[Guillain-Barré syndrome caused by intravesical instillation of Bacillus Calmette-Guérin]. / Bacillus Calmette­Guérin intravesicalis instillációja által okozott Guillain­Barré-szindróma.

Introduction - Guillain-Barré syndrome (GBS) is an acute inflammatory demyelinating polyneuropathy. In the vast majority of patients, 1-4 weeks before the onset of GBS-related symptoms, an event such as upper respiratory tract or gastrointestinal tract infection, surgical intervention or vaccination is present. To the best of our knowledge, this is the first case of GBS that occurred after intravesical Bacillus Calmette-Guérin (BCG) therapy in the absence of tuberculosis or any other infection in the English literature.
Case report – A 65-year-old male patient, who had no systemic disorders except hypertension and coronary artery disease, underwent transurethral resection of a bladder tumour further to imaging studies investigating macroscopic haematuria. A pathologic examination revealed a non-muscle-invasive high-grade (pT1HG) transitional cell carcinoma. Immediately after the fourth cycle of intravesical BCG, which was administered 2 months after surgery, the patient experienced numbness and weakness in his lower and upper extremities, respectively. There were no signs or symptoms related to an acute cranial pathology or infectious disease. Nerve conduction studies, which were carried out on the 7th day after the onset of the neurologic symptoms, revealed a demyelinating sensorimotor polyneuropathy with mild secondary axonal damage in upper and lower limbs with a sural sparing pattern.
Conclusion - Without tuberculosis infection, GBS can occur secondary to increased immune response and antibodies triggered by intravesical BCG therapy. However, considering the worldwide use of BCG vaccination and thousands of intravesical BCG therapies, this is a very rare adverse effect. 

Effect of sexual arousal on semen parameters during abstinence.

Semen analysis and physical examination are performed while first evaluation for patients with male infertility. Alcohol, smoking and dietary habits can affect the semen parameters. This study aimed to evaluate whether semen parameters are changed with sexual arousal. After excluding, 100 patients with ages of 18-45 were included to the study. All semen analysis were performed with three days of sexual abstinence. An identified 20 min video link was determined to the patients and while the sexual abstinence were told to watch this video once a day; after 3 days abstinence semen analysis was examined again. In the detailed examination normal spermatozoa ratio (Tygerberg strict criteria), spermatozoa concentration, semen volume, total motility and progressive motility ratios were noted. When the two semen analysis from the same patient are compared, it was observed that all parameters did not change except semen volume and total motile sperm count (p < 0.001). In conclusion, to understand the effect of sexual arousal during the sexual abstinence, we need studies with high patient number and longer follow-up.

Correlation of the Grade Group of Prostate Cancer according to the International Society of Urological Pathology (Isup) 2014 Classification between Prostate Biopsy and Radical Prostatectomy Specimens.

ABTRACTWe aimed to assess the correlation between ISUP 2014 grades of needle biopsy (NB) and radical prostatectomy (RP) specimens and the parameters effecting this correlation. A total of 353 patients, who underwent a radical prostatectomy with diagnose of prostate cancer, were included in the study. Especially, the maximum percentage of core involved by cancer (MPCI) of upgraded group was significantly higher than those of correlated group and downgraded group. MPCI might be used as a preoperative value to determine risk classification and to help counsel patients with regard to treatment decision and prognosis of disease.

Prognosis of primary or metachronous prostate cancer in multiple primary genitourinary cancers; a single center experience with long-term results.

OBJECTIVE: This study aims to analyze the challenges, approaches and long-term results of primary or metachronous prostate cancer (PCa) in cases with multiple primary genitourinary cancers. METHODOLOGY: A total of 17 patients were included in the study. Patients with multiple primary genitourinary cancers were divided into two groups according to the diagnosis of primary or metachronous PCa as group 1 and group 2. RESULTS: The median age of patients was similar in both groups. The median smoking status (pack-years) was higher in group 2 than group 1. The median prostate-specific antigen (PSA) level was higher in group 1 than group 2. The median follow-up time from primary to the metachronous tumour was higher in group 1 than group 2. The rate of recurrence in PCa was higher in group 1 than group 2. No statistically significant difference was observed in terms of patients' age, smoking status, PSA levels at diagnosis of PCa and biochemical recurrence or metastasis between the two groups (p > 0.05). CONCLUSION: Primary PCa cases may progress more aggressively than metachronous PCa cases. Biochemical recurrence and metastasis may be less threatening in metachronous PCa cases than primary cases. Therefore, aggressive treatment can be avoided for metachronous PCa cases.

Is there any association of COVID-19 with testicular pain and epididymo-orchitis?

