Comparison of HoLEP, ThuLEP and ThuFLEP in the treatment of benign prostatic obstruction: a propensity score-matched analysis.

PURPOSE: To compare the efficacy and safety of Holmium laser enucleation of the prostate (HoLEP), Thulium laser enucleation of prostate (ThuLEP) and Thulium fibre laser enucleation of prostate (ThuFLEP) by performing propensity score matched analysis (PSM). METHODS: We retrospectively analysed the patients who underwent HoLEP (Group 1, n = 696), ThuLEP (Group 2, n = 146) and ThuFLEP (Group 3, n = 193) surgery because of benign prostatic obstruction (BPO). A 1:1:1 HoLEP: ThuLEP: ThuFLEP group matching was performed using PSM analysis. Perioperative, postoperative functional outcomes and complications were analysed and compared. RESULTS: We observed significant improvement in functional parameters regarding IPSS, Qmax, PVR and quality of life in all groups compared to baseline values at the 1st, 6th and 12th postoperative months. There was no significant difference between different laser types in terms of urge (UUI) and stress urinary incontinence (SUI) at 1st postoperative month. In all three groups, no patient had postoperative SUI or UUI at 6th and 12th postoperative months. In addition, no significant difference was observed between laser types in terms of postoperative complications. CONCLUSION: HoLEP, ThuLEP and ThuFLEP are safe and effective LEP methods with improvement in functional parameters and low complication rates. Similar results in terms of functional outcomes and complications clearly show that these surgeries are alternatives to each other for the patients with BPO. Experts' opinions, practices and enucleation techniques should also be taken into consideration when choosing a laser for BPO surgery.

Can near-infrared imaging distinguish a gelatin-based matrix granuloma from a malignancy in a kidney?

Aim: Differentiating granulomas from cancerous tissue poses a significant challenge in upper urinary tract surgery. We present the case of a 62-year-old male with a gelatin-based matrix (SurgifloTM) granuloma in the kidney following renal cyst decortication eight years earlier.Methods: Contrast-enhanced abdominal tomography revealed a Bosniak type-4 cyst at the previous operation site. The patient underwent laparoscopic partial nephrectomy with near-infrared imaging.Results: The lesion presented as hypofluorescent relative to normal kidney tissue. Histopathological examination revealed a foreign body granuloma due to unabsorbed Surgiflo.Conclusion: The fluorescence pattern could not distinguish a Surgiflo granuloma from a malignant lesion of the kidney.

Effect of the Ureteral Access Sheath Size on Acute Kidney Injury Biomarkers in Retrograde Intrarenal Surgery: A Prospective, Randomized Study.

INTRODUCTION: The aim of the study was to investigate the effect of the diameter of the ureteral access sheath (UAS) used during RIRS on kidney injury based on acute kidney injury (AKI) biomarkers. METHODS: This prospectively randomized controlled study included a total of 125 patients divided into three groups: group 1 (n = 52) in which a 12/14 Fr UAS was used, group 2 (n = 52) in which a 9.5/11.5 Fr UAS was used, and group 3 (n = 21) that was designed as the control group with no urogenital disease history. Urine samples were collected preoperatively and at the postoperative second and 24th hours after surgery and analyzed for AKI using the urinary kidney injury molecule-1 (uKIM-1), N-acetyl-ß-D-glucosaminidase, and neutrophil gelatinase-associated lipocain biomarkers. RESULTS: In group 1, there was no statistical change in any of the three AKI biomarkers at the postoperative second or 24th hour compared to the preoperative period. In group 2, the values of all three AKI biomarkers were statistically significantly increased at the postoperative second and 24th hours compared to the preoperative period while no statistical difference was observed between the two postoperative evaluation times. At the postoperative second hour, the uKIM-1 value was statistically significantly higher in group 2 compared to group 1 (p = 0.043). CONCLUSIONS: The results of our study showed that AKI was not observed in RIRS performed with a 12/14 Fr UAS while the use of a 9.5/11.5 Fr UAS resulted in AKI according to the assessment of the related biomarkers.

