Machine learning based assessment of preclinical health questionnaires.

BACKGROUND: Within modern health systems, the possibility of accessing a large amount and a variety of data related to patients' health has increased significantly over the years. The source of this data could be mobile and wearable electronic systems used in everyday life, and specialized medical devices. In this study we aim to investigate the use of modern Machine Learning (ML) techniques for preclinical health assessment based on data collected from questionnaires filled out by patients. METHOD: To identify the health conditions of pregnant women, we developed a questionnaire that was distributed in three maternity hospitals in the Mureș County, Romania. In this work we proposed and developed an ML model for pattern detection in common risk assessment based on data extracted from questionnaires. RESULTS: Out of the 1278 women who answered the questionnaire, 381 smoked before pregnancy and only 216 quit smoking during the period in which they became pregnant. The performance of the model indicates the feasibility of the solution, with an accuracy of 98 % confirmed for the considered case study. CONCLUSION: The proposed solution offers a simple and efficient way to digitize questionnaire data and to analyze the data through a reduced computational effort, both in terms of memory and computing power used.

Investigating the Impact of Two Major Programming Environments on the Accuracy of Deep Learning-Based Glioma Detection from MRI Images.

Brain tumors have been the subject of research for many years. Brain tumors are typically classified into two main groups: benign and malignant tumors. The most common tumor type among malignant brain tumors is known as glioma. In the diagnosis of glioma, different imaging technologies could be used. Among these techniques, MRI is the most preferred imaging technology due to its high-resolution image data. However, the detection of gliomas from a huge set of MRI data could be challenging for the practitioners. In order to solve this concern, many Deep Learning (DL) models based on Convolutional Neural Networks (CNNs) have been proposed to be used in detecting glioma. However, understanding which CNN architecture would work efficiently under various conditions including development environment or programming aspects as well as performance analysis has not been studied so far. In this research work, therefore, the purpose is to investigate the impact of two major programming environments (namely, MATLAB and Python) on the accuracy of CNN-based glioma detection from Magnetic Resonance Imaging (MRI) images. To this end, experiments on the Brain Tumor Segmentation (BraTS) dataset (2016 and 2017) consisting of multiparametric magnetic MRI images are performed by implementing two popular CNN architectures, the three-dimensional (3D) U-Net and the V-Net in the programming environments. From the results, it is concluded that the use of Python with Google Colaboratory (Colab) might be highly useful in the implementation of CNN-based models for glioma detection. Moreover, the 3D U-Net model is found to perform better, attaining a high accuracy on the dataset. The authors believe that the results achieved from this study would provide useful information to the research community in their appropriate implementation of DL approaches for brain tumor detection.

Vision transformer and explainable transfer learning models for auto detection of kidney cyst, stone and tumor from CT-radiography.

Renal failure, a public health concern, and the scarcity of nephrologists around the globe have necessitated the development of an AI-based system to auto-diagnose kidney diseases. This research deals with the three major renal diseases categories: kidney stones, cysts, and tumors, and gathered and annotated a total of 12,446 CT whole abdomen and urogram images in order to construct an AI-based kidney diseases diagnostic system and contribute to the AI community's research scope e.g., modeling digital-twin of renal functions. The collected images were exposed to exploratory data analysis, which revealed that the images from all of the classes had the same type of mean color distribution. Furthermore, six machine learning models were built, three of which are based on the state-of-the-art variants of the Vision transformers EANet, CCT, and Swin transformers, while the other three are based on well-known deep learning models Resnet, VGG16, and Inception v3, which were adjusted in the last layers. While the VGG16 and CCT models performed admirably, the swin transformer outperformed all of them in terms of accuracy, with an accuracy of 99.30 percent. The F1 score and precision and recall comparison reveal that the Swin transformer outperforms all other models and that it is the quickest to train. The study also revealed the blackbox of the VGG16, Resnet50, and Inception models, demonstrating that VGG16 is superior than Resnet50 and Inceptionv3 in terms of monitoring the necessary anatomy abnormalities. We believe that the superior accuracy of our Swin transformer-based model and the VGG16-based model can both be useful in diagnosing kidney tumors, cysts, and stones.

