Predictive role of ureteral wall thickness and patient characteristics in endoscopic treatment outcomes for ureteral stricture disease following stone surgery.

PURPOSE: To evaluate the role of certain radiological parameters and patient characteristics in predicting the success of endoscopic treatment in ureteral stricture disease. METHODS: Fifty one adult patients with ureteral stricture disease (< 1 cm) after developing due to upper ureteral stones with ureteroscopic laser disintegration were included and in addition to stone and patient parameters, radiological parameters including ureteral wall thickness (UWT) at the impacted stone site were also measured on computed tomography (CT) images. Patients were divided into two groups: Group 1: Patients with endoscopic treatment success and Group 2: Patients with endoscopic treatment failure. The possible relationship between the UWT values and other radiological parameter was comparatively evaluated. RESULTS: Mean UWT value assessed at the treated stone site was significantly higher in cases unresponsive to endoscopic treatment with values of 2.77 ± 1.03 mm and 4.25 ± 1.32 mm in Group 1 and 2 respectively. A cut off value 3.55 mm for UWT was found to be highly predictive for endoscopic treatment failure. CONCLUSIONS: Our current results indicated that assessment of UWT value at the obstructing stone could be helpful enough to predict the likelihood of failure following endoscopic management of strictures with high sensitivity and specificity. Evaluation of this particular parameter could let the endourologists to look for more rational treatment alternatives with necessary measures taken on time.

Metabolic Syndrome is Associated with Prostate Cancer Diagnosed on Biopsy but not the Gleason Score and the Number of Cancer-Positive Cores: A Prospective Controlled Study.

OBJECTIVE: We aimed to investigate the association between metabolic syndrome (MetS) and prostate cancer (PCa) in patients undergoing prostate biopsy. MATERIALS AND METHODS: Between January 2018 and December 2022, MetS was investigated according to Adult Treatment Panel III (ATP III) criteria in men who underwent prostate biopsy with transrectal ultrasound (TRUS). Clinicopathological factors such as, digital rectal examination (DRE), prostate-specific antigen (PSA), prostate volume, waist circumference, body mass index (BMI), age, blood pressure, testosterone, lipid profiles, fasting blood glucose level, C-reactive protein (CRP) and MetS were analyzed. RESULTS: A total of 908 men underwent biopsies, of which 492 (51.5%) had MetS according to ATP III criteria. The number of patients diagnosed with PCa in biopsy was 270 (29.7%). PCa cases were significantly older, with a lower prostate volume and a higher PSA value and higher blood pressure compared to patients without PCa (p < 0.001). 146 of 416 (35.0%) patients with MetS had PCa while 124 of 492 (25.2%) patients without MetS had PCa (p < 0.001). Out of 270 patients with PCa, 174 (64.4%) had Gleason score <7 and 96 (35.6%) had Gleason score ≥7. In patients with a Gleason score ≥7, PSA, DRE(+) and core positive number were significantly higher compared to patients with Gleason score <7, while glycemia and high-density lipoprotein (HDL) cholesterol levels were significantly lower (p < 0.001). Multivariate analysis showed that age, PSA, positive DRE, prostate volume (p < 0.001), diastolic blood pressure, CRP and MetS were the only independent parameters associated with a higher risk of cancer on biopsy (p < 0.05). CONCLUSIONS: Our findings show that MetS is associated with PCa diagnosed on biopsy but not with the Gleason score and the number of cancer-positive cores. However, these results should be confirmed by larger, multicenter and prospective studies.

Effect of constipation on acute urinary retention following transrectal prostate biopsy.

