The prediction of semen quality based on lifestyle behaviours by the machine learning based models.

PURPOSE: To find the machine learning (ML) method that has the highest accuracy in predicting the semen quality of men based on basic questionnaire data about lifestyle behavior. METHODS: The medical records of men whose semen was analyzed for any reason were collected. Those who had data about their lifestyle behaviors were included in the study. All semen analyses of the men included were evaluated according to the WHO 2021 guideline. All semen analyses were categorized as normozoospermia, oligozoospermia, teratozoospermia, and asthenozoospermia. The Extra Trees Classifier, Average (AVG) Blender, Light Gradient Boosting Machine (LGBM) Classifier, eXtreme Gradient Boosting (XGB) Classifier, Logistic Regression, and Random Forest Classifier techniques were used as ML algorithms. RESULTS: Seven hundred thirty-four men who met the inclusion criteria and had data about lifestyle behavior were included in the study. 356 men (48.5%) had abnormal semen results, 204 (27.7%) showed the presence of oligozoospermia, 193 (26.2%) asthenozoospermia, and 265 (36.1%) teratozoospermia according to the WHO 2021. The AVG Blender model had the highest accuracy and AUC for predicting normozoospermia and teratozoospermia. The Extra Trees Classifier and Random Forest Classifier models achieved the best performance for predicting oligozoospermia and asthenozoospermia, respectively. CONCLUSION: The ML models have the potential to predict semen quality based on lifestyles.

Comparative analysis of combined spinal-epidural anesthesia and general anesthesia in percutaneous nephrolithotomy: a prospective study on surgical team and operating room personnel satisfaction.

OBJECTIVE: We aimed to investigate the efficacy and complications of combined spinalepidural anesthesia and general anesthesia in percutaneous stone surgery prospectively. MATERIALS AND METHODS: The study prospectively included patients who underwent percutaneous nephrolithotomy with general anesthesia (Group.1) or combined spinal-epidural anesthesia (Group.2) at the Department of Urology, Training and Research Hospital, Karabuk University. between December 2018 and December 2019. The effect of the anesthesia technique on the comfort and satisfaction of the operating room personnel, surgeon and anesthesia team were prospectively evaluated and recorded. RESULTS: During the postoperative period, the spinal anesthesia group had a significantly lower visual analog score than the general anesthesia group. No patient in either group required narcotic analgesics during the postoperative period. In terms of overall satisfaction scores, the surgeon performing the surgical procedure had a significantly higher satisfaction score in the general anesthesia group than in the CSEA group. The score was considered good in the general anesthesia group and moderate in the CSEA group. Personnel satisfaction was higher in the patient group that underwent CSEA. In the general anesthesia group, the score was considered to be average. In the CSEA group, the satisfaction score was considered good, with a statistically significant difference (p < 0.05). The anesthesia team's satisfaction score was moderate, with no significant difference between the CSEA and general anesthesia groups (p > 0.05). CONCLUSION: PCNL under CSEA can be performed safely in certain individuals. Different anesthetic techniques may have varied levels of satisfaction among the surgical team.

The effect of fear of covid-19 transmission on male sexual behaviour: A cross-sectional survey study.

INTRODUCTION: In December 2019, cases of pneumonia, a new type of corona virus (SARS-CoV-2), began to be reported in Wuhan, China. We aimed to evaluate changes in sexual behaviour of men in the Covid-19 outbreak in Turkey. MATERIAL-METHOD: In our cross-sectional and descriptive study, an online questionnaire evaluating sexual habits during the Covid-19 outbreak was conducted on the men living in the Western Black Sea Region between 8 and 25 June6 2020. In the questionnaire, questions were asked to evaluate the sociodemographic data of the participants, their comprehensive medical history, their sexual preferences, their family and social life during the Covid-19 outbreak, their concerns about Covid-19 and their changes in their sexual behaviour after the Covid-19 outbreak. RESULTS: A total of 536 participants with mean age of 38.6 ± 10.3 years were included in the study. 23.9% (128) respondents stated that they had the fear of transmitting Covid-19 to their partner during sexual intercourse. It was observed that 19.4% (104) of the participants developed a fear of Covid-19 transmission from her sexual partner during the relationship. While the number of weekly sexual intercourse of the participants before the pandemic was 2.34 ± 1.35, this number was found to be 1.54 ± 1.45 during the epidemic period (P = .001). CONCLUSION: The fear of infection and transmission of the disease to the partner that occurs during the Covid-19 pandemic manifests itself in the form of a decrease in the frequency and quality of sexual intercourse.

The effect of breastfeeding on spontan resolution of monosymptomatic enuresis.

PURPOSE: The aim of this study was to examine whether the duration of breastfeeding during infancy was associated with the time of spontaneous resolution of monosymptomatic enuresis (SRME). MATERIALS AND METHODS: A total of 1500 people were surveyed at four centers. One hundred and eighty-one people with a history of monosymptomatic enuresis (ME) who received no treatment and had no day time symptoms were included in the study. The relationship between the duration of breastfeeding and SRME was assessed by considering the duration of breastfeeding as both continuous and categorical (cut-off value 5 months) variable. The multivariate general linear model was used to identify independente predictors such as gender, family history, and educational status of parents. RESULTS: Pearson correlation analysis of the age of SRME and duration of breastfeeding found no statistically significant relationship. However, there was a significant difference in the age of SRME of those who were breastfed for 5 months or less compared to those who were breastfed for more than 5 months. According to the multivariate analysis, gender and educational status of parents were not effective on the age of SRME. Stepwise linear regression model showed that breastfeeding for five months or less and family history could affect the age of SRME. The regression formula was: age of SRME=9.599 + (3.807×five months or less of breastfeeding) + (1.258×positive family history). CONCLUSIONS: It was found that when breastfeeding lasted for more than 5 months, there was a positive contribution to SRME.

The Time of Spontaneous Resolution of Monosymptomatic Nocturnal Enuresis (MNE) Is Familial.

PURPOSE: To investigate whether or not the age of spontaneous resolution of monosymptomatic nocturnal enuresis (MNE) was familial. PATIENTS AND METHODS: A questionnaire was administered to more than 1,500 people, and 100 appropriate participants were identified from four referral hospitals. We included the participants who had MNE and whose parents also had MNE with spontaneous resolution. Then the association between the spontaneous resolution time of MNE in parents and that in their children was investigated. RESULTS: The mean ages of spontaneous resolution were 10.7 (10-30 years), 9.4 (6-17 years) and 10.9 (6-18 years) in participants, their mothers and their fathers, respectively. According to the statistical analysis, there was a positive correlation between participants and both their mothers and fathers (p < 0.05). In addition, it was revealed that familial MNE history based on first- and second-degree relatives, in addition to their parents, was also associated with the increased spontaneous resolution age of MNE (p < 0.05). According to our results, gender and parents' education status were not statistically associated with the spontaneous resolution (p > 0.05). CONCLUSION: As a conclusion, the age of spontaneous resolution of MNE is familial. Although the exact reasons of spontaneous resolution still remain a mystery; further genetic investigations may be able to resolve this mystery.

Content quality and reliability of the YouTube videos about chronic prostatitis.

Background: YouTube is one of the most used social media platforms for accessing health information. Objective: To evaluate the quality and reliability of YouTube videos about chronic prostatitis. Methods: YouTube search using the keywords "kronik prostatit" for Turkish videos and 'chronic prostatitis' for English videos were done. The videos were evaluated through modified-Quality Criteria for Consumer Health Information (DISCERN), the Journal of the American Medical Association (JAMA), the Global Quality Scale (GQS), and Video Power Index (VPI) scoring systems. The characters of the videos were also recorded and analyzed. Results: Of the 65 Turkish videos, videos of health professions (HPv) were uploaded 58 and seven videos of non-professional in health (NPv). There were no significant differences between the views, like counts, VPI, or the content quality and reliability of HPv and NPv. Of the 62 English videos, videos of HP were uploaded 40 and 22 videos of non-professional in health. Although HPv were found to have greater DISCERN and JAMA values, Lv had more views, view ratio, and Video Power Index than HPv. When all 127 videos were evaluated regardless of the language, NPv were found to have more total views and ratings, but there were no significant differences between like ratio, VPI, DISCERN, JAMA, and GQS values between the two groups. Conclusion: Most YouTube videos about chronic prostatitis did not have enough quality and reliable information. Health associations should be more attentive to posting more content videos of sufficient quality and reliability on social media platforms.

Antecedentes: YouTube es una de las plataformas de medios sociales más utilizadas para acceder a información sobre salud. Objetivo: Evaluar la calidad y fiabilidad de los vídeos de YouTube sobre prostatitis crónica. Métodos: Se realizaron búsquedas en YouTube utilizando las palabras clave "kronik prostatit" para los vídeos en turco y 'prostatitis crónica' para los vídeos en inglés. Los vídeos se evaluaron mediante los sistemas de puntuación: Criterios de calidad modificados para la información en salud consultada por publico en general (DISCERN), el Journal of the American Medical Association (JAMA), the Global Quality Scale (GQS) y el Video Power Index (VPI). También se analizaron los vídeos. Resultados: De los 65 vídeos turcos, se analizaron 58 vídeos de profesionales en salud (HPv) y siete vídeos de no profesionales (NPv). No hubo diferencias significativas entre los videos vistos, los recuentos, el VPI o la calidad y fiabilidad del contenido de HPv y NPv. De los 62 vídeos en inglés, se analizaron 40 vídeos de HPv y 22 vídeos de no profesionales en salud. Aunque se observó que los HPv tenían mayores valores DISCERN y JAMA, los NPv tenían más visionados, ratio de visionados e Índice de Poder de Vídeo que los HPv. Cuando se evaluaron los 127 vídeos independientemente del idioma, se observó que los NPv tenían más visualizaciones y valoraciones totales, pero no hubo diferencias significativas entre los valores de like ratio, VPI, DISCERN, JAMA y GQS entre los dos grupos. Conclusiones: La mayoría de los vídeos de YouTube sobre prostatitis crónica no tenían suficiente calidad e información fiable. Las asociaciones de salud deberían estar más comprometidas para la publicación de vídeos con contenido mas fiable y con mayor calidad, en las plataformas de las redes sociales.

Hydrocele with Paratesticular Liposarcoma.

Paratesticular liposarcoma (PLS) is a rare type of genitourinary malignancy in the spermatic cord presenting as scrotal swelling. In this case study, we report an 82-year male who presented with prolonged left scrotal swelling and pain that did not respond to analgesic treatment for one week. His ultrasound confirmed increased fluid content in the left scrotal compartment in the form of septated hydrocele, and hydrocelectomy was planned. During the operation, infected fluid was drained. The testicle and surrounding tissues were infected; hence, left orchiectomy was performed. The pathological examination revealed a dedifferentiated liposarcoma. To our knowledge, this is the first report of liposarcoma of the spermatic cord with hydrocele in the literature. Key Words: Liposarcoma, Spermatic cord, Scrotal swelling, Hydrocele.

Comparison of retrograde intrarenal surgery and percutaneous nephrolithotomy in multiple calyceal stones: A match pair analysis of 190 cases. / Comparación entre cirugía retrograda intrarenal (CRIR) y nefrolitotomía percutánea (NLP) en litiasis caliciales múltiples: análisis pareado de 190 casos.

OBJECTIVES: The current nephrolithia-sis guidelines have no recommendation about multiple calyceal stones treatment. We aimed to compare the results of two effective methods of RIRS and PNL operations in the treatment of multicalyx stones. METHODS: Data of patients who underwent RIRS or PNL for multicalyx stones between September 2014 and May 2019 in our clinic were evaluated retrospectively. In both groups, stone-free and complication rates, hospital stay, scopy times, and operation times were examined. In RIRS group, the number of sessions and total stone-free rates at the end of each session were evaluated separately. RESULTS: A total of 162 patients in the RIRS group, and 103 patients in the PNL group were evaluated. After the match pair 1:1, data of 95 patients were selected in each group. Stone burden, number, density, ASA scores, BMI were similar in both groups. At the end of the first session RIRS, 59 (62.1%) patients became stone-free, while in the PNL group 73 (76.8%) patients (p: 0.027). The statistical analysis showed that the stone-free rates obtained in the second sessions in the RIRS group were similar to those of the PNL group. After a total of 124 sessions of RIRS, a stone-free rate of 81.1% was achieved by 1.3 sessions on average. CONCLUSION: At least two session of RIRS is as effective as PNL on multiple calyceal stones. Stage RIRS can be an alternative to PNL at multicalyceal renal stones.

OBJETIVOS: Las guías actuales de nefrolitiasis no tienen recomendaciones sobre el tratamiento de litiasis caliciares múltiples. Nuestro objetivo es comparar los resultados de 2 métodos de tratamiento efectivos de CRIR y NLP en el tratamiento de litiasis mul-ticaliciares.MÉTODOS: Los datos de pacientes que recibieron CRIR y NLP para el tratamiento de litiasis múltiples caliciares entre septiembre 2014 y mayo 2019 en nuestra clínica, fueron evaluados retrospectivamente. En ambos grupos, la tasa libre de litiasis y las complicaciones, la estancia hospitalaria, el tiempo de escopia, y el tiempo quirúrgico fueron examinados. En el grupo CRIR, el número de sesiones y la tasa libre de litiasis al final de cada sesión fueron evaluadas de forma independiente. RESULTADOS: Un total de 162 pacientes en el grupo CRIR y 103 en el grupo NLP fueron evaluados. Después del emparejamiento de pacientes 1:1, los datos de 95 pacientes fueron seleccionados en cada grupo. El volumen litiásico, número, densidad, ASA, IMC fueron similares entre grupos. Al final de la primera sesión de CRIR, 59 (62%) pacientes llegaron a ser libres de litiasis, mientras que en grupo de NLP fueron 73 (76/8%) (p=0,027). El análisis estadístico demostró que las tasas libres de litiasis obtenidas en la segunda sesión de CRIR fueron similares a las de NLP. Después de un total de 124 sesiones de CRIR, la tasa libre de litiasis fue de 81,8% en una media de 1,3 sesiones. CONCLUSIONES: Como mínimo dos sesiones de CRIR es tan efectivo como una NLP en litiasis calicares múltiples. CRIR en múltiples sesiones puede ser una alternativa a la NLP para litiasis caliciares múltiples.

Safety and efficacy of retrograde intrarenal surgery in geriatric patients by age groups.

PURPOSE: To evaluate the effects of aging on the success rate of retrograde intrarenal surgery (RIRS) and the development of medical and surgical complications by dividing geriatric patients into subgroups based on their chronological age. METHOD: Data of the patients who underwent RIRS due to kidney stones at our clinic between June 2014 and January 2020 were retrospectively reviewed. Patients were divided into three groups based on age: 65-74 years (Group 1), 75-84 years (Group 2), and ≥ 85 years (Group 3). The comorbid diseases of patients were evaluated using the Charlson Comorbidity Index (CCI), total Cumulative Illness Rating Scale for Geriatrics (CIRS-G) score, and CIRS severity index (CIRS-G SI). RIRS success rates and complications were evaluated based on age groups. RESULTS: A total of 336 patients were included in the study. The mean age of the patients was 72.7 ± 6.59 years. Stone-free rate was 81.5% in patients aged > 65 years and did not change with age. The modified Clavien-Dindo grade I/II complication rates for surgical complications were similar in all three groups (p = 0.818). In the evaluation of ROC analysis for medical complications, it was observed that the cut-off values were 76.5 years, CIRS-G score of 4.5, CCI score of 2.5, and CIRS-SI score of 1.18 (p < 0.001). CONCLUSION: RIRS is an effective and safe treatment option for kidney and proximal ureteral stones in geriatric patients. Although there is an increase in medical complications post-RIRS with aging, surgical complications and stone-free rates remain unchanged.

YouTube as a source of premature ejaculation.

INTRODUCTION AND OBJECTIVES: To evaluate the quality of information in You Tube videos pertaining to premature ejaculation. MATERIALS AND METHODS: A search for "premature ejaculation" (PE) was performed on You Tube in August 2018. Two senior urologist viewers watched and categorized each video for their sources, suggestions and information contents (excellent, fair or poor). RESULTS: Of the three hundred videos viewed on You Tube, 155 videos were included and analyzed. Mean video length (mean±standard deviation) was 3.08±2.02min. The information content was excellent only in 17 (10.9%) of all videos while for a majority of them it was poor (57.4% n=89). Fair videos constituted 31.7% (n=49) of the videos. There was no relation between the trustworthiness of the videos' contents and either their viewings or ratings (p=0.561, p=0.0966, respectively). Videos uploaded by health professionals were more reliable than those uploaded by laypersons (p<0.001). CONCLUSIONS: The study suggests that although some videos, especially those uploaded by healthcare professionals, are useful; the majority of them have misleading information. Therefore, they are not a reliable source of PE information for patients. It is incumbent on urologists to counsel patients for other available useful internet information sources on PE.

Ureteral Access Sheath Application Without Fluoroscopy in Retrograde Intrarenal Surgery.

OBJECTIVE: To compare the results and complications of the two techniques of ureteral access sheath application, with and without using fluoroscopy. STUDY DESIGN: A comparative study. PLACE AND DURATION OF STUDY: Department of Urology, Karabuk University Medical Faculty Training and Research Hospital and Ankara Diskapi Yildirim Beyazid Training and Research Hospital between April 2014 and January 2018. METHODOLOGY: Retrospective evaluation was made of patients applied with retrograde intrarenal surgery using ureteral access sheath (UAS). In Group 1, defined method were used for UAS application without using scopy. In Group 2, following semi-rigid ureterorenoscopy, localisation of guidewire was checked with fluoroscopy. UAS was advanced to ureter over guidewire under fluoroscopy imaging. RESULTS: Success rate of UAS placement was similar in both groups (p=0.747). The time of UAS placement was 14.75 secs in Group 1 and 14.99 secs in group 2 (p=0.073). Fluoroscopy was not used at all during UAS placement in Group 1. In Group 2, the mean duration of fluoroscopy use was 9.93±3.89 secs. Total stone-free rate was 82.09% and 83.28% in Group 1 and 2, respectively. (p=0.653). CONCLUSION: The method described in this paper provides protection against radiation exposure for both the patient and the operating team; and prevents potential complications by enabling clear evaluation of ureteral orifice. Key Words: Renal stone surgery, Retrograde intrarenal surgery, Radiation protection, Flouroscopy, Radiation free.

The effect of modifiable lifestyle factors on semen quality.

INTRODUCTION AND OBJECTIVES: To examine the association between lifestyle factors (body mass index, smoking, alcohol consumption, coffee intake, physical activity, sauna and cell phone usage, wearing tight-fitting underwear), and conventional semen parameters. MATERIALS AND METHODS: 1311 participants who attended the Andrology Clinic were included in the study. All participants were separated into two groups as men with normozoospermia and dysspermia. All participants answered a questionnaire which contains questions about the modifiable lifestyle factors. The total risk scores were calculated after all the positive lifestyle factors had been counted. RESULTS: Men with normozoospermia and dysspermia consisted of 852 (65.0%) and 459 (35.0%) participants respectively. A negative relationship between the wearing of tight underwear and having normal semen parameters was detected between the two groups (p=0.004). While going to a sauna regularly was negatively related to semen concentration, wearing tight underwear was also related to both lower motility, normal morphology as well as semen concentration (p<0.05). While the total score of all participants was 5.22±1.34 point, there were no statistical differences between the two groups (p=0.332). It was found that having 3 more or fewer points was not related to any type of semen parameters and results of a spermiogram. CONCLUSION: The clinicians should give advice to infertile male patients about changing their risky lifestyle, for infertility, to a healthy lifestyle for fertility. Better designed studies, with larger sample sizes using conventional semen analysis with sperm DNA analysis methods, should be planned to identify the possible effects of lifestyle factors on semen quality.

The Predictive Role of Abdominal Fat Parameters and Stone Density on SWL Outcomes.

BACKGROUND: Our aim was to detect the role of radiological abdominal fat parameters by tomography and stone density by plain X-ray on extracorporeal Shock Wave Lithotripsy (SWL) stone-free rate. METHODS: The patients who had undergone SWL for a single opaque renal stone < 2 cm in diameter and proximal ureteric stone < 1 cm in diameter were collected retrospectively. The characteristics of patients and stones were recorded. The stone attitude, HU, abdominal fat parameters, paraperirenal fat area, perirenal infiltration and severity of hydronephrosis with pre-treatment Non- Contrast Computed Tomography (NCCT) and stone density with radiography were evaluated by a radiologist. Four weeks after the last SWL; all patients were evaluated by plain X-ray and categorized as Stone Free (SF) and Residual Fragment (RF) group. RESULTS: 51 patients with renal stones and 88 patients with proximal ureteral stones were included in the study. 24 (47%) and 63 (71%) patients were classified as SFfor renal and ureteral stones respectively. Only stone size was an independent predictor for stone-free rates after SWL for renal and proximal ureteral stones on multivariate analysis. The Receiver Operating Characteristic (ROC) curves for renal calculi revealed that creatinine level, stone size, stone attitude, Houns-Field Unit (HU) and Skin-to-Stone Distance (SSD) were the predictive factors for the SWL outcome (p< 0.05). The ROC curve for ureteral calculi demonstrated that HU, stone size and attitude were the predictive factors (p< 0.05). CONCLUSION: All abdominal fat parameters and the stone density were not related to SWL failure. A large follow-up with more patients is essential to confirm the role of radiological parameters on the outcome of SWL.

Outcomes with ureteral access sheath in retrograde intrarenal surgery: a retrospective comparative analysis.

BACKGROUND: Retrograde intrarenal surgery is used for treatment of urinary system stones. The ureteral access sheath (UAS) is used to decrease intrapelvic pressure, help with access of multiple instruments, and facilitate drainage and removal of the fragmented stones. OBJECTIVE: Assess the effect of the UAS on the outcomes of retrograde intrarenal surgery. DESIGN: A retrospective patient data review. SETTING: Training and research hospital in Turkey. PATIENTS AND METHODS: We reviewed the data of patients who had undergone retrograde intrarenal surgery between 2012-2019. Patients who had kidney anomalies, were <18 years old, and who had ureteral and urethral strictures were excluded from the study. The demographic characteristics, stone type, complications, intraoperative and postoperative data of the patients were reviewed. A successful outcome was defined as being stone free or having clinically insignificant residual fragments (<3 mm). The use of the UAS was compared with other procedures in terms of efficiency and safety. Factors determining UAS usage were assessed by multivariate analysis. MAIN OUTCOME MEASURES: Stone free rate and complication rate in patients who underwent retrograde intrarenal surgery. SAMPLE SIZE: 1808 patients met inclusion criteria. RESULTS: The UAS was used in 1489 procedures, while other methods were used in 319 procedures. Operation time was 46.9 (17.3) minutes and 42.9 (19.0) minutes with other methods. Postoperative double J stent usage rates were 88.2% and 63% in the UAS and other methods, respectively. The rate of successful outcome was 88.2% and 81.2% in the UAS and other methods, respectively (P<.001). The rate of complications was similar in both groups (P=.543). In a multivariate analysis, UAS usage was directly proportional with stone size and inversely proportional with preoperative JJ stent usage CONCLUSION: The UAS can be effectively and successfully used in retrograde intrarenal surgery for treatment of urinary system stones. UAS usage should be considered for the patients who have large stones (2 cm) and do not have a preoperative double J stent. LIMITATIONS: Retrospective design. CONFLICT OF INTEREST: None.

Fixation of the glans penis and urethral catheter to the abdominal skin to avoid wound dehiscence after a hypospadias surgery: A comparative study.

OBJECTIVE: To evaluate the effect of glanular and urethral catheter fixation to the abdominal skin on wound dehiscence. MATERIAL AND METHODS: After a standard tubularized incised plate urethroplasty (TIPU) for hypospadias repair, 128 patients were divided into two groups based on glanular and urethral catheter fixation to the abdominal skin as follows: no glanular and urethral catheter fixation (Group A) and glanular and urethral catheter fixation (Group B). Groups A and B included 61 and 67 patients, respectively. RESULTS: No significant difference was determined between the groups with respect to age, meatal localization, and length of hospital stay. Wound dehiscence was noted in 13.1% and 2.9% patients in Groups A and B, respectively, after surgery (p=0.029, odds ratio=4.9). Patients in Group B had no excessive analgesic usage and unpleasant scarring due to the glans suture. CONCLUSION: Glanular and urethral catheter fixation to the lower abdominal skin considerably reduced wound dehiscence after hypospadias repair.

A different perspective for morbidity related to Fournier's gangrene: which scoring system is more reliable to predict requirement of skin graft and flaps in survivors of Fournier's gangrene?

PURPOSE: To identify the prognostic factors that might predict morbidity related to Fournier's gangrene (FG) and particularly requirement of skin grafting and flaps. We also evaluated the validities of different severity indexes. METHODS: Thirty male patients with complete data who were treated for FG between January 2012 and December 2018 were retrospectively evaluated. Fournier's Gangrene Severity Index (FGSI), Uludag Fournier Gangrene Severity Index (UFGSI) and Age-Adjusted Charlson Comorbidity Index (ACCI), Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score, the Combined Urology and Plastics Index (CUPI) and neutrophil-lymphocyte ratio (NLR) were calculated for 27 surviving patients. These patients were divided into two groups: Group I (14 patients with primary skin closure) and Group II (13 patients with requiring skin grafting and flaps). RESULTS: Body temperature (p = 0.026), heart rate (p < 0.001), respiratory rate (p = 0.029), creatinine (p = 0.002), white blood cell count (p = 0.014), hemoglobin levels (p = 0.018), involvement of pelvic floor or beyond (p = 0.018), length of hospital stay (p = 0.049), previous endourologic instrumentation (p = 0.035), requirement of cystostomy (p = 0.041), colostomy (p = 0.046), orchiectomy (p = 0.034) and intensive care unit (p = 0.046) were found to be significantly higher in Group II. All six different scoring systems were significantly higher in the patients who underwent skin grafting and flaps. In multivariate analysis, heart rate, FGSI, UFGSI, NLR, requirement of colostomy and intensive care unit were determined as independent factors for predicting requirement of skin grafting and flaps. CONCLUSION: FGSI, UFGSI and NLR are more reliable parameters for predicting skin reconstruction method (with the threshold values of 4.5, 5.5, and 7.87, respectively).

2% Lidocaine gel or plain lubricating gel: Which one should be used in male flexible cystoscopy?

OBJECTIVE: To investigate and compare the effects on pain of intraurethral 2% lidocaine gel and plain lubricating gel in male patients underwent flexible cystoscopy. MATERIAL AND METHODS: The data of 220 male patients who underwent flexible cystoscopy between March 2012 and August 2014 were retrospectively analized. The patients were divided into 2 groups according to using intraurethral gel types. Group I included 120 patients who were underwent flexible cystoscopy with 2% lidocaine gel and Group II was consisted from 100 patients who underwent flexible cystoscopy with plain lubricating gel. The groups were compared according to postprocedure data including pain score, procedure time and age of patients. RESULTS: The mean age of the patients in Group I was 50.02±11.87 years while that in Group II was 52.03±13.37 years (p=0.492). The mean procedure times were 6.02±0.787 and 6.28±0.689 minutes in Group I and Group II respectively (p=0.061). Pain perception scores were not statistically different between the groups (Group I: 3.10±0.980, Group II: 3.34±0.789, p=0.132). CONCLUSION: Use of intraurethral 2% lidocaine gel has no advantage over plain lubricating gel in regard to pain control during flexible cystoscopy in men.

Penile degloving and dorsal dartos flap rotation approach for the management of isolated penile torsion.

OBJECTIVE: Penile torsion is a counterclockwise rotational anomaly of the penile shaft or glans. We aimed to evaluate the outcomes of penile degloving and dorsal dartos flap rotation used for the repair of isolated penil torsion. MATERIAL AND METHODS: During evaluation of the patients admitted to our polyclinic for circumcision between January 2013-December 2014, 5 cases of isolated penile torsion were determined. Following the circumcision procedure performed with bipolar cautery, patients undergoing penile degloving were checked whether penile torsion was relieved or not. In case of insufficient improvement, torsion was corrected with application of dorsal dartos flap. Penile torsion was corrected with dartos flap in 2, and penile degloving in 3 cases. RESULTS: The mean age of the patients was 5.6 years (4-7), and the mean operative time 12 minutes (7-20), respectively. The mean operation time was 17.5 (15-20) minutes and 8.3 (7-10) minutes in the dorsal dartos flap and penile degloving groups, respectively. The preoperative mean degree of penile torsion was 50° (30°-70°). The mean degree of torsion was 65° and 40° in the dorsal dartos and penile degloving groups, respectively. During the postoperative follow up, 1 case of residual torsion (<10°) was observed in the dorsal dartos flap group. Residual torsion was not observed in other patients. CONCLUSION: Exploration for isolated cases of penile torsion during the circumcision procedure should not be overlooked. Successful results can be obtained with penile degloving and dartos flap rotation in cases with low and moderate torsion.

Comparison of retrograde intrarenal surgery and percutaneous nephrolithotomy in multiple calyceal stones: a match pair analysis of 190 cases / Comparación entre cirugía retrograda intrarenal (CRIR) y nefrolitotomía percutánea (NLP) en litiasis caliciales múltiples: análisis pareado de 190 casos

OBJECTIVES: The current nephrolithiasis guidelines have no recommendation about multiple calyceal stones treatment. We aimed to compare the results of two effective methods of RIRS and PNL operations in the treatment of multicalyx stones. METHODS: Data of patients who underwent RIRS or PNL for multicalyx stones between September 2014 and May 2019 in our clinic were evaluated retrospectively. In both groups, stone-free and complication rates, hospital stay, scopy times, and operation times were examined. In RIRS group, the number of sessions and total stone-free rates at the end of each session were evaluated separately. RESULTS: A total of 162 patients in the RIRS group, and 103 patients in the PNL group were evaluated. After the match pair 1:1, data of 95 patients were selected in each group. Stone burden, number, density, ASA scores, BMI were similar in both groups. At the end of the first session RIRS, 59 (62.1%) patients became stonefree, while in the PNL group 73 (76.8%) patients (p: 0.027). The statistical analysis showed that the stonefree rates obtained in the second sessions in the RIRS group were similar to those of the PNL group. After a total of 124 sessions of RIRS, a stone-free rate of 81.1% was achieved by 1.3 sessions on average. CONCLUSION: At least two session of RIRS is as effective as PNL on multiple calyceal stones. Stage RIRS can be an alternative to PNL at multicalyceal renal stones

OBJETIVOS: Las guías actuales de nefrolitiasis no tienen recomendaciones sobre el tratamiento de litiasis caliciares múltiples. Nuestro objetivo es comparar los resultados de 2 métodos de tratamiento efectivos de CRIR y NLP en el tratamiento de litiasis mul-ticaliciares. MÉTODOS: Los datos de pacientes que recibieron CRIR y NLP para el tratamiento de litiasis múltiples caliciares entre septiembre 2014 y mayo 2019 en nuestra clínica, fueron evaluados retrospectivamente. En ambos grupos, la tasa libre de litiasis y las complicaciones, la estancia hospitalaria, el tiempo de escopia, y el tiempo quirúrgico fueron examinados. En el grupo CRIR, el número de sesiones y la tasa libre de litiasis al final de cada sesión fueron evaluadas de forma independiente. RESULTADOS: Un total de 162 pacientes en el grupo CRIR y 103 en el grupo NLP fueron evaluados. Después del emparejamiento de pacientes 1:1, los datos de 95 pacientes fueron seleccionados en cada grupo. El volumen litiásico, número, densidad, ASA, IMC fueron similares entre grupos. Al final de la primera sesión de CRIR, 59 (62%) pacientes llegaron a ser libres de litiasis, mientras que en grupo de NLP fueron 73 (76/8%) (p = 0,027). El análisis estadístico demostró que las tasas libres de litiasis obtenidas en la segunda sesión de CRIR fueron similares a las de NLP. Después de un total de 124 sesiones de CRIR, la tasa libre de litiasis fue de 81,8% en una media de 1,3 sesiones. CONCLUSIONES: Como mínimo dos sesiones de CRIR es tan efectivo como una NLP en litiasis calicares múltiples. CRIR en múltiples sesiones puede ser una alternativa a la NLP para litiasis caliciares múltiples

The effect of breastfeeding on spontan resolution of monosymptomatic enuresis

ABSTRACT Purpose The aim of this study was to examine whether the duration of breastfeeding during infancy was associated with the time of spontaneous resolution of monosymptomatic enuresis (SRME). Materials and Methods A total of 1500 people were surveyed at four centers. One hundred and eighty-one people with a history of monosymptomatic enuresis (ME) who received no treatment and had no day time symptoms were included in the study. The relationship between the duration of breastfeeding and SRME was assessed by considering the duration of breastfeeding as both continuous and categorical (cut-off value 5 months) variable. The multivariate general linear model was used to identify independent predictors such as gender, family history, and educational status of parents. Results Pearson correlation analysis of the age of SRME and duration of breastfeeding found no statistically significant relationship. However, there was a significant difference in the age of SRME of those who were breastfed for 5 months or less compared to those who were breastfed for more than 5 months. According to the multivariate analysis, gender and educational status of parents were not effective on the age of SRME. