16) or severe (0-10) ED. Patients with normal, mild and moderate ED score were designated as group A, B and C, respectively. Patients were classified in 2 groups to evaluate the impact of extracorporeal circulation and cross clamping period on erectile function in patients undergoing CABS. Patients who had no change in ED score in group A and patients who had recovery in group B were included in group1. Patients who had impaired ED score in group A and group B were included in group 2. All patients were also interviewed for sociodemographic and relevant medical history. Sociodemographic data were age, job, marital status, alcohol, narcotic and smoking habit. Medical risk factors were diabetes, hypertension and psychiatric disorders. RESULTS: The mean age of patients included in the study were 46,6 (range 31-55). After the operation, 3 (7.5%) of 41 patients in group A had moderate, 1 (2.5%) had mild and 37 (90%) had no change in ED score. In group B, 2 (28%) of 7 patients had moderate, 4 (57%) had recovery in ED score, 1 had no change in ED score. There were only 2 patients in group C and 1 had severe, the other one had mild ED after the operation. The mean operation period was 234.8 m inutes in group 1 and 280 min in group 2. Cross clamping period and extracorporeal circulation of patients in group 1 and 2 were 33.2, 41.6 min and 54.7, 64.6 min, respectively. The groups were not statistically different with regard to mean operation, cross clamping and extracorporeal circulation period. CONCLUSION: Preoperative erectile function seems to be the best predictor of postoperative erectile function in patients who will undergo CABS.

A prospective study of the efficacy of Serenoa repens, tamsulosin, and Serenoa repens plus tamsulosin treatment for patients with benign prostate hyperplasia.

INTRODUCTION: Increasing attention has been focused on the use of phytotherapeutic agents to alleviate the symptoms of benign prostatic hyperplasia (BPH) in recent times. The best described and studied phytotherapeutic agent is Serenoa repens (SR). MATERIALS AND METHODS: This prospective study was designed to have 3 arms including SR 320 mg per day (N = 20), Tamsulosin (TAM) 0.4 mg per day (N = 20) and SR + TAM (N = 20) to reveal the superiority or equivalence between these treatment regimens in BPH. RESULTS: The groups were not statistically different with regard to increase in maximal urinary flow rate (Q (max)) and decrease in International Prostate Symptom Score (I-PSS) (P > 0.05). No adverse effect was detected in SR therapy group. CONCLUSION: Treatment of BPH by both SR and TAM seems to be effective alone. None of them had superiority to another and additionally, combined therapy (SR + TAM) does not provide extra benefits. Furthermore SR is a well-tolerated agent that can be used alternatively in the treatment of LUTS due to BPH.

Brucella orchitis: a rare cause of testicular mass: report of a case.

Brucellosis is a multiorgan infectious disease. The genitourinary system is affected in 2-20% of the cases and the most common form is orchitis. Rarely, patients may present with a testicular mass and it must be distinguished from malignant processes. We report brucellar orchitis, a rare cause of testicular mass, in a 22-year-old man. We described the clinicopathological features of this rare entity and reviewed the literature.

Penile metastasis from other malignancies. A study of ten cases and review of the literature.

Primary penile carcinoma is one of the rarest male genital tract tumors. We rarely encounter this malignancy in Turkey because circumcision is routinely performed as a part of the Islamic tradition. Despite the medical paradox that the penis is rarely affected by metastases, approximately 300 cases have been reported in the literature. The primary lesion is almost 75% of pelvic origin; genitourinary or rectosigmoid primaries and penile metastasis from extrapelvic primaries constitute 25% of other primaries. Furthermore, isolated metastatic penile carcinomas are exceptionally rare. The rarity of the event prompted this study, which describes 10 cases of metastatic tumors of the penis including 7 cases with transitional cell carcinoma of the bladder, and in 1 case each of squamous cell carcinoma of the lung, adenocarcinoma of the prostate and leukemia. The main characteristics of the primary tumor are described, along with the diagnosis, treatment and the outcome of patients.