Comparison of spermiograms of infertile men before and during the COVID-19 pandemic

SUMMARY OBJECTIVE: Since the start of the COVID-19 pandemic, there has been interest in the impact of both SARS-CoV-2 infection and pandemic-induced social restrictions on male reproductive health. This study aimed to evaluate the spermiogram values of men who presented for infertility during the pandemic compared with the previous 2 years. METHODS: Patients who presented to a urology outpatient clinic for the first time due to infertility were included. The patients' age, semen volume, and spermiogram results were recorded. Based on the presentation date, the patients were divided into prepandemic group 1 (March 2018-February 2019), prepandemic group 2 (March 2019-February 2020), and pandemic group (March 2020-February 2021) for comparison. RESULTS: A total of 594 patients were included. There was no significant difference between the three groups in terms of the number of patients who presented for infertility (207, 190, and 197 patients, respectively; p=0.691). The mean age was 36.6±7.2 in the prepandemic group 1, 35.5±7.1 in the prepandemic group 2, and 33.1±6.3 in the pandemic group. Patients who presented during the pandemic were significantly younger (p<0.001). There were no differences between the groups in terms of semen volume (p=0.910) or rates of normospermia and pathological spermiogram findings (p=0.222). CONCLUSIONS: In the first year of the COVID-19 pandemic, there was no significant difference in the number of patients who presented for infertility or in their spermiogram results compared with 2018 and 2019. However, it is noteworthy that the patients were significantly younger during the pandemic than in the previous 2 years.

Prognostic value of HPV DNA in Urothelial Carcinoma of the Bladder: A Preliminary Report of 2-Year Follow-up Results.

PURPOSE: The association between the human papillomavirus (HPV) and anogenital carcinomas is well established. However, despite its anatomic adjacency, the relationship between HPV and urothelial carcinoma of the bladder (UCB) is less clear. Recent meta-analysis and case-control studies demonstrated a significant relationship between the presence of HPV DNA and UCB. The aim of this clinical study was to compare the 2-year follow-up results of HPV-positive and HPV-negative UCB patients to evaluate the prognostic value of HPV DNA positivity in UCB. METHODS: The study included patients with stage pTa and pT1 UCB who underwent polymerase chain reaction (PCR) analysis of HPV DNA between January 1 and November 30, 2018. Based on their PCR results, 19 HPV-positive and 38 HPV-negative UCB patients who had regular follow-up in our clinic were evaluated in terms of tumor recurrence and disease progression over a 2-year follow-up period. RESULTS: There was no significant difference between the groups in terms of age, follow-up time, smoking, or tumor grade (P= .576, P= .368, P= .080, and P= .454). Tumor recurrence was observed at least once in 47.3% (n=9) of the 19 HPV-positive patients and 36.8% (n=14) of the 38 HPV-negative patients (P= .445). There was no difference in disease progression between the groups during follow-up. CONCLUSION: In our sample of UCB patients, the presence of HPV DNA was associated with a trend toward higher recurrence rate during the 2-year follow-up, though the difference was not statistically significant. No difference in disease progression was observed based on HPV DNA positivity.

HPV infection in urology practice.

Human papillomavirus (HPV) is the most common pathogen of sexually transmitted disease worldwide. While HPV is responsible for low-grade benign lesions in the anogenital area such as condyloma acuminatum, it is also strongly associated with cervical, anal, vulvar/vaginal, and penile carcinomas. In addition to being an oncogenic virus, HPV causes a substantial socioeconomic burden due to the recurrence of benign lesions, the lack of a definitive treatment option that provides a complete cure, and the high cost of treatment. The global incidence of HPV infection is rising, especially among young and sexually active individuals; as a result, in recent years these infections have also become increasingly conspicuous in urology practice, both as incidental findings and primary complaints. The aim of this review is to evaluate the pathogenesis, diagnosis, and treatment modalities of HPV infections in light of the current literature from the urologist's perspective.

Is There any Association between Urothelial Carcinoma of the Bladder and Human Papillomavirus? A Case-Control Study.