PURPOSE: To evaluate the possible effect of constipation on the acute urinary retention (AUR) after transrectal ultrasound-guided prostate biopsy (TRUS PB). MATERIALS AND METHODS: A total of 1,167 patients with prostate-specific antigen (PSA) >4 ng/mL and/or abnormal digital rectal examination underwent a standard 12 core transrectal ultrasound-guided prostate needle biopsy in our hospital and the findings were examined prospectively. Chronic constipation (CC) was defined according to the Rome IV criteria. All cases were well evaluated with respect to clinical-histopathological factors; International Prostate Symptom Score (IPSS), prostate volume, post-void residue, age, body mass index, histopathological inflammation, and AUR. RESULTS: The mean age of patients was 64.63±8.31 years, the PSA level was 11.60±16.83 ng/mL, and the prostate volume was 54.66±25.44 mL. In 265 cases (22.7%), CC anamnesis was present and AUR developed in 28 (2.4%) of the cases. In the multivariate analysis for the risk of developing urinary retention, prostate volume, pre-operative IPSS, and presence of CC requiring manual maneuvers to facilitate defecation were found to be risk factors (p=0.023, 0.010, and 0.001, respectively). CONCLUSIONS: Our findings demonstrated that CC may be a critical factor in the prediction of AUR formation following TRUS PB.

Infectious complications after transrectal prostate biopsy is increased in patients with chronic idiopathic constipation. / Las complicaciones infecciosas después de biopsia próstata transrectal están incrementadas en pacientes con estreñimiento crónico idiopático.

OBJECTIVE: This study aims to compare infectious complications after a prostate biopsy in patients with or without chronic idiopathic constipation (CIC). METHODS: Six hundred and sixty-three patients who underwent a transrectal ultrasound-guided biopsy (TRUSBx) of the prostate between 2012 and 2018 were evaluated prospectively. Patients were divided into two groups according to their CIC status and monitored for complications. CIC was defined by the Rome III criteria. Multivariate analysis was performed to assess the risk factors. RESULTS: Thirty-five patients (5.8%) developed a urinary tract infection (UTI) while sepsis occurred in only three cases (0.5%). CIC was found as a risk factor for infection. Infection occurred in 18.1% of the men with CIC compared to 2.3% of those without CIC (p=0.001). Sepsis occurred in 1.4% of the men with CIC compared to vs 0.2% of those without CIC (p=0.68). In multivariate analysis, CIC (OR of 9.27 and 95% CI 4.40-19.54, p<0.05) and Diabetes Mellitus (OR of 3.11 and 95% CI 1.52-6.36, p=0.002) were associated with an increased risk factor of UTI and sepsis. CONCLUSIONS: We demonstrated that CIC is an important risk factor of infection after a prostate biopsy. Prevention is important to minimize complications after this very common worldwide procedure.

OBJETIVO: Este estudio tiene como objetivo comparar las complicaciones infecciosas después de una biopsia de próstata en pacientes con o sin estreñimiento idiopático crónico (CIC).MÉTODO: Se evaluó prospectivamente a seiscientos sesenta y tres pacientes que se sometieron a una biopsia de próstata guiada por ecografía transrectal (TRUS-Bx) entre 2012 y 2018. Los pacientes se dividieron en dos grupos según su estado CIC y se monitorizaron para detectar complicaciones. El CIC fue definido por los criterios de Roma III. Se realizó un análisis multivariado para evaluar los factores de riesgo. RESULTADOS: Treinta y cinco pacientes (5,8%) desarrollaron una infección del tracto urinario (ITU), mientras que la sepsis se produjo en sólo tres casos (0,5%). CIC se encontró como un factor de riesgo de infección. La infección ocurrió en el 18,1% de los hombres con CIC en comparación con el 2,3% de los que no tenían CIC (p=0,001). La sepsis ocurrió en el 1,4% de los hombres con CIC en comparación con el 0,2% de los que no tenían CIC (p=0,68).En el análisis multivariado, CIC (OR de 9,27 e IC del 95% 4,40-19,54, p <0,05) y Diabetes Mellitus (OR de 3,11 e IC del 95% 1,52-6,36, p=0,002) se asociaron con un mayor factor de riesgo de ITU y septicemia.CONCLUSIÓN: Demostramos que la CIC es un factor de riesgo importante de infección después de una biopsia de próstata. La prevención es importante para minimizar las complicaciones después de este procedimiento muy común en todo el mundo.

Transient cessation of antiplatelet medication before percutaneous stone surgery: does it have any safety concern on bleeding related problems?

To evaluate the short term effects of transient AP medication cessation on the safety of percutaneous nephrolithotomy (PCNL) and evaluate them with normal cases in a comparative manner. 71 cases undergoing PCNL for renal pelvic stones were divided into two groups: Group 1 (n: 35) Cases under AP medication (100 mg/day acetyl salicylic acid) in whom the medication was stopped for 7 days before PCNL procedure. Group 2 (n: 36) Cases without any AP medication prior to PCNL. Coagulation test parameters were normal in all cases prior to stone removal. Treatment related parameters with an emphasis on post-operative course were evaluated between two groups. While prolonged macroscopic hematuria (mean 3.5 days) was present in a 25.7 % of the cases in Group 1; it was 5.7 % in Group 2 (mean 2 days). Mean duration of nephrostomy tube was longer in Group 1 (3.49 vs 2.64 days respectively). Additionally, hospitalization period was longer in cases under antiplatelet therapy when compared with the others. No statistically significant difference was noted between two groups regarding post-operative Hb drop rates, transfusion, fever, embolization rates. Lastly, of all the risk factors evaluated; use of AP medication was found to increase the risk of macroscopic hematuria 5.8-fold on logistic regression analysis. Our findings demonstrated that despite the cessation of the antiplatelet agents with an appropriate regimen; these cases should be followed for the risk of prolonged hematuria and tube drainage after PCNL in a very close manner.

Emergency management of ureteral stones: Evaluation of two different approaches with an emphasis on patients' life quality.

OBJECTIVES: To evaluate the emergency management of obstructing ureteral calculi with two different techniques (SWL and URS) with an emphasis on patients life quality. METHODS: A total of 80 patients presenting with acute colic pain due to a single obstructing ureteral stone were treated within 24 hours following the onset of pain with two different approaches in a randomized manner. Patients requiring DJ stent placement and/or auxiliary measures after both procedures were excluded and the remaining 65 patients were evaluated [Group1: ESWL (n = 34); Group 2: URS (n = 31)]. Patients were followed during 4-weeks period with respect to the analgesic requirement, number of renal colic attacks and emergency department visits along with the HRQOL scores. RESULTS: While 26 patients treated with URS (83.9%) were stone-free, 24 cases in SWL were stone-free (70.6%) after 4 weeks. Evaluation of the cases during this follow-up period demonstrated that cases undergoing SWL required significantly higher amount of analgesics when compared with URS group (p < 0.001). In addition to the lower mean number of renal colic attacks and emergency department visits in URS group; both the mean HRQOL in terms of EQ-5D index and mean EQ-5D VAS values were also significantly higher in these cases when compared with the cases tretaed with SWL. CONCLUSIONS: Due to the negative impact of stone related events after emergency SWL on patients HRQOL, emergency URS may be applied more effectively with the advantages of prompt fragmentation of the calculi along with the immediate relief of obstruction and pain.

The protective effects of an herbal agent tutukon on ethylene glycol and zinc disk induced urolithiasis model in a rat model.

To evaluate protective effects of Tutukon®, a plant derived herbal product, on the development of rat urolithiasis model. A total of 45 rats were divided into three groups namely; Group 1 (control group; drinking water + zinc disk), Group 2 (0.5 % ethylene glycol [EG] to drinking water + zinc disk) and Group 3 (study group-0.5 % EG + Tutukon + zinc disk). Moreover, zinc disks were placed into bladder of rats to serve as a nidus for stone development. Five rats from each group were killed at the end of the 1st, 2nd and 4th week. The level of bladder inflammation, the disk weights and the urine oxalate, calcium and pH values and were evaluated and compared. The inflammation scores of the pathological evaluation were not significantly different among three groups. At the end of the 28th day, weights of the zinc disks were significantly higher in Group 2 (394.4 ± 41.2) when compared to Group 1 (1517.5 ± 367.3) and Group 3 (386.2 ± 26.9) (p = 0.016). The disk weights increased gradually at 7th, 14th and 28th days in Group 1 (p = 0.018) and Group 2 (p = 0.009) while remained stable in Group 3 (p = 0.275). Urine calcium levels were not affected among three groups throughout the study period. At the end of the 28th day, while the urine oxalate levels of rats in Group 1 was lower than that of both Group 2 (p = 0.046) and Group 3 (p = 0.008); Group 2 and Group 3 had similar oxalate excretion levels (p = 0.701). However, the difference was not significant. Tutukon seems to decrease stone deposition on zinc disks implanted in the bladder of rats. The exact mechanism of this preventive effect is, however, not well understood.