A Retrospective Analysis of 83 Patients with Testicular Mass Who Underwent Testis-Sparing Surgery: The Eurasian Uro-oncology Association Multicenter Study.

INTRODUCTION: Herein, we analyzed the histopathological, oncological and functional outcomes of testis-sparing surgery (TSS) in patients with distinct risk for testicular cancer. METHODS: This is a multicenter retrospective study on consecutive patients who underwent TSS. Patients were categorized in high- or low-risk testicular germ cell tumor (TGCT) according to the presence/absence of features compatible with testicular dysgenesis syndrome. Histology was categorized per size and risk groups. RESULTS: TSS was performed in 83 patients (86 tumors) of them, 27 in the high-risk group. Fifty-nine patients had a non-tumoral contralateral testis present. Sixty masses and 26 masses were benign and TGCTs, respectively. No statistical differences were observed in mean age (30.9 ± 10.32 years), pathological tumor size (14.67 ± 6.7 mm) between risk groups or between benign and malignant tumors (p = 0.608). When categorized per risk groups, 22 (73.3%) and 4 (7.1%) of the TSS specimens were malignant in the high- and low-risk patient groups, respectively. Univariate analysis showed that the only independent variable significantly related to malignant outcome was previous history of TGCT. During a mean follow-up of 25.5 ± 22.7 months, no patient developed systemic disease. Local recurrence was detected in 5 patients and received radical orchiectomy. Postoperative testosterone levels remained normal in 88% of those patients with normal preoperative level. No erectile dysfunction was reported in patients with benign lesions. CONCLUSION: TSS is a safe and feasible approach with adequate cancer control, and preservation of sexual function is possible in 2/3 of patients harboring malignancy. Incidence of TGCT varies extremely between patients at high and low risk for TGCT requiring a careful consideration and counseling.

Impact of the COVID-19 Pandemic on the Psychosexual Functions of Healthcare Workers.

BACKGROUND: A novel infection, COVID-19, emerged in China and soon became a global pandemic. Pandemic conditions have resulted in stress in the workplace and led to anxiety among healthcare workers (HCWs), having negative impacts on different aspects of their lives, including their sexual function. AIM: To evaluate the changes in the anxiety status of HCWs during the COVID-19 pandemic and the impact of anxiety on their sexual functions. METHODS: This is a longitudinal study based on an online survey conducted from April 2020 to February 2021 in hospitals designated as pandemic healthcare centers. An online survey link was sent to HCWs that provided consent for participation in the study. The anxiety status of the participants was assessed using the State Anxiety Inventory, and sexual function was evaluated using the International Index of Erectile Function-15 for men and Female Sexual Function Index for women. OUTCOMES: Scores obtained at the beginning of the pandemic were compared with those obtained at 6 months into the pandemic to determine the changes in the anxiety levels and sexual functions of the HCWs. RESULTS: A total of 399 HCWs participated in the survey, and the median age was 32 (20-60) years. Compared to the beginning of the pandemic, there was a significant increase in the State Anxiety Inventory score of the female and male HCWs at the sixth month of the pandemic. Among the women, the mean total Female Sexual Function Index score was 23.55 ± 8.69 at the beginning of the pandemic and 21.42 ± 8.91 at the sixth month, and there was a significant decrease in all parameters except pain. Among the men, the International Index of Erectile Function-15 total score was 62.75 ± 12.51 at the beginning of the pandemic and 55.1 ± 12.87 at the sixth month, indicating a significant decrease in all parameters. CLINICAL IMPLICATIONS: Considering that the pandemic will continue for a long time, more psychological support should be provided, and interventions should be made to protect the mental health of HCWs. STRENGTHS & LIMITATIONS: The strength of the study is that it had a fairly high number of participants across several institutions. However, being conducted in one country and the sample not being randomly selected and being based on voluntariness can be considered as limitations. CONCLUSION: Our results show that the COVID-19 pandemic has led to an increase in the anxiety levels of both female and male HCWs, and this situation has negatively affected their sexual functions. Eroglu U, Balci M, Coser S, et al, Impact of the COVID-19 Pandemic on the Psychosexual Functions of Healthcare Workers. J Sex Med 2022;19:182-187.