AIMS: This study aims to analyse the novel Coronavirus disease- (COVID-19) related testicular pain in hospitalised patients because of COVID-19 and to review as an aetiological factor for epididymitis, orchitis or both. METHODS: A total of 91 patients were included in the study. A questionnaire was formed for the questioning of testicular pain or epididymo-orchitis in patients with COVID-19. Demographics and past medical history was also recorded. Patients' neutrophil and lymphocyte counts, neutrophil-lymphocyte ratios (NLR), C-reactive protein (CRP) levels and D-dimer values were recorded. Patients with COVID-19 were divided into two groups according to absence or presence of testicular pain or epididymo-orchitis as group 1 and group 2. All results were compared for both groups. RESULTS: The median age of patients was similar in both groups. Testicular pain was occurred in 10.98% of the patients. Clinical presentation of epididymo-orchitis was diagnosed in only one patient. No statistically significant difference was reported in terms of patients' age, levels of CRP and D-Dimer or NLR and results of questionnaire form queries between the two groups (P > .05). CONCLUSION: Testicular pain was observed more frequently in hospitalised COVID-19 cases. While no inflammation marker which is related to predict of testicular pain or epididymo-orchitis was found in patients with COVID-19.

COVID-19 infection threat in patients with high-risk non-muscle invasive bladder cancer receiving intravesical BCG therapy.

AIM: We evaluated the COVID-19 infection threat in patients receiving intravesical BCG therapy which has immunotherapeutic effects and is of vital importance in most of the individuals with high-risk non-muscle-invasive bladder cancer (NMIBC) and investigated the need for postponement of this therapy. METHODS: A total of 71 patients, who were diagnosed with high-risk NMIBC and on intravesical BCG treatment regularly (induction or maintenance), were enrolled in the study. The patients were classified into two groups depending on whether they were diagnosed with COVID-19 during the pandemic period or not. RESULTS: Of 71 patients, 26 underwent a COVID-19 polymerase chain reaction test with clinical suspicion during the pandemic period. Of these 26 patients, 4 were diagnosed with COVID-19. Age of the patients, working status (working/retired), compliance with containment measures against the pandemic, number of BCG courses, adverse effects after BCG therapy and systemic immune-inflammation index, which is an inflammation-related parameter, were not different between groups (P > .05). Neutrophil/lymphocyte ratio was significantly higher in the COVID-19 positive group (P < .05). COVID-19 positivity was higher in age groups 50-64 (6.6%) and 65-80 (5.8%) years than that in similar age groups of the normal population. CONCLUSION: Every effort should be made to administer intravesical BCG treatment in high-risk NMIBC patients even during the pandemic period. However, increased risk of COVID-19 transmission should be kept in mind and protective measures against COVID-19 for healthcare providers and patients before the procedure should be taken optimally. The procedure should be postponed in patients with lymphopenia in recent complete blood count.

Can the systemic immune inflammation index be a predictor of BCG response in patients with high-risk non-muscle invasive bladder cancer?

AIM: We aimed to investigate the predictor role of the systemic immune-inflammation index (SII) on Bacille Calmette-Guerin (BCG) response in patients with high-risk non-muscle invasive bladder cancer (NMIBC). METHODS: A total of 96 patients with high-risk NMIBC, who received intravesical BCG, were enrolled in the study. BCG responsive group (group 1) and BCG failure group (group 2) were compared in terms of demographic and pathological data, peripheral lymphocyte, neutrophil and platelet counts, neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), SII, recurrence-free survival (RFS) and progression-free survival (PFS). The SII was calculated as in the formula: SII = neutrophil × platelet/lymphocyte. The prognostic ability of the SII for progression was analysed with multivariate backward stepwise regression models. RESULTS: The mean follow-up time 34.635 ± 14.7 months. Group 2 had significantly higher SII, peripheral lymphocyte, neutrophil and platelet counts than group 1. An ROC curve was plotted for the SII to predict the BCG failure and the cut-off point was calculated as 672.75. Effect of the SII to the model was statistically significant (P = .003) and a higher SII increased the progression onefold. A tumour greater than 30 mm in size and a high SII together increased the progression 3.6 folds. CONCLUSIONS: The SII might be a successful, non-invasive and low-cost parameter for prediction of BCG failure in patients with high-risk NMIBC. The cut-off value for SII is 672.75 and above this level BCG failure and progression to MIBC might be anticipated. However, these results should be validated in prospective randomised controlled studies with large patient groups.

The Lifelong Mysterious Relapsing "Kidney" Disease of the Founder of Turkey; Atatürk (1881-1938) in Connection with European Medical and Political History.