Evaluation of sexual function in patients submitted to ureteroscopic procedures.

OBJECTIVE: We aimed to evaluate the possible effects of ureteroscopic procedures on the sexual function of both genders. MATERIALS AND METHODS: A total of 102 sexually active cases (60 male, 42 female) undergoing ureteroscopic procedures were included in this study. Sexual function has been evaluated in detail by using International Index of Erectile Function (IIEF) in male and Female Sexual Function Index (FSFI) forms in female cases both before and 1-month after the procedures. Pre-and postoperative data were evaluated in a comparative manner. RESULTS: The pre-and postoperative mean IIEF scores were 57.86 ± 2.26 and 54.57 ± 2.48 (p = 0.19) in males and the mean FSFI scores were 13.58 ± 1.46 and 14.46 ± 1.52 (p = 0.41), respectively in females. Evaluation of these values showed that regarding the effects of this procedure on male cases although the total scores for sexual function were not influenced it was observed a significant reduction in the intercourse satisfaction subdomain (IIEF-IS) in males (p < 0.05). In female cases however, unlike the male cases no statistically significant alterations with respect to these scores were noted (p = 0.418). CONCLUSION: Ureteroscopic interventions could have some adverse effects on the sexual function particularly in male cases. However, it is clear that further prospective studies in both genders with large population of cases are certainly needed in order to outline this unresolved but important subject.

Evaluation of sexual function in patients submitted to ureteroscopic procedures

ABSTRACTObjective:We aimed to evaluate the possible effects of ureteroscopic procedures on the sexual function of both genders.Materials and Methods:A total of 102 sexually active cases (60 male, 42 female) undergoing ureteroscopic procedures were included in this study. Sexual function has been evaluated in detail by using International Index of Erectile Function (IIEF) in male and Female Sexual Function Index (FSFI) forms in female cases both before and 1-month after the procedures. Pre-and postoperative data were evaluated in a comparative manner.Results:The pre-and postoperative mean IIEF scores were 57.86±2.26 and 54.57±2.48 (p=0.19) in males and the mean FSFI scores were 13.58±1.46 and 14.46±1.52 (p=0.41), respectively in females. Evaluation of these values showed that regarding the effects of this procedure on male cases although the total scores for sexual function were not influenced it was observed a significant reduction in the intercourse satisfaction sub-domain (IIEF-IS) in males (p<0.05). In female cases however, unlike the male cases no statistically significant alterations with respect to these scores were noted (p=0.418).Conclusion:Ureteroscopic interventions could have some adverse effects on the sexual function particularly in male cases. However, it is clear that further prospective studies in both genders with large population of cases are certainly needed in order to outline this unresolved but important subject.

Shock Wave Lithotripsy in Ureteral Stones: Evaluation of Patient and Stone Related Predictive Factors

ABSTRACTPurpose:To evaluate the patient and stone related factors which may influence the final outcome of SWL in the management of ureteral stones.Materials and Methods:Between October 2011 and October 2013, a total of 204 adult patients undergoing SWL for single ureteral stone sizing 5 to 15 mm were included into the study program. The impact of both patient (age, sex, BMI,) and stone related factors (laterality, location, longest diameter and density as CT HU) along with BUN and lastly SSD (skin to stone distance) on fragmentation were analysed by univariate and multivariate analyses. Results: Stone free rates for proximal and distal ureteral stones were 68.8% and 72.7%, respectively with no statistically significant difference between two groups (p=0.7). According to univariate and multivariate analyses, while higher BMI (mean: 26.8 and 28.1, p=0.048) and stone density values (mean: 702 HU and 930 HU, p<0.0001) were detected as statistically significant independent predictors of treatment failure for proximal ureteral stones, the only statistically significant predicting parameter for the success rates of SWL in distal ureteral stones was the higher SSD value (median: 114 and 90, p=0.012).Conclusions:Our findings have clearly shown that while higher BMI and increased stone attenuation values detected by NCCT were significant factors influencing the final outcome of SWL treatment in proximal ureteral stones; opposite to the literature, high SSD was the only independent predictor of success for the SWL treatment of distal ureteral stones.

