Characterizing prostate zonal shape changes associated with 5α-reductase inhibitors using MRI.

Benign prostatic hyperplasia (BPH) is a prevalent medical disorder that primarily affects elderly males. It is distinguished by enhanced angiogenesis of the prostate, aggravating lower urinary tract symptoms (LUTS) and diminishing overall quality of life. Dutasteride, a 5α-reductase inhibitor, has emerged as a significant therapeutic choice for BPH owing to its efficacy in reducing prostate volume. The objective of this study is to analyze alterations in the shapes of prostate zones resulting from dutasteride treatment of BPH, using MRI. We examined 19 drug-administered patients and 33 non-drug-administered patients. MRI sections of all participants before and after drug treatment were collected retrospectively. The transition zone and peripheral zone of the prostate were marked with selected landmarks using TPSDIG v2.04. Generalized Procrustes Analysis was used to analyze shapes statistically. Our results showed that the 5α-reductase inhibitor significantly altered the shape of the transition zone by narrowing its posterior part. There were significant statistical differences between the drug-administered and non-drug-administered groups in the initial and final shapes of the transition zone. These findings indicate that the use of 5α-reductase inhibitors yielded favorable outcomes in terms of prostate size reduction and amelioration of symptoms associated with BPH.

The Emerging Role of AI in Patient Education: A Comparative Analysis of LLM Accuracy for Pelvic Organ Prolapse.

OBJECTIVE: This study aimed to evaluate the accuracy, completeness, precision, and readability of outputs generated by three Large Language Models (LLMs): GPT by OpenAI, BARD by Google, and Bing by Microsoft, in comparison to patient education material on Pelvic Organ Prolapse (POP) provided by the Royal College of Obstetricians and Gynecologists (RCOG). METHODS: A total of 15 questions were retrieved from the RCOG website and input into the three LLMs. Two independent reviewers evaluated the outputs for accuracy, completeness, and precision. Readability was assessed using the Simplified Measure of Gobbledygook (SMOG) score and the Flesch-Kincaid Grade Level (FKGL) score. RESULTS: Significant differences were observed in completeness and precision metrics. ChatGPT ranked highest in completeness (66.7%), while Bing led in precision (100%). No significant differences were observed in accuracy across all models. In terms of readability, ChatGPT exhibited higher difficulty than BARD, Bing, and the original RCOG answers. CONCLUSION: While all models displayed a variable degree of correctness, ChatGPT excelled in completeness, significantly surpassing BARD and Bing. However, Bing led in precision, providing the most relevant and concise answers. Regarding readability, ChatGPT exhibited higher difficulty. The study found that while all LLMs showed varying degrees of correctness in answering RCOG questions on patient information for Pelvic Organ Prolapse (POP), ChatGPT was the most comprehensive, but its answers were harder to read. Bing, on the other hand, was the most precise. The findings highlight the potential of LLMs in health information dissemination and the need for careful interpretation of their outputs.

The predictive factors that total laser energy consumed during retrograde intrarenal surgery (RIRS): stone area and density.

Holmium: YAG (Ho: YAG) laser lithotripsy with flexible ureterorenoscopy can be used with high stone-free and low complication rates for renal stones. This study aimed to determine the factors affecting the total laser energy in cases with provided stone-free status after a single session of retrograde intrarenal surgery (RIRS). Data of 222 patients who underwent RIRS between October 2017 and March 2020 were evaluated retrospectively. After exclusion criteria, the study was carried out with 184 stone-free cases. All cases were performed without using a ureteral access sheath (UAS), and dusting was preferred as the lithotripsy method. The effects of age, gender, body mass index (BMI), previous RIRS history, previous shock wave lithotripsy (SWL) history, stone localization, number of stones, stone surface area, and stone density on total laser energy were analyzed. There was no significant correlation between total laser energy with gender, BMI, previous RIRS history, previous SWL history, stone localization, and the number of stones (p:0.347, p:0.482, p:0.119, p:0.167, p:0.907, p:0.933 respectively). There was a significant correlation between age and total laser energy (p = 0.032), but it was not observed when the effect of the stone surface area was removed (p = 0.354). There were significant correlations between total laser energy and stone surface area, stone density, and total laser time (p<0.001, p<0.001, and p <0.001, respectively). Stone area and stone density affect the total energy consumed during laser lithotripsy. Urologists should consider the stone area, stone density, and the power of the laser device to determine which surgical technic to prefer.