OBJECTIVES: Human papillomavirus (HPV) is a well-known oncogenic virus associated with anogenital carcinomas. Despite the anatomical proximity of the bladder and the anogenital region, the relationship between HPV and urothelial carcinoma of the bladder (UCB) is still a controversial issue. This study aimed to test the urethral swabs and first-void urine samples of patients with UCB for HPV-Deoxyribonucleic acid (DNA) using polymerase chain reaction (PCR) assay and to compare the results with a control group. MATERIALS AND METHODS: Sixty-nine patients who were diagnosed with UCB between January and December 2018 were included in this case-control study. Sixty-nine patients who visited the urology outpatient clinic for non-oncological reasons within the study period were designated as the control group. Urethral swab and first-void morning urine samples were collected from each patient. HPV-DNA presence was investigated using a PCR kit that can detect a total of 22 HPV genotypes, of which 18 are high-risk and 3 are low-risk genotypes. RESULTS: The mean age of the patients included in the study was 63.2 ± 12.6 years and the male to female ratio was 5.3. HPV-DNA was detected in 28.9% (20/69) of the patients in the case group and in 8.7% (6/69) of the patients in the control group. HPV-DNA positivity was significantly higher in the case group (OR 4.24; 95% CI 1.63-12.34). No statistically significant relationship was found between HPV-DNA positivity and tumor grade (p = 0.36). CONCLUSION: A statistically significant relationship exists between HPV infection and UCB, regardless of the tumor grade.

Glutathione S-transferase M1 and T1 genotypes and myocardial infarction.

Myocardial infarction (MI), which is the most important manifestation of coronary artery disease, is the leading cause of morbidity and mortality in the world. Glutathione S transferases (GSTs) are enzymes responsible for the metabolism of numerous xenobiotics and are known to be polymorphic in humans. We investigated the association between the GSTM1 and GSTT1 gene polymorphisms and MI. The study consists of 296 healthy controls and 324 consecutive patients who had undergone coronary angiography for suspicion of coronary artery disease and with a past history of myocardial infarction. DNA was extracted from whole blood of patient and control. GSTM1 and GSTT1 gene polymorphisms were examined using multiplex PCR. We found that the null GSTM1 was associated with protective effect on MI, although this increase was not significant for GSTM1 (p < 0.054). However, GSTT1 genotype was associated with an increase in the risk of developing MI. In addition to after adjusting other all coronary risk factors, the interactive effect of GSTT1 null genotype remained statistically significant (p < 0.001) for MI disease but GSTM1 null genotype was not statistically significant. Patients, who smoke having the null genotypes of GSTM1, were at a higher risk for developing MI (p < 0.001, OR = 0.41, 95 % CI = 0.240-0.207). There was an effect of interaction of GSTM1 null genotype and smoking on MI development between patient and control groups (p < 0.001). Our results showed that individuals with the null genotypes for GSTM1 had protective effect, while GSTT1 was at a higher risk for MI disease. In addition, there was additional effects of smoking when smoking and non-smoking groups were compared.

Percutaneous treatment of simple renal cysts with n-butyl cyanoacrylate and iodized oil.

PURPOSE: The aim of this study was to demonstrate the efficacy of n-butyl cyanoacrylate (NBCA) and iodized oil mixture in treatment of simple renal cysts. MATERIALS AND METHODS: Twenty-three patients with 27 symptomatic or large ( > 3 cm) simple cysts were treated by computed tomography (CT)-guided percutaneous aspiration and injection of NBCA and iodized oil mixture. The patients (17 men and 6 women, mean age, 57.2 +/- 10.5 years) were treated with as out-patients. The volume of the treated cysts was calculated with periodic noncontrast enhanced CT examinations 1 and 6 months after the procedure. The procedure was considered successful during follow-up when the diameter of the cyst was measured less than 50% of the initial diameter in CT . RESULTS: The sclerotherapy was technically successful in all patients. The diameter of the cysts ranged between 3.5 and 8 cm (mean, 5.6 +/- 1.3 cm), and 1 and 3.4 cm (mean, 2.1 +/- 0.6 cm) before and after sclerotherapy, respectively (P < 0.001). Average diameter reduction was 62.5% during the follow-up period. The mean follow- up lasted 9.1 months (6-14 months). Flank pain resolved in 20 of 23 symptomatic patients (87%). In three patients, the symptoms decreased slightly. At follow-up CT, the procedure was successful in 25 of 27 cysts (93%). We did not observe any complications related to the procedure. CONCLUSION: Percutaneous sclerotherapy with NBCA and iodized oil mixture was found to be a simple, safe, effective, well tolerated alternative technique for management of simple renal cysts.