Limitation of apoptotic changes and crystal deposition by Tutukon following hyperoxaluria-induced tubular cell injury in rat model.

This study aimed at evaluating the protective effects of a herbal medication (Tutukon) on the hyperoxaluria induced apoptotic changes and crystal deposition in renal tubular epithelium in rat model. 60 male wistar rats were divided into three different groups (each group n: 20). In Group I severe hyperoxaluria was induced by ethylene glycol (EG) (0.75%) administration for 28 days. In Group II, in addition to hyperoxaluria induction, animals were treated with Tutukon for 28 days. Group III animals constituted the controls without any specific medication and/or intervention. While the presence and degree of crystal deposition in the tubular lumen were examined histopathologically under light microscopy, tubular apoptotic changes were evaluated using immunohistochemical staining for cysteine-aspartic acid protease-3 (Caspase-3) and tumor necrosis factor alpha (TNF-α) positivity on days 14 and 28, respectively. Evaluation of apoptotic changes by Caspase-3 positivity showed that while the majority of animals undergoing EG only showed evident apoptotic changes (n: 9), Tutukon application demonstrated a significant limitation with limited or no apoptosis (n: 7) in these animals. Similar data were noted for TNF alpha expression; while apoptotic changes were evident in 8 (80%) in Group I animals, limited changes were noted in Tutukon Group (n: 2). Regarding crystal deposition despite evident changes in Group I (9 animals), like apoptotic alterations, it was again significantly limited in animals receiving Tutukon (4 animals). Renal tubular crystal deposition and apoptotic changes induced by hyperoxaluria play a role in the pathogenesis of urolithiasis and the limitation of these changes might be instituted by Tutukon as a result of its antioxidant and antiinflammatory effects.

Alta frecuencia de variación de la secuencia de la mutación E148Q en niños con fiebre mediterránea familiar en el sureste de Turquía / High frequency of E148Q sequence variation in children with familial Mediterranean fever in southeast Turkey

Objetivo: El objetivo de este estudio fue investigar el espectro de las mutaciones genéticas localizadas en el gen de la fiebre mediterránea (MEFV) y la correlación entre el genotipo y el fenotipo en niños con fiebre mediterránea familiar (FMF) en el sureste de Turquía. Métodos: En el estudio se incluyeron 507 niños (274 eran de sexo femenino) con FMF y mutaciones genéticas localizadas en el gen MEFV. Se realizó una evaluación retrospectiva de 15 años; y se analizaron los siguientes parámetros: edad, sexo, edad al inicio de los síntomas, edad al diagnóstico de la FMF, demora entre el inicio de los síntomas y el diagnóstico, síntomas de ataque de la FMF y respuesta a la colchicina. Se calcularon los índices de severidad de la enfermedad y se realizó el análisis de la mutación del genMEFV mediante PCR en tiempo real para las seis mutaciones más frecuentes. Con el fin de aportar homogeneidad, se excluyeron los niños con comorbilidades o con un resultado negativo en las pruebas de mutaciones del gen MEFV. Resultados: Se encontró que el 60,2% (n= 305) de los pacientes tenían antecedentes familiares. Los síntomas más frecuentes que manifestaron durante los ataques de FMF fueron dolor abdominal (98,0%), fiebre (93,9%) y artralgia (47,3%); el 75,0% de los pacientes (n= 380) eran heterocigotos; el 14,2% homocigotos (n= 72) y el 10,8% heterocigotos compuestos (n= 55). Se identificaron las siguientes mutaciones en los alelos del gen MEFV: E148Q (40,1%), M694V (25,9%), V726A (15,8%), R761H (7,4%), M680I (6,8%), y P369S (4,1%). En el subgrupo M694V se observó una edad media más joven de inicio de la enfermedad y un puntaje medio más alto de gravedad de la enfermedad, mientras que el grupo E148Q tuvo un inicio medio de enfermedad más tardío y un puntaje medio más bajo de severidad de la enfermedad (p <0,05). Conclusión: La frecuencia más alta de la mutación E148Q y la enfermedad más leve en la evolución de la FMF en la población de nuestro estudio quizás se deba a las diferencias étnicas del sureste de Turquía.