What Is the Interaction between Urine C-Reactive Protein, Prostatic Inflammation, and Doxazosin Treatment in Patients with Benign Prostatic Hyperplasia? A Pilot Study.

INTRODUCTION: It was aimed to show the relationship between benign prostatic hyperplasia and inflammation by measuring urinary C-reactive protein values before and after alpha-blocker treatment. METHODS: A total of 71 patients with a total prostate-specific antigen <3.5 ng/mL, International Prostate Symptom Score >7, and maximum urinary flow rate <15 mL/s were included in the study. Doxazosin 4 mg p.o. once daily was started orally as an alpha-blocker treatment. Serum and urine C-reactive protein values, International Prostate Symptom Score, maximum urinary flow rate, and the post-void residual volume of patients were recorded at the first admission and in the first month of alpha-blocker treatment. RESULTS: The mean age of the patients was 59.2 ± 7.5 years. The mean serum C-reactive protein values of the patients at the first admission and follow-up were 2.62 ± 1.8 (range, 0-5) mg/L and 2.83 ± 1.6 (0-6) mg/L, respectively. The mean urine C-reactive protein values of the patients at the first admission and follow-up were 0.45 ± 0.11 (range, 0.28-0.99) mg/L and 0.14 ± 0.04 (range, 0.79-0.328) mg/L, respectively, which was statistically significantly different. In the subgroup analysis, the urine C-reactive protein level change was more prominent in severely symptomatic patients than in moderately symptomatic patients. CONCLUSION: Our results showed that C-reactive protein was detectable in urine, alpha-blocker treatment significantly reduced urine C-reactive protein levels, and the decrease was more prominent in severely symptomatic patients.

Comparison of holmium laser enucleation with bipolar transurethral enucleation of the prostate in patients with benign prostatic hyperplasia: Results of a multicentre study.

To assess the efficacy and morbidity of the holmium laser enucleation of the prostate and bipolar transurethral enucleation of the prostate in patients with benign prostatic hyperplasia. The study included 60 (55%) and 49 (45%) patients who underwent laser and bipolar enucleation of the prostate respectively. According to the perioperative data, except for length of hospital stay and enucleated prostate weight, all the remaining parameters were similar between the groups. There were significant differences between the preoperative and the postoperative third and 12th month voiding parameters in both groups. In the laser group, the maximum urine flow rate value was better than the bipolar group at the postoperative third and 12th months. However, we did not find any statistically significant difference between the groups in terms of the serum prostate-specific antigen level, International Prostate Symptom Score and postvoid residual urine volume at the postoperative third and 12th months. Our results show that both laser and bipolar techniques are effective minimally invasive surgical treatment options for men with benign prostatic hyperplasia. When compared to bipolar technique, laser technique provides shorter hospital stay, more prostatic tissue enucleation and better maximum urine flow rate values.

Comparison of the impact of open and laparoscopic inguinal hernia operations on male sexual function and pain during sexual activity.

In the current study, we aimed to compare sexual function and pain during the sexual activity of men who underwent surgery with the open or laparoscopic total extraperitoneal hernia repair techniques. Patients were randomised into two groups according to the technique used during the operation: the Lichtenstein hernia repair open technique (n = 63) and the laparoscopic total extraperitoneal repair technique (n = 57). In both groups, postoperative sexual function score was significantly improved compared with the preoperative period (p < .001 for both), but the change was higher in the laparoscopy group (6.8 ± 3.7) compared with the open group (4.3 ± 4.4) (p < .001). In both groups, postoperative pain during sexual activity score was significantly decreased compared with the preoperative period (p = .001 for the open group and p < .001 for the laparoscopy group), with the amount of decrease being higher in the laparoscopy group (1.8 ± 0.9) compared with the other (1.1 ± 1.4) (p = .002). This study showed that both hernia repair techniques had a positive impact on sexual function and pain during sexual activity. The improvement in sexual parameters and pain during sexual intercourse was better in the laparoscopy group.