Clinical preferences and treatment attitudes among urologists, gynecologists, and geriatricians: An independent online questionnaire survey for comparison of treatment choices in the management of overactive bladder.

OBJECTIVE: Overactive bladder (OAB) is a common clinical problem with associated morbidities both in men and women. Although real-life management strategies have been examined among urologists (URO), treatment choices may differ between different specialties. In the present study, an online survey was conducted to determine and compare the management strategies and clinical preferences of UROs, obstetricians/gynecologists (OB/GYN), and geriatricians (GER) in the treatment of OAB in their daily practices. METHODS: Between December 2020 and February 2021, an online questionnaire was sent to URO, OB/GYN, and GER specialists/residents. Current strategies and attitudes toward treatment of OAB in patients <65 years were compared between URO and OB/GYN, whereas the responses were compared between all three specialties in patients ≥65 years. RESULTS: A total of 733 specialists/physicians (433 URO, 236 OB/GYN, and 64 GER) completed the online survey. Patients with OAB were more likely to present to URO compared to OB/GYN and GER (p = 0.001). A combination of behavioral modification and pharmacotherapy (antimuscarinics and/or beta-3 agonists) were chosen for the initial treatment of patients with OAB in both specialties with a significantly higher proportion by URO than by OB/GYN (51.9% vs. 38.1%; p = 0.001). Antimuscarinics were the most frequently prescribed medications by both the URO and OB/GYN specialties (81.8% vs. 78.4%; p = 0.27). Combination therapy with antimuscarinics was preferred more often by URO (91.5% vs. 77.1%; p = 0.001) when no or an inadequate response after initial treatment occurred. Multiple medication use, comorbidities, and risk of cognitive side effects affected medication preference by all specialists, especially by GER (p = 0.018). CONCLUSIONS: Patients with OAB present to UROs, OB/GYN and GER more frequently compared to other specialities. Although antimuscarinics and beta-3 adrenoceptor agonists are equally recommended as first-line pharmacotherapy for OAB, antimuscarinics were preferred for most patients as the initial molecule by all specialties. Beta-3 agonists are increasingly preferred for elderly patients.

Evaluation of incidence and histolopathological findings of soft tissue sarcomas in genitourinary tract: Uludag university experience.

PURPOSE: In this study we aimed to review urological soft tissue sarcomas of genitourinary tract that were diagnosed in our institution and their prognostic factors for survival. MATERIALS AND METHODS: The clinical and pathological records of 31 patients who had diagnosis of soft tissue sarcomas primarily originating from the genitourinary tract between 2005-2011 were reviewed. RESULTS: The most common site was kidney (17 cases, 54.8%), and most common diagnosis was leiomyosarcoma (11 cases, 35.4%). A total of 24 patients (77.4%) had surgical excision. The surgical margins were positive in 7 patients who presented with local recurrence after primary resection. Twelve patients developed metastatic disease. During follow-up (range 9-70 month), 26 of the 31 patients (88.9%) were alive. Significant survival differences were found according to histological type (p: 0.001), with lower survival rates for malignant fibrous histiocytoma. The tumor size, the presence of metastasis at the time of diagnosis and tumor localization were not statistically significant for overall survival. CONCLUSIONS: In our series, prostate sarcomas, paratesticular rhabdomyosarcoma and malignant fibrous histiocytoma had poor prognosis, especially in patients presenting with metastatic disease.