The effect of coronary revascularization on new-onset complete atrioventricular block due to acute coronary syndrome.

BACKGROUND: Coronary artery disease is one of the most common causes of complete atrioventricular block (AVB) in adults. In this study, we evaluated whether prompt revascularization of the coronary artery occlusion can ameliorate new-onset complete AVB due to acute coronary syndrome (ACS). METHODS: Five patients (4 men and 1 woman) with a mean age of 69.8+/-7.1 years with diagnosed new-onset complete AVB and proven coronary artery disease were enrolled in the study. At the time of AVB diagnosis, 3 of the patients had acute myocardial infarction, and the other 2 patients had unstable angina pectoris. All patients underwent complete coronary bypass surgery after the diagnosis of complete AVB. A patient who underwent 2 coronary bypasses also underwent aortic valve replacement. RESULTS: No mortality was observed in the study group. All but one of the patients converted back to sinus rhythm after a mean interval of 30+/-13.6 hours following revascularization procedures. Complete AVB persisted in 1 patient, and a permanent pacemaker was implanted. All patients were discharged uneventfully. The mean hospital stay was 11.4+/-4.5 days. All patients are still being followed up after surgery; at a mean follow-up of 27.4+/-0.9 months, there have been no further problems. CONCLUSION: Coronary revascularization may ameliorate ACS-related new-onset complete AVB with an acceptable rate of successful reversion to sinus rhythm. An especially appropriate time for surgery, complete coronary revascularization, and management of myocardial protection during surgery might improve the results of coronary bypass procedures in these patients.

[The effect of nondipper blood pressure pattern on target organ damage in patients with metabolic syndrome]. / Metabolik sendromlu hastalarda nondipper kan basinci seyrinin hedef organ hasari üzerine etkisi.

OBJECTIVES: Both metabolic syndrome (MetS) and nondipping status (insufficient reduction in nocturnal blood pressure) have been linked with target organ damage. We evaluated the effect of nondipping status on target organ damage in subjects with MetS. STUDY DESIGN: Eighty-two patients diagnosed as having MetS were divided into two groups according to the findings of 24-hour ambulatory blood pressure monitoring as dipper (n=35, 19 women, 16 men; mean age 48.4+/-6.4 years) and nondipper (n=47, 35 women, 12 men; mean age 50.4+/-4.7 years). Cardiac damage was assessed by conventional and tissue Doppler echocardiography, and renal damage by 24-hour urinary albumin excretion. RESULTS: The two groups were similar with regard to age, body mass index, presence of diabetes, smoking, clinical and 24-hour, daytime and nighttime blood pressures, plasma lipid profile, distribution of and the mean total number of MetS criteria. The ratio of early (Em) to late (Am) left ventricular peak diastolic myocardial velocities (Em/Am) was significantly lower in nondippers (p=0.016). Nondippers also had higher values of left ventricular mass index, myocardial performance index, and 24-hour urinary albumin excretion, but these differences did not reach a significant level (p=0.110, p=0.099, p=0.093, respectively). Multivariate regression analysis showed increasing age and nondipping status as independent factors associated with decreased Em/Am ratio (beta=-0.25, p=0.020 and beta=-0.22, p=0.042, respectively). CONCLUSION: In subjects with MetS, nondipping status may be associated with both cardiac and renal damage independent of other components of MetS. Since the degree of diastolic dysfunction is more marked than that of albuminuria in nondippers, it may be extrapolated that the extent of cardiac damage surpasses renal damage in these subjects.