An analysis of three different prostate cancer risk calculators applied prior to prostate biopsy: A Turkish cohort validation study.

The study aimed to investigate the best-performing of three risk calculators (RCs) for the Turkish population in predicting cancer-free status and high-risk prostate cancer (PCa) in patients undergoing transrectal ultrasound-guided prostate biopsy. The electronic medical records of 527 patients who underwent prostate biopsy for the first time due to PSA of 0.3-50 ng/dl and/or cancer suspicion at digital rectal examination (DRE) between January 2017 and December 2020 were retrieved retrospectively. The predictive power of the RCs in the biopsy and the surgical cohort was calculated by two urologists using European Randomised Study of Screening for Prostate Cancer (ERSPC) RC, the North American Prostate Cancer Prevention Trial-RC (PCPT-RC), and the Prostate Biopsy Collaborative Group (PBCG)-RC. All three RCs were successful in predicting PCa and high-risk disease at ROC analysis (p < 0.0001). Of these three nomograms, PBCG-RC outperformed PCPT-RC 2.0 and ERSPC-RH in predicting benign pathology outcomes at biopsy. A better performance of PBCG-RC was also observed in terms of prediction of high-risk disease at biopsy. Using any of the available RCs prior to biopsy is of greater assistance to prostate-specific antigen and DRE than examination alone. The study results show that PBCG-RC performed before biopsy has a higher predictive power than the other two RCs.

Evaluation of factors associated with the detection of incidental prostate cancer after open prostatectomy for benign prostatic hyperplasia.

We aimed to evaluate the incidental prostate cancer (PCa) rate and predictive factors in patients who underwent open prostatectomy (OP) with a pre-diagnosis of benign prostatic hyperplasia (BPH). This study included patients with a pre-diagnosis of BPH, who underwent OP due to symptomatic prostate enlargement. Our database included age, medications, prostate-specific antigen (PSA), free/total PSA ratio, PSA density, digital rectal examination (DRE), prostate volume, serum neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, aspartate aminotransferase/alanine aminotransferase ratio, presence of metabolic syndrome (MetS) and histopathological results after OP. Of the 430 patients that underwent OP, 406 (94.4%) with a benign pathological diagnosis were evaluated as the benign group and 24 (5.6%) detected to have PCa constituted the incidental PCa group. The rate of incidental PCa was much higher in the elderly patients. The cut-off value of age was 71.5 years in the PCa group according to the receiver operating characteristic curve analysis. According to the multivariate analysis, DRE and the presence of MetS were effective in predicting PCa (p < .001 and p = .031, respectively). DRE was found 16 times more effective and MetS was 2.8 times more effective than the other parameters. Our results showed that DRE and the presence of MetS could be useful predictive factors of incidental PCa in OP.

Retrograde intrarenal surgery of renal stones: a critical multi-aspect evaluation of the outcomes by the Turkish Academy of Urology Prospective Study Group (ACUP Study).