Efficacy and safety of onabotulinumtoxinA injection in patients with refractory overactive bladder: First multicentric study in Turkish population.

AIMS: To investigate the efficacy and safety of intradetrusor onabotulinumtoxinA (onaBoNT-A) injection in patients with overactive bladder (OAB) refractory to antimuscarinic treatment. METHODS: A total of 80 patients with OAB symptoms were enrolled in this prospective multicenter study and received 100 U intradetrusor onaBoNT-A injection.The changes from baseline in the frequency of voiding, urge urinary incontinence (UI) and urge episodes, mean and maximum bladder capacities, uroflowmetry, post-void residual urine volume (PVR), quality of life score, and treatment benefit scale score were assessed. The need for a second injection,and treatment-related adverse events were also examined postoperatively. RESULTS: OnaBoNT-A injection significantly decreased the UI episodes(P = 0.0001), the mean voiding frequency (P = 0.0001), and the urgency episodes (P = 0.0001) in the third month compared to baseline. Similarly, the mean bladder capacity, and maximal bladder capacity were increased (P < 0,05). The quality of life scores improved by 57.1% compared to the pre-treatment rate (P = 0,0001). No significant change was observed in the PVR or maximum flow rate. Urinary retention developed in 3 (3.75%) patients and urinary infection and transient hematuria were observed in five patients (6.25%) each. The UI episodes, voiding frequency and urgency episodes were significantly lower at the 9th month than at baseline (all P = 0.0001). Overall 67% of the patients continued to experience benefits from the injection. Sixteen patients (20%) required a second injection in the third month. Eight patients were lost to follow-up at the last visit in the 9th month, and 34 of the remaining 56 patients required a second injection at the 9th month. Cumulatively, 50 (63%) patients needed re-injections. CONCLUSIONS: Our results demonstrated that the onaBoNT-A injection produced significant improvement in all OAB symptoms with a low incidence of treatment related adverse events.

Urodynamics findings in transverse myelitis patients with lower urinary tract symptoms: Results from a tertiary referral urodynamic center.

AIMS: To characterize urodynamic findings in patients referred with transverse myelitis (TM) and lower urinary tract symptoms (LUTS), as well as to identify any characteristics predictive of urodynamics findings. METHODS: This is a retrospective review of an IRB-approved neurogenic bladder database of patients followed by a single surgeon between 2001 and 2013. Patient characteristics, questionnaire data, radiologic studies, and urodynamic parameters were analyzed. RESULTS: Of the 836 patients in the neurogenic bladder database, 28 patients (17 females, 11 males) were referred with a principle diagnosis of TM (3%). Twenty-one of twenty-eight patients (75%) underwent urodynamics testing. Bladder management at initial urologic evaluation was CIC or urethral catheter for 16/28 patients (57.1%). Median MCC was 303 ml (85-840 ml), detrusor overactivity (DO) was present in 16/21 (76%), detrusor sphincter dyssynergia (DSD) in 10/21 (48%), and decreased compliance in 7/21 (33%). For those voiding, mean Qmax was 12 ± 10 ml/sec and pdet at Qmax was 41 ± 17 cmH2 O. Longitudinally extensive TM (LETM) was the only patient characteristic associated with DO (P = 0.0276). No other patient characteristics were associated with urodynamics parameters. CONCLUSIONS: Significant urodynamic testing abnormalities are noted in the majority of TM patients undergoing urodynamics, with 95% having DO, DSD, altered compliance, or detrusor underactivity. Other than the association between LETM and DO, there were no patient characteristics predictive of urodynamics findings. Based on the severity of urodynamics findings in our series, patients with TM and LUTS should have thorough baseline urological evaluations including urodynamics and be offered ongoing surveillance. Neurourol. Urodynam. 36:360-363, 2017. © 2015 Wiley Periodicals, Inc.

Urodynamics for incontinence after midurethral sling removal.