Objective: The aim of this study was to investigate the spectrum of Mediterranean fever (MEFV) gene mutations and genotype-phenotype correlation in children with familial Mediterranean fever (FMF) in southeast Turkey. Methods: A total of 507 children (274 females) with FMF and MEFV gene mutation(s) were included. A 15-year retrospective evaluation was conducted; parameters analyzed were: age, sex, age at symptoms onset, age at FMF diagnosis, delay between symptoms onset and diagnosis, FMF attack symptoms, and response to colchicine. Disease severity scores were calculated and MEFV mutation analysis was performed via real-time PCR for the 6 most frequent mutations. Children with comorbid diseases or tested negative for MEFV gene mutations were excluded to provide homogeneity. Results: A family history of FMF was found in 60.2% (n= 305) of patients. The most common symptoms reported for FMF attacks were abdominal pain (98.0%), fever (93.9%) and arthralgia (47.3%); 75.0% of patients (n= 380) were heterozygous, 14.2% were homozygous (n= 72) and 10.8% were compound heterozygous (n= 55).The following MEFV gene mutation alleles were identified: E148Q (40.1%), M694V (25.9%), V726A (15.8%), R761H (7.4%), M680I (6.8%), and P369S (4.1%). The M694V subgroup had the lowest mean age of disease onset and the highest mean disease severity score, whereas the E148Q group had later mean disease onset and the lowest mean disease severity score (p<0.05). Conclusion: The highest E148Q mutation frequency and milder disease in the course of FMF in our study population may be due to geographic and ethnic background dissimilarities of southeast Turkey.

Does metabolic syndrome increase the risk of infective complications after prostate biopsy? A critical evaluation.

PURPOSE: To evaluate the possible association between metabolic syndrome (MetS) and infectious complications after prostate biopsy. METHODS: A total of 480 men underwent prostatic biopsy due to elevated prostate-specific antigen levels and/or abnormal digital rectal examination. Patients were divided into two subgroups with respect to the presence or absence of MetS. Patients in both groups were closely followed with respect to infectious complications after biopsy and the possible effect of MetS as a certain risk factor on these complications was evaluated with a multivariate analysis. RESULTS: Infectious complications were observed in 33 cases (6.8%), while urinary tract infection (UTI) was detected in 30 (6.2%) cases, sepsis occurred in three (0.6%) cases. The percentage of the cases with infectious complications was 11.0 and 3.4% in men with and without MetS, respectively (p = 0.002). These rates were 3.7 versus 1.5%, respectively, for UTI (p < 0.003) and 0.9 versus 0.4%, respectively, for sepsis in both groups (p = 0.594). Multivariate analysis of the data confirmed that MetS was associated with an increased risk of infective complications (odds ratio 3.44 and 95% CI 1.56-7.58, p < 0.002) after this procedure. CONCLUSIONS: MetS could pose a certain increased risk for infectious complications after prostate biopsy. Patients with MetS should be considered as risk cases for this procedure, and they should be evaluated and followed in a very close manner with respect to these complications.

Acoustic radiation force impulse (ARFI) elastography for detection of renal damage in children.

BACKGROUND: Acoustic radiation force impulse (ARFI) imaging is a promising method for noninvasive evaluation of the renal parenchyma. OBJECTIVE: To investigate the contribution of ARFI quantitative US elastography for the detection of renal damage in kidneys with and without vesicoureteral reflux (VUR). MATERIALS AND METHODS: One hundred seventy-six kidneys of 88 children (46 male, 42 female) who had been referred for voiding cystourethrography and 20 healthy controls were prospectively investigated. Patients were assessed according to severity of renal damage on dimercaptosuccinic acid (DMSA) scintigraphy. Ninety-eight age- and gender-matched healthy children constituted the control group. Quantitative shear wave velocity (SWV) measurements were performed in the upper and lower poles and in the interpolar region of each kidney. DMSA scintigraphy was performed in 62 children (124 kidneys). Comparisons of SWV values of kidneys with and without renal damage and/or VUR were done. RESULTS: Significantly higher SWV values were found in non-damaged kidneys. Severely damaged kidneys had the lowest SWV values (P < 0.001). High-grade (grade V-IV) refluxing kidneys had the lowest SWV values, while non-refluxing kidneys had the highest values (P < 0.05). Significant negative correlations were found between the mean quantitative US elastography values and DMSA scarring score (r = -0.788, P < 0.001) and VUR grade (r = -0.634, P < 0.001). SWV values of the control kidneys were significantly higher than those of damaged kidneys (P < 0.05). CONCLUSION: Our findings suggest decreasing SWV of renal units with increasing grades of vesicoureteric reflux, increasing DMSA-assessed renal damage and decreasing DMSA-assessed differential function.