AIMS: To outline and evaluate the incidence, management and follow-up of the residual fragments (RFs) following retrograde intrarenal surgery (RIRS) of renal stones by the Turkish Academy of Urology Prospective Study Group (ACUP Study). METHODS: Following the ethical committee approval, 15 centers providing data regarding the incidence, management, and follow-up of RFs after RIRS were included and all relevant information was recorded into the same electronic database program ( https://acup.uroturk.org.tr/ ) created by Turkish Urology Academy for Residual Stone Study. RESULTS: A total of 1112 cases underwent RIRS for renal calculi and RFs were observed in 276 cases (24.8%). Of all the parameters evaluated, our results demonstrated no statistically significant relation between preoperative DJ stenting and the presence of RFs (χ2 (1) = 158.418; p = 0.099). RFs were significantly higher in patients treated with UAS (82 patients, 29.3%) during the procedure compared to the cases who did not receive UAS (194 patients, 23.3%) (χ2 (1) = 3.999; p = 0.046). The mean period for a secondary intervention after RIRS was 28.39 (± 12.52) days. Regarding the procedures applied for RF removal, re-RIRS was the most commonly performed approach (56%). CONCLUSIONS: Despite the reported safe and successful outcomes, the incidence of RFs is higher, after the RIRS procedure particularly in cases with relatively larger calculi. Such cases need to be followed in a close manner and although a second flexible ureteroscopy is the treatment of choice for fragment removal in the majority of these patients, shock wave lithotripsy and percutaneous nephrolithotomy may also be preferred in selected cases.

Comparison of synchronous bilateral transperitoneal and posterior retroperitoneal laparoscopic adrenalectomy: results of a multicenter study.

BACKGROUND: Different techniques for laparoscopic adrenalectomy have been proposed with the lateral transperitoneal approach and posterior retroperitoneal approach being the two more frequently minimally invasive surgeries in most of the clinics. There are no sufficient studies in which the results of lateral transperitoneal and posterior retroperitoneal approaches in synchronous bilateral laparoscopic adrenalectomy have been compared. In the current study, we aimed to report our multicenter results of the lateral transperitoneal and posterior retroperitoneal synchronous bilateral laparoscopic adrenalectomy experience in patients who had different bilateral adrenal pathologies and to compare the outcomes of these two different operative procedures. METHODS: Between 2012 and 2018, a total of 52 patients with a mean age of 43.5 years underwent simultaneous bilateral laparoscopic adrenalectomy at 6 different centers. Twenty-seven and 25 patients underwent bilateral lateral transperitoneal and posterior retroperitoneal laparoscopic adrenalectomy, respectively. Patients' age, gender, body max index, operative indications, mass size, operation time, blood loss, length of hospitalization, intraoperative and postoperative complications and pathology reports were analyzed. RESULTS: Synchronous bilateral transperitoneal group was younger than synchronous posterior retroperitoneal group (37 years vs. 50.4 years.) (p: 0.001). Posterior retroperitoneal group had significantly decreased operating time and less blood loss than transperitoneal group. No significant difference was found with regard to postoperative hospital stay, perioperative and postoperative complications between two groups. Majority of the histopathological results were adrenal hyperplasia associated with Cushing's disease (61.5%). Less frequent pathological results were adrenal adenoma and pheochromocytoma (15.4% and 13.5%, respectively). During the follow-up period, no recurrence or disease-related mortality was observed in the patients. CONCLUSION: Our results shows that shorter operative time and less bleeding can be achieved with posterior retroperitoneal approach in synchronous bilateral laparoscopic adrenalectomy. In our series, intraoperative and postoperative complication rates were similar between both surgical approaches.

Comparison of percutaneous nephrolithotomy and retrograde intrarenal surgery outcomes for kidney stones larger than 2 cm from Guy's stone scoring system perspective.