INTRODUCTION: Although Mustafa Kemal Atatürk (1881-1938) was a national hero with his intrepid and enlightened attempts to establish modern Turkey from the remnants of Ottoman heritage, he had been suffering from lifelong "kidney disease" that appeared with intermittent flank pain and fever without an identified source. However, we think that this physical pain that he endured only increased his motivation to focus on his military and political aims. Methods & Results: In this historical review article, we have focused on his personal medical life and specifically his "kidneys" from the beginning of the complaint till his death through European medical and political history with geographic locations and speculated upon it via past, near past, and recent medical literature. CONCLUSION: Mustafa Kemal Atatürk, the great military and political leader for his country, had always suffered from uro/nephrological problems throughout his life. We think that this was one of the reasons that urology has been privileged and thus to be the oldest separated medical surgical branch in Turkey and to some significant extent with European urological history.

Is primary adult hypospadiatic prepuce different from healthy prepuce in terms of microvascular density and androgen-estrogen-progesterone receptors?

This study aims to determine the histological data such as microvessel density, nerve density, and the androgen, oestrogen and progesterone receptor density in the prepuce of primary distal hypospadias cases in adulthood, compared to that of healthy individuals in the same age group. Between 2014 and 2019, we prospectively evaluated adult hypospadias and adult circumcision patients. A total of 28 patients were included: Group 1 (18 patients) primary distal hypospadias and Group 2 (10 patients-control group) healthy individuals who had a previous circumcision request for social/religious reasons. The prepuce of healthy individuals that were excised after the circumcision and the excised parts excluded from the prepuce that was used in reconstruction during the repair of hypospadias, were shaped and stored to be able to perform a study by the pathology clinic. Histopathological findings on adult distal hypospadias cases showed that the microvascular density and inflammation in the prepuce with hypospadias were found to be increased compared to the healthy prepuce and the density of androgen and oestrogen receptors was similar in both groups. Unlike childhood studies, in this study with adults, the progesterone receptor was detected in both groups and found to be significantly lower in the hypospadias group.

Unusual presentation of epidermoid cyst from testis in an aging male.

Epidermoid cysts, which constitute 1% of all testicular tumors, are considered to be benign even though histogenesis is not clear. Patients usually suffer from painless scrotal mass or this mass is realized during the routine physical examination. Hematospermia may be a finding for both benign and malignant testicular tumors. Many authors advocate the testicular sparing surgery in the treatment but epidermoid cysts are usually treated with radical inguinal orchiectomy, because of the difficulties in the diagnosis, concurrence of the malignant tumors, and the debate on the histogenesis.

Laparoscopic surgery for upper ureteral calculi in geriatric patients: 5 years experience.

OBJECTIVE: We have reviewed the success of laparoscopic calculi surgeries in geriatric patients. METHODS: A retrospective analysis was performed on the laparoscopic ureterolithotomy surgeries performed at our central between January 2014 and January 2019 to treat upper ureteral calculi in geriatric patients. Among the patients who underwent these surgeries, we evaluated data on 24 cases whose records could be fully retrieved. RESULTS: The age interval of the patients was 60-73 years, and the mean age was 63 ± 3.43 years. The size of the calculi was 19-24 mm, and mean size was 20.2 ± 2.5 mm. Because stone disease was present previously, 5 of these patients underwent endoscopic intervention, whereas two underwent open surgery. Sixteen of these patients had a history of unsuccessful shock wave lithotripsy (SWL) or ureterorenoscopy. The calculi-free rate was 100%. According to the modified Clavien classification, no major perioperative and postoperative complications were observed. The duration of hospital stay was 1-3 days, and the mean duration of stay was 1.6 ± 0.9 days. CONCLUSION: We believe that owing to the high success and low complication rates, laparoscopic ureterolithotomy can be the first option of treatment for geriatric patients with impacted large calculi, with a history of unsuccessful SWL or ureterorenoscopy (semirigid, flexible).

Results of purified micronized flavonoid fraction in the treatment of categorized type III chronic pelvic pain syndrome: a randomized controlled trial.