Comparison of increased aspirin dose versus combined aspirin plus clopidogrel therapy in patients with diabetes mellitus and coronary heart disease and impaired antiplatelet response to low-dose aspirin.

The effects of therapy with aspirin 300 mg/day and with combined aspirin 100 mg/day plus clopidogrel 75 mg/day on platelet function were compared in patients with diabetes mellitus and coronary artery disease and impaired antiplatelet responses to aspirin 100 mg/day. The study population consisted of 151 outpatients with type II diabetes mellitus and coronary artery disease who were taking aspirin 100 mg/day. Of the 151 patients, a subgroup of subjects with impaired aspirin response were selected on the basis of the results of platelet aggregometry. Nonresponsiveness to aspirin was defined as mean aggregation > or =69% with 3 micromol/L adenosine diphosphate and mean aggregation > or =70% with 2 micromol/L collagen. Aspirin semiresponders were defined as meeting 1 but not both of these criteria. Nonresponders and semiresponders were randomized equally to aspirin 300 mg/day and aspirin 100 mg/day plus clopidogrel 75 mg/day, and aggregation tests were repeated after 2 weeks. Sixty of the 151 patients with diabetes (40%) were found to respond to aspirin inadequately. Platelet aggregation induced by adenosine diphosphate and collagen decreased significantly after aspirin 300 mg/day or combined therapy. Combined treatment was found to have a stronger inhibitory effect on platelet aggregation induced by adenosine diphosphate than aspirin 300 mg/day (p = 0.002). Impaired aspirin response was resolved by increasing the aspirin dose or adding clopidogrel to aspirin (p <0.0001 for each). However, desired platelet inhibition was achieved in significantly more patients by combined treatment than by aspirin 300 mg/day (p <0.05). In conclusion, aspirin 100 mg/day does not inhibit platelet function adequately in a significant number of patients with diabetes mellitus and coronary artery disease. Increasing the aspirin dose to 300 mg/day or adding clopidogrel to aspirin can provide adequate platelet inhibition in a significant number of those patients with impaired responses to low-dose aspirin.

Surgical treatment of postinfarction pseudoaneurysms of the left ventricle.

BACKGROUND: Left ventricular pseudoaneurysm is a rare and frequently fatal complication of acute myocardial infarction. It occurs as a consequence of rupture of the ventricular free wall that gets confined by a portion of the pericardium. The purpose of this study was to present our surgical experience of postinfarction left ventricular pseudoaneurysms and to evaluate mid-term results. METHODS: The study population comprised five symptomatic patients diagnosed with left ventricular pseudoaneurysm and treated surgically in a short period of time. There were three males and two females. The mean age of the patients was 66.8 +/- 10.8 years. The diagnosis was made initially by echocardiography and subsequently confirmed by angiography. An additional cardiac magnetic resonance imaging study was performed in three patients. Surgical resection of the pseudoaneurysm was combined with an endoaneurysmorrhaphy procedure in all patients. Associated cardiac operations were performed in three patients. Definitive diagnosis of pseudoaneurysm was confirmed by histopathological evaluation of the excised wall in all patients. RESULTS: All patients survived the operation and were discharged to home care. The mean duration of hospital stay was 11.6 +/- 4.6 days. Patients were either in class I or II of New York Heart Association classification at discharge. All patients are still being followed after surgery with a mean follow-up period of 10.4 +/- 6.6 months with no further problems. CONCLUSION: Surgical repair is indicated in left ventricular pseudoaneurysm as it carries a high risk of rupture and sudden cardiac death. Surgical repair combined with an endoaneurysmorrhaphy procedure carries a low mortality risk and improves functional capacity.

Comparison of antioxidant enzyme activity in the internal spermatic vein and brachial veins of patients with infertile varicocele.