INTRODUCTION: We reviewed the role of urodynamics (UDS) in the management of women with incontinence following mid-urethral sling removal (MUSR). METHODS: Following IRB approval, women from a longitudinal database who had persistent or recurrent urinary incontinence (UI) after MUSR, desired further therapy, and subsequently underwent UDS were reviewed. Women with neurogenic bladder, obstructive symptoms without UI, urethra-vaginal fistula, anterior compartment prolapse >Stage 2, or those who had concomitant autologous sling surgery at the time of MUSR were excluded. Interval time between MUSR and UDS, UDS findings, and UI management after UDS were recorded. RESULTS: From 2006 to 2013, 71 of 246 women had UDS after MUSR for persistent or recurrent UI. For the 54 women in the final analysis, mean time between tape removal and UDS was 12.4 months (range: 4-65). UDS demonstrated incontinence in 78% of patients: stress urinary incontinence (SUI) in 19 (35%), detrusor overactivity incontinence (DOI) in 6 (11%), and mixed urinary incontinence (MUI) in 17 (32%). On pressure-flow studies, the following voiding patterns were demonstrated: normal voiding (39), valsalva voiding (6), obstruction (2), underactive detrusor (1), no voiding records (6). UDS storage and emptying data were used in subsequent symptom-based patient counseling for treatment planning. Urethral bulking agent was the most commonly chosen management (43%). CONCLUSION: Our current guidelines for UDS in women after incontinence procedures and MUSR are currently based on a low level of evidence. This study reinforces the role of UDS to guide therapy for UI after MUSR. Neurourol. Urodynam. 35:939-943, 2016. © 2015 Wiley Periodicals, Inc.

Quality of life after suprapubic catheter placement in patients with neurogenic bladder conditions.

AIMS: To evaluate quality of life in patients with neurogenic bladder (NGB) conditions who have elected to undergo suprapubic catheterization (SPC), as well as assess adverse events (AEs) related to the procedure. METHODS: This is a retrospective review from a database of NGB patients from 1/1/2003 to 6/30/2013. Patients who underwent SPC placement were invited to complete a validated, single item Patient Global Impression of Improvement (PGI-I) questionnaire. Success or positive response was defined as 1 or 2 on a scale of 1-7. All patients were included in the assessment of AEs. RESULTS: Of the 128 patients who underwent SPC, 89 patients (54 female, 35 male) met inclusion criteria. Response rate to the PGI-I questionnaire was 65.2% (58/89). Mean age at the time of SPC placement was 54.4 years (± 14.4). The mean time from SPC placement to PGI-I questionnaire was 48.3 months (Range 4.4-128.4). Overall, success was seen in 49/58 patients (84.5%). Only 5.2% (3/58) patients reported a negative PGI-I (score 5/7). There was an 18.8% rate of short term complications, with the majority of these being classified as Clavien I. There was one Clavien IIIb complication (0.8%), which consisted of a small bowel perforation. CONCLUSIONS: SPC is an effective bladder management in carefully selected NGB patients who have failed other options. Over 80% considered the SPC to have improved their urological quality of life with a mean time to questionnaire of 4 years. Severe AEs are rare, though can be particularly serious in this group of neurologically impaired patients. Neurourol. Urodynam. 35:831-835, 2016. © 2015 Wiley Periodicals, Inc.

Prolapse Recurrence after Transvaginal Mesh Removal.