OBJECTIVES: The management of chronic pelvic pain syndrome (CPPS) is controversial because of the unclear pathogenesis of this disease. In one theory, prostatitis has been proposed to be associated with pelvic venous diseases such as varicocele and hemorrhoids, dilatation of the Santorini plexus. In this study, we investigated the effect of micronized flavonoid fraction (an agent used in venous insufficiency) in the treatment of type III CPPS. METHODS: Patients diagnosed with type III chronic prostatitis were randomized and divided into 3 groups. Group 1 consisted of patients using antibiotics + anti-inflammatory + alpha-blocker (n = 47), Group 2 consisted of patients using antibiotics + anti-inflammatory + purified micronized flavonoid fraction (n = 45), and Group 3 consisted of patients using only purified micronized flavonoid fraction (n = 35). RESULTS: The mean age of the patients was 32.93 ± 4.70 (range; 23-44) years. There was a statistically significant difference between the groups in terms of the 6th month NIH-CPSI (National Institute of Health Chronic Prostatitis Symptom Index) total scores (p = .000). Also, it was found that NIH-CPSI total scores at month 12 in Group 3 were significantly higher than those in Group 1 and 2 (p1 = .000, p2 = .002). NIH-CPSI total scores at month 12 in Group 2 were significantly higher than those in Group 1 (p = .000). CONCLUSION: The use of purified micronized flavonoid will decrease prostatic inflammation occurring due to increased perineal venous return.it can also be preferred as part of multimodal therapy because of its profile with relatively less side effects and being more affordable compared with alpha-blockers.

The Clinical Significance of Seminoma Component in Testicular Mixed Germ Cell Tumour.

BACKGROUND: The aim of this study was to examine clinical/pathological characteristics, prognosis and tendency to metastasis of mixed germ cell tumours (MGCTs) that contain a seminoma component. METHODS: A total of 111 MGCT cases between 2008 and 2018 were retrospectively enrolled. The patients were divided into 2 groups according to the absence (group 1) or presence (group 2) of seminoma component in MGCTs. Patients' age, complaints at admission to our clinic, primary tumour localization, primary tumour size, preoperative testicular tumour markers, MGCT histopathological components and percentages, lymphovascular invasion, pathological tumour stage, postoperative testicular tumour markers, presence of lymph node involvement in abdominal tomography, lung metastasis based on thorax tomography, clinical tumour stage, adjunctive therapies performed, state of recurrence and survival were compared in 2 groups. RESULTS: The mean age of the patients was 24.51 ± 4.79 years. The mean age, initial complaint rates, primary tumour size, postoperative testicular tumour markers, presence of lymphovascular invasion, presence of lymph node involvement and lung metastasis were found to be higher in group 2 than in group 1, although these differences were not statistically significant. Especially, it was found that a seminoma component rate of 30% and higher had a higher tendency for a poor prognosis. CONCLUSION: Although the word "seminoma" may be initially interpreted as an indication of good prognosis, a seminoma component in MGCTs is actually not a good prognostic factor. MGCTs that contain a seminoma component (especially 30% and higher) can have a higher tendency for occult metastatic disease.

A case of seminoma presented with clinical manifestations of testicular torsion.

Testicular tumors rarely manifest themselves with clinical picture of testicular torsion. In this presentation of ours, we reported a 30-year-old patient whose post-orchiectomy histopathology report revealed the presence of seminoma. The patient consulted us with acute scrotum whose physical examination and Doppler ultrasonographic findings showed testicular torsion. Though rarely seen patients, in cases who consulted with acute scrotum, the possibility of testicular tumor should not be discarded. For the establishment of differential diagnosis detailed anamnesis and physical examination findings should be supported with laboratory tests and imaging modalities.

Effects of obesity surgery (laparoscopic sleeve gastrectomy technique) on lower urinary tract symptoms, depression and quality of life of males: Prospective study.

PURPOSE: Technically, obesity weakens the pelvic base muscles by causing an increase in the intraabdominal pressure and intravesical pressure due to increasing fat and it triggers the occurrence of lower urinary tract symptoms. However it is believed that weight loss will cause recovery of these symptoms. Our purpose in this study is to research about the effects of the weight loss achieved by using especially the Laparoscopic Sleeve Gastrectomy (LSG) technique of bariatric surgery which is being more and more widely used today. MATERIALS AND METHODS: Out of all patients who had LSG surgery due to obesity earlier in our center during the period between April 2014 and March 2015, 22 applicable male patients were considered after a brief exclusion criteria application. Age, height, weight, and body mass index (BMI) data of these patients were recorded before the operation. International Prostate Symptom Score (IPSS), International Consultation on Incontinence Questionnaire - short from) (ICIQ-SF), Beck depression inventory (BECK) and Short form - 36 (SF-36) were filled for the patients and the data were recorded. Also, the weight loss amounts and BMI decreases of the patients after the operation were recorded. RESULTS: After the procedure, the decrease in the averages of BECK depression inventory, IPSS, ICIQ-SF and the increase in the Mental and Physical subgroup scores of SF-36 were found statistically coherent. CONCLUSION: The adverse effect of obesity, which is observed more and more often in today's world, on lower urinary tract symptoms and on the quality of life is undeniable. In our study, we think that the bariatric surgery made by using the LSG technique, not only causes serious amount of weight loss, but also reduces urinary dysfunction and enhances the quality of life among males.