AIM: Recent studies have shown that both oxidative and reductive stresses are present within the internal spermatic vein of patients with varicocele. The aim of this study was to compare the activities of antioxidant enzymes in the internal spermatic vein and brachial vein of patients with varicocele. METHODS: Fifteen primary infertile varicocele patients and ten normal-nonvaricocele-fertile control subjects participated in this study. The patients and subjects were first given a physical and color doppler examination, and then whole blood samples were drawn from the brachial vein and a dilated internal spermatic vein during surgery. Superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) enzyme activities were assessed by enzymatic methods, and the results were compared using the Mann-Whitney U test. RESULTS: The activity of SOD in the internal spermatic veins and brachial veins of patients with varicocele was 60.17+/-2.15 and 42.10+/-1.60 U/g protein, respectively; that of GSH-Px was 5.44+/-0.14 and 3.92+/-0.14 U/g protein, respectively. The results were statistically significant (P<0.05). In the control group, the activity of SOD in the internal spermatic veins and brachial veins was 43.12+/-1.80 and 40.01+/-2.10 U/g protein, respectively; that of GSH-Px was 3.35+/-0.20 and 3.7+/-0.10 U/g protein, respectively (P>0.05). CONCLUSIONS: Increased antioxidant enzyme activity in the internal spermatic vein may be due to increased oxidative stress in the internal spermatic vein: the increase in antioxidant enzyme activity may be a response to offset the toxic actions of reactive oxygen species. Further studies are needed to confirm this suggestion.

Influence of menstrual cycle on cardiac performance.

OBJECTIVES: The purpose of this study was to investigate the relationship between endogen sex hormone levels and myocardial performance in two different phases of menstrual cycle. BACKGROUND: The relationships between cardiac performance and sex hormone levels in menstrual cycle have not yet been clearly identified. METHODS: Twenty-seven women at the age of 19-42 years (mean 24.11+/-6.02) with regular menstrual cycles (28-31 days) were enrolled in this study. Cardiac performance was evaluated by tissue Doppler imaging (TDI) derived myocardial performance index (MPI) in the menstrual and the luteal phases of the menstrual cycle. RESULTS: Left ventricular MPI were statistically significant between the menstrual phase and luteal phase of the menstrual cycle (Inferior 0.53+/-0.10 versus 0.44+/-0.09, P<0.001; Anterior 0.54+/-0.13 versus 0.45+/-0.10, P<0.008; Lateral 0.50+/-0.09 versus 0.44+/-0.12, P<0.03; Septum 0.54+/-0.07 versus 0.46+/-0.10, P<0.005; Global 0.52+/-0.06 versus 0.44+/-0.09, P<0.001). Right ventricle MPI between the two periods was also significantly different (0.49+/-0.10 versus 0.42+/-0.10, P<0.01). There was a moderate correlation between estrogen levels and global MPI (r=0.46, P=0.001), but no correlation was found between progesterone levels and global MPI (r=0.22, P=NS). CONCLUSION: We firstly demonstrated that endogen estrogen or progesterone improved the combined systolic and diastolic function in both left and right ventricle during luteal phases of menstrual cycle. Considering the previous studies and our results, estrogen may be responsible for this improvement.

Sympathetic skin responses in Type-1 diabetic children: relationship to urodynamic findings.

AIMS: Cystopathy is an important problem in diabetes mellitus (DM) when diabetes is not well-controlled. In most cases of diabetic csytopathy, autonomic involvement is responsible, which develops insidiously over a long time. We investigated the hand and genital sympathetic skin responses (SSRs) and its relation to urodynamic abnormalities in this group of patients. METHODS: We performed hand and genital SSRs in 24 children with Type-1 DM, whose hemoglobin A1C values were above normal limits. We also recruited 19 healthy children for SSRs measurements. Cystometry was performed in 24 children with Type-1 DM. Based on cystometry findings, these children were classified into two groups as normal (n:6) and abnormal (n:18). The amplitude and latency of hand and genital SSRs of 24 children with Type-1 DM and 19 healthy children were compared. RESULTS: Hand and genital SSRs were obtained from all of the diabetic and healthy children. The mean genital SSRs amplitude in diabetic children was significantly lower than the controls. There was no difference in the mean values of all investigated parameters between the normal group and controls. When compared to the controls, there was prolonged latency and decreased amplitude of genital SSRs and decreased hand SSRs amplitude in abnormal group. CONCLUSIONS: SSR is a non-invasive test for the evaluation of autonomic sympathetic involvement. Our study revealed differences in genital SSR before the manifestations of cystopathy. Children with abnormal urodynamic findings had changes in both hand and genital SSRs. These findings suggest that SSR tests may have a place in the evaluation of diabetic cystopathy in the early asymptomatic period.