PURPOSE: We determined the rate of pelvic organ prolapse recurrence after transvaginal mesh removal. MATERIALS AND METHODS: Following institutional review board approval a longitudinally collected database of women undergoing transvaginal mesh removal for complications after transvaginal mesh placement with at least 1 year minimum followup was queried for pelvic organ prolapse recurrence. Recurrent prolapse was defined as greater than stage 1 on examination or the need for reoperation at the site of transvaginal mesh removal. Outcome measures were based on POP-Q (Pelvic Organ Prolapse Quantification System) at the last visit. Patients were grouped into 3 groups, including group 1--recurrent prolapse in the same compartment as transvaginal mesh removal, 2--persistent prolapse and 3--prolapse in a compartment different than transvaginal mesh removal. RESULTS: Of 73 women 52 met study inclusion criteria from 2007 to 2013, including 73% who presented with multiple indications for transvaginal mesh removal. The mean interval between insertion and removal was 45 months (range 10 to 165). Overall mean followup after transvaginal mesh removal was 30 months (range 12 to 84). In group 1 (recurrent prolapse) the rate was 15% (6 of 40 patients). Four women underwent surgery for recurrent prolapse at a mean 7 of months (range 5 to 10). Two patients elected observation. The rate of persistent prolapse (group 2) was 23% (12 of 52 patients). Three women underwent prolapse reoperation at a mean of 10 months (range 8 to 12). In group 3 (de novo/different compartment prolapse) the rate was 6% (3 of 52 patients). One woman underwent surgical repair at 52 months. CONCLUSIONS: At a mean 2.5-year followup 62% of patients (32 of 52) did not have recurrent or persistent prolapse after transvaginal mesh removal and 85% (44 of 52) did not undergo any further procedure for prolapse. Specifically for pelvic organ prolapse in the same compartment as transvaginal mesh removal 12% of patients had recurrence, of whom 8% underwent prolapse repair.

Mini-slings can cause complications.

INTRODUCTION AND HYPOTHESIS: Single-incision mini-slings (SIMS) have been advocated to avoid the complications of transobturator and retropubic midurethral slings. We present a series of SIMS complications and their outcome after vaginal removal at a tertiary care center. METHODS: Following Institutional Review Board approval, a prospective database of consecutive women who underwent SIMS removal for complications and had a minimum follow-up of 6 months was reviewed. Patient-reported outcomes were assessed by main symptom category. In addition, an ideal outcome or cure was defined as continent, pain-free, sexually active if active preoperatively, and not requiring additional medical or surgical therapy. RESULTS: Of 23 women, 17 met inclusion criteria. Presenting symptoms were varied but dominated by incontinence (14), pelvic pain (11), dyspareunia (10), and obstructive urinary symptoms/urinary retention (5), with 76 % presenting with more than one complaint. Type of SIMS included MiniArc™ (11), Solyx™ (4), and TVT-Secur™ (2). At a mean follow-up of 17 ± 9 (range 7-44) months after SIMS removal, six (35 %) women were cured of their presenting complaint. Among the 11 women with pelvic pain, 6 had resolution of pain, 2 improvement, and 3 persistent pain. Six of seven women who were sexually active beforehand resumed sexual activity. Dyspareunia persisted in three women. Of 14 with incontinence, 8 had cure or improvement, and obstructive symptoms resolved in 4 of 5. CONCLUSIONS: This series outlines several complications with SIMS, similar to what has been reported with other suburethral synthetic tapes. Therefore, caution is required and patient counseling is important.

Comparison of ureteroscopic laser lithotripsy with laparoscopic ureterolithotomy for large proximal and mid-ureter stones.

OBJECTIVES: To compare the effectiveness and complications of ureteroscopic laser lithotripsy with laparoscopic ureter laparoscopic ureterolithotomy in mid- or proximal portion of large ureteral stones. MATERIAL AND METHODS: We reviewed patients with large (>15 mm) ureteral stone and those who underwent ureteroscopic laser lithotripsy (URS group) or laparoscopic ureterolithotomy (LU group). The first attempt was considered successful in patients who had residual fragments smaller than 2 mm and no conversion of the primary procedure to another. RESULTS: Sixty patients (URS group 29, LU group 31) met inclusion criteria. FURS was used as an adjunctive procedure in one patient for URS group and in two patients for LU group in the same season. LU had a higher success rate and the first-day stone-free rate when compared with URS. Number of procedures was also significantly higher in URS group. There was no difference in stone-free rates at the first and third months, and length of hospitalization and operation were higher in the LU group. Only two patients in the LU group and one patient in the URS group had major complications. CONCLUSIONS: Laparoscopy is an effective option of large proximal and mid-ureter stone treatment; however, URS provides similar stone-free rates at three months as a minimal invasive procedure.