Efficacy and safety of semirigid ureteroscopy combined with holmium: YAG laser in the treatment of upper urinary tract calculi: Is it a good alternative treatment option of flexible ureteroscopy for developing countries?

OBJECTIVE: To assess the success rates of endoscopic management of upper ureteral stones using semirigid ureterorenoscopy and holmium: YAG laser lithotripters. METHODS: A total of 74 patients with an established diagnosis of upper ureteric stone and scheduled for endoscopic ureteral stone treatment were retrospectively evaluated. Failure was defined as the inability to contact or fragment the stone, migration of the stone into the renal pelvis and difficulty in visualizing the stone for the second time. Success rates and influencing factors as for stone-free state were investigated. RESULTS: Mean age of our patients was 45.99±15.00 (range: 24-82) years. In 14 of 74 patients procedural failure was observed. Double J stents were implanted in 65 % of the patients and ureteral catheterization was performed on 20% of them. The total success rate was 81.1 %. Major complication rate was 1.1 percent. Factors effecting the success rate as gender, age, body mass index, grade of hydronephrosis and stone size were evaluated and only age was found to be statistically significant. CONCLUSIONS: Despite some potential risks, semirigid ureterorenoscopic stone extraction and holmium: YAG laser lithotripters are still safe and effective treatment alternatives for management of upper ureteral stones.

Late-onset secondary nocturnal enuresis in adolescents associated with post-traumatic stress disorder developed after a traffic accident.

Secondary nocturnal enuresis is generally seen between 5 and 7 years of age and it is rarely encountered when compared with the primary incontinence. Patients with suggested diagnosis of secondary nocturnal enuresis should be examined for neurological and spinal anomalies and diabetes mellitus, diabetes insipidus, renal failure and urinary tract infection should be ruled out in differential diagnosis (1-3). Herein, we are presenting case reports of adolescent patients with secondary nocturnal enuresis refractory to medical therapy and developed after in-vehicle and extravehicular accidents.

Contralateral tumor seeding of renal cell carcinoma mimicking late metastasis of liver after laparoscopic nephrectomy: A case report with review of the literature.

Laparoscopic surgery has been increasingly used every day in the management of urologic malignancies. Even though it seems as a minimally invasive surgery, during these interventions tumor seeding, as seen in open surgery, confronts us as a rarely seen serious risk. Herein, we have reported a case who demonstrated peritoneal tumor implantation at 12 month postoperative follow up after laparoscopic radical nephrectomy (LRN) performed for Furhman grade 1 (T2N0M0) renal cell cancer.

Extraintestinal gastrointestinal stromal tumor of undetermined origin: Is the mass resection a wrong approach? A case report and review of the literature.

Gastrointestinal stromal tumor (GIST) was first defined by Mazur et al. in 1983. GIST is evaluated among tumoral lesions that can be acquired or congenital. Those not associated with gastrointestinal system are termed as extragastrointestinal stromal tumor (EGIST). EGISTs can develop on intraperitoneal spaces as omentum, mesenterium and gallbladder and they can occur on retroperitoneum, extraperitoneal (prostate) and intrapelvic organs. Herein, we present a case with EGIST in a 65-year-old male patient located in intrapelvic and retroprostatic area which had no connection with gastrointestinal system as assessed by radiological methods and we discuss its treatment. We reviewed the literature and observed that ours is the first case report on a patient in which the mass was only extirpated rather than performing radical surgery. He is still at the 2. year of his follow-up period without any disease recurrence.

Lower pole renal cut injury due to the iliac wing fracture: A rare case report.

The most frequent causes of blunt genitourinary injuries are falls from heights, motor vehicle accidents and sports injuries. Firearm injuries and penetrating stab wounds are also frequently encountered. Skeletal system traumas in the vicinity of the urogenital system can cause urological organ injuries. Though rarely, renal traumas can be dependent on the kinetic energy of the trauma and the retroperitoneal movement capacity of the kidneys and cannot be explained with the proximity of the kidney to the skeletal system. In cases with high-energy decelerations, renal pedicle and ureteropelvic junction traumas are more frequently observed. Herein, we presented a grade 3 left kidney lower pole injury developed secondary to A2 type pelvic fracture following a high energy deceleration trauma. It should not be forgotten that especially in this type of fractures, injuries of the lower renal pole can occur.