Urothelial carcinoma featuring lipid cell and plasmacytoid morphology with poor prognostic outcome.

An aggressive urothelial carcinoma classified as lipid cell variant with plasmacytoid features was diagnosed in a 67-year-old man. His overall survival was 18 months after limited surgery followed by chemotherapy. The histopathologic features were the same in the recurrences.

Validation of 2001 Partin tables in Turkey: a multicenter study.

OBJECTIVE: Although Partin tables were developed in United States to predict the stage of prostate cancer preoperatively, they are used by many clinics throughout the world assuming that these figures apply to their population as well. However the predictive value of current Partin tables, which was updated in 2001, has not been validated in most of the countries as well as in Turkey. Therefore, we evaluated the validity of 2001 Partin tables, for the ability to predict the pathological stage in Turkish patients. PATIENTS AND METHODS: The clinical and pathological findings of 1043 patients who have had radical prostatectomy were assessed. Serum PSA values, clinical stage, biopsy Gleason score and the pathological features of the radical prostatectomy specimens were collected from each clinic and evaluated. The predictive value of Partin nomogram and pathological findings of prostatectomy specimens were compared and analyzed according to Receiver Operating Characteristics (ROC) analysis. RESULTS: Median age of the patients was 60 (45-74). In the presented study, percentage of patients with clinical stage T1c was 43%. Patients with Gleason score of 2-4 in biopsy constituted 23.4% of the study group. In the present study, the ratio of the patients with serum PSA higher than 10 ng/ml was 39.6%. Organ confined disease, seminal vesicle involvement, lymph node metastases ratios were 64.7%, 10.3%, 1.8% respectively. Area Under Curve (AUC) values for organ confined disease, seminal vesicle involvement and lymph node involvement were calculated as 0.665, 0.733 and 0.759 respectively. CONCLUSION: It appears that Partin tables have a reasonable predictive value for the final pathological features like organ confined disease, seminal vesicle and lymph node involvement in Turkish patients. This multicenter study showed that current Partin tables could also be used in Turkish patients with comparable accuracy.

Bilateral disruption of corpus cavernosum with complete urethral rupture.

Penile fracture is a relatively rare condition. We report an unusual case of the bilateral disruption of the corpus cavernosum with complete urethral rupture resulting from blunt trauma during sexual intercourse. The subject underwent emergency surgery with preservation of erectile and voiding functions in the follow-up.

Percutaneous nephrolithotomy for pediatric stone disease--our experience with adult-sized equipment.

OBJECTIVE: We evaluated the outcomes and complications of percutaneous nephrolithotomy (PNL) operations performed in pediatric patients using adult-sized surgical equipment at our center. MATERIAL AND METHODS: The medical and surgical records of 23 children who underwent a total of 25 PNL operations using 24 or 26 F rigid nephroscopes were evaluated retrospectively. The following aspects were considered: stone burden; duration of surgery and complications; details concerning recovery, success, residual fragments and auxiliary procedures; and follow-up details. RESULTS: The success rate of a single PNL session was 70.8%; with the use of auxiliary procedures this was increased to 91.6%. Perioperative and early postoperative complications were excessive bleeding and transfusion in two patients, hydro-pneumothorax in one, perforation of the collecting system in three and urinoma in one. Complications were more common in children aged <7 years or with staghorn stones. The mean time to catheter removal was 3.4 days and the mean hospitalization time was 4.8 days. Idiopathic hypercalciuria, hypocitraturia, cystinuria and hyperoxaluria were diagnosed in two, two, one and three patients, respectively. CONCLUSION: Performing PNL with adult-sized equipment is associated with significant complications in children aged <7 years or with staghorn stones. This treatment should not be considered in routine clinical practice. As all stone-removal methods are associated with complications, PNL should be used only if other methods fail or are unavailable.