Anterior vaginal wall suspension procedure for moderate bladder and uterine prolapse as a method of uterine preservation.

PURPOSE: We report our experience with anterior vaginal wall suspension for moderate anterior vaginal compartment prolapse and uterine descent less than stage 2. MATERIALS AND METHODS: Data on patients who underwent anterior vaginal wall suspension with uterine preservation by hysteropexy and had a 1-year minimum followup were extracted from a long-term, prospective, institutional review board approved, surgical prolapse database. The indication for uterine preservation was uterine descent not beyond the distal third of the vagina with traction with the patient under anesthesia, and negative Pap smear and pelvic ultrasound preoperatively. The upper suture of the anterior vaginal wall suspension secures the cardinal ligament complex, allowing for uterine suspension once the suture is transferred suprapubically. Failure was defined as prolapse recurrence greater than stage 2 on physical examination or the need for reoperation for uterine descent. Outcome measures at serial intervals included validated questionnaires, physical examination, standing voiding cystourethrogram at 6 months postoperatively and complications. RESULTS: From May 1996 to March 2012, 52 of 739 patients met inclusion criteria. Mean followup was 55 months (range 12 to 175, median 44). Mean patient age was 62 years (range 38 to 81), mean body mass index was 26.7 kg/m(2) (range 18.3 to 49.4) and mean parity was 2.7. There were no transfusions or intraoperative complications. Overall 7 (13%) patients underwent subsequent hysterectomy for uterine prolapse recurrence at 7 months to 6 years postoperatively. CONCLUSIONS: The anterior vaginal wall suspension procedure offers a simple, mesh-free surgical alternative with acceptable long-term followup in patients with moderate uterine prolapse who wish for uterine preservation. However, patients should be appropriately counseled about the low risk of subsequent hysterectomy.

Can ChatGPT, an Artificial Intelligence Language Model, Provide Accurate and High-quality Patient Information on Prostate Cancer?

OBJECTIVE: To evaluate the performance of ChatGPT, an artificial intelligence (AI) language model, in providing patient information on prostate cancer, and to compare the accuracy, similarity, and quality of the information to a reference source. METHODS: Patient information material on prostate cancer was used as a reference source from the website of the European Association of Urology Patient Information. This was used to generate 59 queries. The accuracy of the model's content was determined with F1, precision, and recall scores. The similarity was assessed with cosine similarity, and the quality was evaluated using a 5-point Likert scale named General Quality Score (GQS). RESULTS: ChatGPT was able to respond to all prostate cancer-related queries. The average F1 score was 0.426 (range: 0-1), precision score was 0.349 (range: 0-1), recall score was 0.549 (range: 0-1), and cosine similarity was 0.609 (range: 0-1). The average GQS was 3.62 ±â€¯0.49 (range: 1-5), with no answers achieving the maximum GQS of 5. While ChatGPT produced a larger amount of information compared to the reference, the accuracy and quality of the content were not optimal, with all scores indicating need for improvement in the model's performance. CONCLUSION: Caution should be exercised when using ChatGPT as a patient information source for prostate cancer due to limitations in its performance, which may lead to inaccuracies and potential misunderstandings. Further studies, using different topics and language models, are needed to fully understand the capabilities and limitations of AI-generated patient information.

Prognostic value of estrogen receptors in patients who underwent prostatectomy for non­metastatic prostate cancer.

Estrogen receptors in prostate cancer (PCa) are a subject of debate. The aim of the present study was to investigate whether estrogen receptor-α (ERα) and estrogen receptor-ß (ERß) impact the biochemical recurrence (BCR) of non-metastatic PCa after surgery. Following the application of the exclusion criteria, data from 108 patients who underwent laparoscopic radical prostatectomy between January 2011 and December 2019 were retrospectively evaluated. A total of 36 patients with BCR constituted the BCR group. The control group was formed using the Propensity Score Matching (PSM) method with a 1:2 ratio, including parameters with well-studied effects on BCR. The median follow-up time was 74.3 (range, 30-127.5) months in the BCR group and 66.6 (range, 31.5-130) months in the control group. Pathology specimens from the two groups were immunohistochemically stained with ERα and ERß antibodies. Logistic regression analysis and survival analysis were performed. No differences in clinicopathological characteristics were detected between the two groups. The patients with ERα(-)/ERß(+) staining results had a significantly fewer BCRs than other patients (P=0.024). In the logistic regression analysis, patients with ERα(-)/ERß(+) PCa also had a significantly lower risk of recurrence (P=0.048). In the survival analysis, the 5-year BCR-free survival rate of patients with ERα(-)/ERß(+) PCa was higher than that of other patients (85.7 vs. 66.1%; P=0.031). Excluding the effects of well-studied risk factors for recurrence by the PSM method, the present study showed that ERα and ERß have prognostic value for non-metastatic PCa. The 5-year BCR-free survival rate is significantly higher in patients whose PCa tissue has ERα(-)/ERß(+) staining results.

Ureterorenoscopic Lithotripsy for Pediatric Kidney Stones Using Holmium:Yttrium-Aluminum-Garnet Laser Devices: 15 W vs 30 W.

Introduction: We aimed to compare the effectiveness of 15- and 30-W holmium:yttrium-aluminum-garnet (Ho:YAG) laser devices used in the treatment of pediatric kidney stones. Methods: Eighty-six consecutive pediatric patients who underwent retrograde intrarenal surgery (RIRS) between February 2010 and August 2020 were enrolled in the study. After exclusion criteria were applied, the data of 79 children were evaluated retrospectively. Patients were divided into two groups according to the laser device power of 15 W (Group 15: N = 30) and 30 W (Group 30: N = 49). The groups were compared according to demographic characteristics, stone feature, and clinical efficacy. Results: The age, gender, height, weight, and stone characteristics were similar between the groups. The mean operation time was shorter in Group 30. The stone-free rate after the first RIRS session (SF1) was 66.7% in Group 15 and 83.3% in Group 30. The SF1 for 20-mm or larger kidney stones was found to be 0% in Group 15 and 62.5% in Group 30. However, there was no statistically significant difference between the two groups in terms of stone-free rate. Conclusions: In pediatric kidney stone treatment, 30-W Ho:YAG laser devices should be preferred as they shorten the operation time compared with 15-W devices and provide the final stone-free status with fewer procedures, especially in large kidney stones.

Factors Influencing Lymphocele Development After Kidney Transplant: Single Center Experience.

OBJECTIVES: Lymphocele is a well-known postoperative surgical complication after kidney transplant. In this study, our aim was to analyze incidence, risk factors, and outcomes of posttransplant lymphocele in a large cohort. MATERIALS AND METHODS: This observational study included 395 consecutive patients (219 males and 176 females) who underwent kidney transplant procedures from 183 living and 212 deceased donors in our center between January 2007 and 2014. A lymphocele was diagnosed with ultrasonography. RESULTS: The incidence of lymphoceles in our cohort was 31.9% (n = 126). There were no significant dif-ferences with regard to body mass indexes, age of donors, deceased donor ratios, acute rejection episodes, and history of abdominal surgery between those with and without lymphoceles. The pre-transplant serum albumin levels (3.29 ± 0.67 vs 3.48 ± 0.69 g/dL; P = .009) in the lymphocele group and diabetes mellitus ratios (15.9% vs 4.5%; P < .001) in the nonlymphocele group were lower than levels shown in the other group. The lymphocele ratio in patients who received cyclosporine was higher than that shown in patients who did not received it (37.5% vs. 27.4%; P = .032). There was no difference in lymphocele incidence between patients who were taking and those who were not taking mammalian target of rapamycin inhibitors, mycophenolate mofetil, or mycophenolate sodium. In regression analysis, presence of diabetes mellitus, transplant from deceased donors, older age of donors, and lower albumin levels were independent risk factors for posttransplant lymphocele occurrence. CONCLUSIONS: Posttransplant lymphocele was a relatively common surgical complication in our cohort. We concluded that diabetes mellitus, use of kidneys from deceased donors, older donor age, and hypoalbuminemia were independent risk factors for lymphocele development.