OBJECTIVE: To compare surgical outcomes of percutaneous nephrolithotomy (PNL) and retrograde intrarenal surgeries (RIRS) as a result of kidney stones larger than 2 cm, together with Guy's stone scores (GSS). MATERIALS AND METHODS: The data of 811 patients with stone sizes 2-6 cm were operated using PNL (n = 361) and RIRS (n = 450) reviewed retrospectively. GSS were graded 1, 2, 3 or 4 according to the computed tomography findings. Stone-free rate (SFR), operation times, length of hospital stay (LOHS) and Clavien complications (CC) were recorded. RESULTS: Although mean operative times were significantly longer in the RIRS group than the PNL group in GSS grades 1, 2 and 3 (P < .001), it was similar between the two groups in GSS grade 4 (P = .186). SFRs in the PNL and RIRS group were 90.3% and 58.4% on post-operative 10th day (P < .001), and it raised up to 95.3% and 81.6% after secondary interventions (P < .001). Significantly higher SFRs observed in the PNL group in GSS grades 1, 2 and 3 categories. On postoperative 10th day, the SFRs were similar in both GSS grade 4 categories (P = .06). LOHS was longer in the PNL group (P < .001). Although LOHS was significantly longer only in GSS grade 3 (P = .043) and GSS grade 4 (P < .001) in the PNL group, it was similar in GSS grade 1 and 2 between groups. Clavien complications increased in line with GSS in the PNL group (P < .001), but the difference did not differ between GSS grade 3 and 4. CONCLUSION: SF of PNL in a single session and short operation time seems to be significant especially in GSS grades 1, 2 and 3 category stones. Although the number of patients in the GSS 4 group is very small to claim this, RIRS might be considered as an alternative to PNL in a special group of patients such as GSS grade 4 because of its lower complication rates and shorter LOHS.

Evaluating the anxiety and depression status of prostate cancer patients whose operations were postponed because of the COVID-19 pandemic.

AIM: In this study, we aimed to evaluate the anxiety and depression status of prostate cancer (PCa) patients whose planned operations in the urology clinic of our hospital, which is serving as a pandemic hospital in Turkey have been postponed because of the coronavirus disease 2019 pandemic. METHODS: This survey study was conducted at urology clinic of Ankara City Hospital between March 1 and June 1, 2020, and included 24 male patients who agreed to answer the questionnaires (State-Trait Anxiety Inventory [STAI] I and II and Beck Depression Inventory [BDI]). Demographical and clinical data (age, time since diagnosis, total serum prostate-specific antigen (PSA) levels, risk groups according to the D'Amico classification system, smoking, alcohol habitus, major surgical history and comorbidities) of the patients were collected from hospital software. RESULTS: The mean STAI-I score of the patients (46.7 ± 1.4 [44-49]) was significantly higher than their STAI-II score (41.7 ± 2.4 [39-47]) (P < .001). The negative correlation between the decrease in age and STAI-I score was found to be statistically significant (r = 0.439, P < .05). The mean BDI score of the patients was 4.3 ± 3.2 (0-13), which was compatible with mild depression. There was no statistically significant difference among the time elapsed from diagnosis, PSA levels, smoking and alcohol habitus, major surgical history and comorbidity status and STAI-I, STAI-II and BDI scores (P > .05). CONCLUSION: Prostate cancer patients with postponed operations should be guided properly in order to manage their anxiety status especially young patients.

The Impact of Minimally Invasive Pituitary Surgery on Male and Female Sexual Dysfunction in Patients with Pituitary Adenoma.

INTRODUCTION: In the present study, we prospectively investigated the impact of endoscopic transnasal trans-sphenoidal surgery (ETTS) on sexual function in male and female patients with pituitary adenoma. METHODS: The study included a total of 40 consecutive patients (male, n = 28 and female, n = 12) aged 22-65 years, who underwent ETTS for pituitary adenoma in our center between March 2019 and August 2019. Twenty-seven (67.5%) and 13 (32.5%) patients had functioning and nonfunctioning pituitary adenomas, respectively. Routine preoperative hormone levels were obtained in every patient. The tests were repeated at the postoperative third month. Preoperatively and at the postoperative third month, the 5-item version of the International Index of Erectile Function and the Female Sexual Function Index (FSFI) was used in male and female patients, respectively. RESULTS: Before surgery, 24 (85.7%) men had erectile dysfunction (ED), and 10 (83%) women had female sexual dysfunction. After surgery, all the patients' abnormal hormone parameters improved. All the male patients' ED degrees were positively affected by surgery. In women, the FSFI was significantly better than in the preoperative period. DISCUSSION/CONCLUSION: Our results showed that both males and females with pituitary adenomas benefitted from minimally invasive pituitary surgery in terms of a high-remission rate and improvement in sexual dysfunction.

Laparoscopic partial adrenalectomy using near-infrared imaging: the initial experience.

INTRODUCTION: To present our initial clinical experience with laparoscopic partial adrenalectomy using indocyanine green dye with near-infrared fluorescence imaging. MATERIAL AND METHODS: A total of eight patients underwent transperitoneal laparoscopic partial adrenalectomy using indocyanine green dye with near-infrared fluorescence imaging in our clinic. After 5 mg intravenous indocyanine green dye administration, we resected the mass under the guidance of near-infrared fluorescence imaging and white light visualization in an effort to completely excise the mass while sparing uninvolved adrenal tissue. RESULTS: Seven patients underwent unilateral and one patient underwent bilateral laparoscopic partial adrenalectomy. The median tumor size was 43 mm. The surgery was successfully performed with negative margins in all patients. The tumors were hypofluorescent relative to normal adrenal tissue with indocyanine green dye with near-infrared fluorescence imaging in patients with Cushing's syndrome, aldosteronoma, and adrenal cyst. However, pheochromocytoma and angiomyolipoma were noted to be isoflourorescent and hyperfluorescent relative to normal adrenal parenchyma, respectively. CONCLUSIONS: Laparoscopic partial adrenalectomy using intraoperative indocyanine green dye with near-infrared fluorescence imaging seems to be safe and feasible. This technology may ultimately be helpful in resecting lesions with more precise surgical margins by identifying the vascular structure during laparoscopic partial adrenalectomy. Abbreviations: LTA: Laparoscopic total adrenalectomy; LPA:Laparoscopic partial adrenalectomy; ICG: Indocynanine green; NIRF: Near-infrared fluorescence; HPA: Hypothalamic-pituitary-adrenal.

Does previous open or percutaneous renal stone surgery affect retrograde intrarenal surgery outcomes?

Background/aim: Open or percutaneous renal stone surgery can have an adverse effect on the collecting system of the kidney. We evaluated retrograde intrarenal surgery outcomes in patients with ≤30 mm renal stones who had open or percutaneous renal stone surgery history. Materials and methods: A total of 707 patients who underwent retrograde intrarenal surgery treatment were included in this study. Fifty-six patients had open or percutaneous renal stone surgery history (Group 1) and the remaining did not (Group 2, n = 651). The groups were compared in terms of age, stone size, stone-free rates, and complications. Results: The mean age of the patients was 51.16 ± 14.8 and 45.95 ± 14.6 years in Groups 1 and 2, respectively (p = 0.008). The mean stone size was 14.97 ± 6.1 mm and 16.47 ± 6.9 mm in Groups 1 and 2, respectively (p = 0.107). The stone-free rates were 71.4% and 84.1% in Group 1 and 2 respectively and it was significantly higher in Group 2 (p = 0.013). The overall rate of postoperative complications was higher in Group 1 (p = 0.019), but there was no difference between the two groups in terms of Clavien 1­2 and 3­4a complication rates. Conclusion: Our results showed that having a history of open or percutaneous renal stone surgery has a negative effect on the success and complication rates in retrograde intrarenal surgery. Therefore, patients should be well informed before this operation.

Laparoscopic Partial versus Total Adrenalectomy in Nonhereditary Unilateral Adrenal Masses.

OBJECTIVE: To compare the surgical outcomes and clinical improvement 1 year after laparoscopic partial and total adrenalectomy for the treatment of patients with nonhereditary unilateral functional adrenal adenomas. MATERIAL AND METHODS: From March 2016 to January 2018, we performed 15 laparoscopic partial adrenalectomy (LPA; Group 1) and 25 laparoscopic total adrenalectomy (LTA; Group 2) procedures. The key points reside in adenoma identification, preservation of the remaining glandular parenchyma, and its blood supply with dissection in the space between the adenoma and the normal parenchyma. The operative and clinical outcomes were compered. RESULTS: The mean age of the patients was 45.1 (17-69) years and the median follow-up was 15 (12-26) months. Operative time, blood loss, and hospital stay were similar between the groups. No major perioperative and postoperative complications occurred. After surgery, all patients had resolution of their symptoms, with no patient in Group 1 requiring steroid replacement. However, a patient in Group 2 required steroid replacement therapy. On postoperative imaging, no residual and recurrent mass was detected. CONCLUSIONS: Our results showed that LPA is safe and feasible, and has similar therapeutic results compared with LTA in patients with a nonhereditary hormonally active unilateral adrenal mass. Furthermore, LPA can obviate the need for steroid replacement in these patients.

Comparison of Monopolar and Bipolar Transurethral Resection of Non-Muscle Invasive Bladder Cancer.

OBJECTIVE: We aimed to compare the safety and efficacy of monopolar and bipolar transurethral resection (TUR) of bladder tumors (TURBTs). MATERIAL AND METHODS: A total of 240 patients who underwent TURBT were prospectively included in the study from May 2011 to May 2014. All patients with suspected bladder tumors were eligible for study inclusion. Those who refused consent and those undergoing routine restaging TURBT were excluded from analysis. Patients were divided on the basis of the monopolar arm and the bipolar arm. Study outcomes included the incidence of bladder perforation and obturator jerk, decrease in hemoglobin and sodium levels, rates of re-coagulation and blood transfusion, TUR syndrome, and operation time. RESULTS: The mean age of the patients was 62 ± 13.7 years. The incidence of obturator jerk and bladder perforation was greater in the bipolar arm. However, with a decrease in the hemoglobin and sodium levels, rates of re-coagulation and blood transfusion were greater in the monopolar arm. Statistical analysis did not show significant differences with regard to study outcomes between the groups. There was no case of TUR syndrome in the 2 arms. The residual tumors' rate was similar between the 2 groups. CONCLUSIONS: Our results showed that efficacy and safety of the monopolar and bipolar methods seems to be comparable in patients with bladder tumors.

Better life quality and sexual function in men and their female partners with short-segment posterior fixation in the treatment of thoracolumbar junction burst fractures.

PURPOSE: Thoracolumbar junction burst fractures remain a challenging problem due to controversy over the treatment choice of short- or long-segment posterior fixation. The aim of the present study was to compare life quality and sexual function of patients after short- and long-segment posterior fixations in the treatment of thoracolumbar junction burst fractures. METHODS: In this prospective, randomized study, 24 sexually active male patients diagnosed with thoracolumbar junction burst fractures were randomly assigned to either the short-segment posterior fixation (SSPF) group or the long-segment posterior fixation group (LLPF). The exclusion criteria were rheumatological disease and spinal surgery history. There were no significant differences in age, body mass index or smoking habits between the groups. The life quality score of EQ-5D and the International Index of erectile function (IIEF-5) score of male patients and the Female Sexual Function Index (FSFI) score of female partners were recorded preoperatively and 1 year after surgery. RESULTS: The mean age of patients in the SSPF and LSPF groups was 44.58 and 42.92 years, respectively. There were no statistically significant differences between the groups in the preoperative EQ-5D and IIEF-5 scores of male patients and the FSFI score of their partners. Postoperatively, the EQ-5D scores (p = 0.011) and IIEF-5 scores (p = 0.000) of male patients and the FSFI score of their partners (p = 0.001) were better in the short-segment group. CONCLUSIONS: Patients treated with SSPF have better sexual function and life quality with their partners compared to those treated with LSPF. The main clinical relevance of this study is that the impact of the choice of short or long-segment treatment on postoperative sexual function and life quality should be considered by surgeons when performing posterior fixation after thoracolumbar junction burst fractures.