The importance of Internet usage for urologic patients.

OBJECTIVES: To evaluate Internet usage frequency, rate of searched diseases and impact of Internet derived data on future patient physician relationship in patients applying to an Urology Department. METHODS: A well prepared questionnaire has been given to 1000 referring cases, out of which 589 accepted to participate on a volunteer basis to a face to face interview. Patients were divided into subgroups with respect to age, gender and as well as their educational and economical status. Regarding Internet, questions inquired the use of Internet, the point of view about it, opinions about healthcare system and most commonly urological diseases searched in Internet. RESULTS: Of 589 patients participating, 38.2% reported access to the Internet; in relation to subgroup analysis of data, there was a statistically significant relationship between the use of Internet and age (p < 0.001), gender (p = 0.048), educational status (p < 0.001) and economical status of (p = 0.002) the cases evaluated. Disease specific information was most frequently sought: 18.2% searched for urolithiasis, 14.2% for non-cancer related kidney diseases, and 14.2% for urologic cancers. CONCLUSIONS: Younger patients with higher educational status tended to use Internet and the majority of these cases share all these information with their physicians during their visit. These findings indicate that all physicians should consider this fact seriously and make their future plans in the light of internet based activities which provides numerous advantages.

Cystic fibrosis of pancreas and nephrotic syndrome: a rare association.

Cystic fibrosis (CF) is a genetic disease with autosomal recessive inheritance and is common in Caucasian people. The prevalence of this disease is between 1/2,000 and 1/3,500 live births, and the incidence varies between populations. Although the CF transmembrane conductance regulator gene is expressed in the kidneys, renal involvement is rare. With advances in the treatment of CF, life expectancy has increased, and some previously unobserved disease associations are now seen in patients with CF. It is important to follow patients with CF for possible abnormalities that may accompany CF. In this paper, we present two rare cases of CF accompanied by nephrotic syndrome.

Simple preoperative parameters to assess technical difficulty during a radical perineal prostatectomy.

PURPOSE: We aimed to propose a practical selection method predicting the easier radical perineal prostatectomy (RPP) cases before the operation. METHODS: Fifty sequential RPP cases were divided into two groups according to the estimated difficulty of the operation (Group I: Easier, Group II: Difficult) which was assessed by using a RPP difficulty scale, constituted by three parameters (operation time, blood loss, and the judgment of the surgeon) each ranging between 1 and 3 points. As the localization parameters, skin-to-prostatic apex (SPAD) and skin-to-prostatic base (SPBD) distances and distance between bilateral ischial tuberosities (ITD) were measured. During suprapubic ultrasonography, a probe-divergence angle (PDA) and prostate volumes (PV) were recorded. These parameters were compared between the groups. RESULTS: In Group I (n = 29) and Group II (n = 21), the difficulty scores were 4.37 (3-5) and 6.80 (6-9), respectively. Data of age, clinical stages, and findings of digital rectal examination were not different between groups. While SPBD, SPAD, and ITD values were found similar (p > 0.05), PDA and PV were significantly different. PDA was > 45 degree in 21 cases in Group I (72.4 %) and in 7 cases in Group II (33.3 %) (p = 0.011). The mean of PV was 37.4 (20-60) cc and 49.9 (30-75) cc in Group I and Group II, respectively (p = 0.001). CONCLUSIONS: While planning RPP operations, by selecting the prostate cancer cases with a prostate of low volume and localized deeper in the pelvis during suprapubic ultrasonography, urologists may have a chance to perform this technique more easily during the learning period.