15 and 30 W Holmium:YAG Laser Lithotriptor in Ureteroscopic Lithotripsy: Which One Is More Effective and Safe?

Background: Holmium:yttrium-aluminium-garnet (Ho:YAG) laser lithotripsy with ureteroscopy (URS) was a safe and successful treatment option for pediatric ureteral stones. We aimed to comparatively evaluate the outcomes of 15 and 30 W Ho:YAG laser lithotriptors in pediatric ureter stones. Materials and Methods: We retrospectively evaluated 55 children who underwent ureteroscopic laser lithotripsy to treat ureter stone size up to 15 mm between September 2009 and March 2020. Groups were formed according to the laser lithotriptor power 15 W (Group 15: n = 32), 30 W (Group 30: n = 23). The efficiency of laser lithotriptors was compared between the groups. Results: The age, gender, and stone characteristics (longest stone diameter, density, location and multiple stones) were similar between the groups. In the postop first month, stone-free status was achieved in all cases except one child in Group 15. The median operative time was significantly shorter in Group 30 (40 minutes) than in Group 15 (52.5 minutes) (P = .010). Clavien-Dindo class (CDC) 2 complications occurred in 2 children in both groups (P = .597). Although ureteric stenosis was observed in 1 patient in Group 15, no ureteric stenosis was seen in Group 30 during follow-up (median 16.1 months). Length of hospital stay (LoHS) and stone-free rates were similar between groups. Conclusion: URS with 15 and 30 W Ho:YAG laser lithotriptors is an effective treatment option for pediatric ureteral stones with a high success rate and low complication rates. In brief, 30 W Ho:YAG laser lithotriptors should be preferred over 15 W lithotriptors due to their shorter operative time with similar success rate.

The Role of Educational Level and Cognitive Status in Men Undergoing Artificial Urinary Sphincter Implantation.

OBJECTIVE: To examine the relationship between education level, cognitive function of patients and the success/ revision rates of artificial urinary sphincter (AUS) implantation in men with postprostatectomy incontinence. METHODS: Between January 2010 and March 2018, 163 patients (mean age, 68 ± 6.8 years) with moderate-to-severe stress urinary incontinence who underwent AUS implantation were retrospectively examined. Demographic data, body mass index, comorbidities, surgical technique, previous strictures, and radiation therapy were recorded. Incontinence was measured by daily pad use and evaluated by International Consultation on Incontinence Questionnaire-short form. Patients' overall improvement was assessed using the Patient Global Impression of Improvement questionnaire. Education level was determined using the International Standard Classification of Education. Cognitive status was assessed using the Mini-Mental State Examination. Treatment success was defined as the need for ≤1 pad/day at last follow-up. RESULTS: AUS was successful in 77.3% of patients. The International Consultation on Incontinence Questionnaire-short form score improved significantly from 19.9 ± 2.9 to 4.4 ± 5.4 (P = .001). The median outcome reported subjectively on the Patient Global Impression of Improvement scale was 2.1 ± 1.5 (1-7) and self-reported as "much better." Patients' education level had statistically no significant relationship with AUS success and revision rates. Similarly, there was no significant relationship between cognitive status, educational level and the need for revision of AUS (P >.05). However, patients with moderate cognitive impairment and a body mass index >30 showed significantly lower AUS success rates (P <.05). CONCLUSION: AUS implantation is safe and effective treatment option especially for nonobese and cognitively intact patients of all educational levels.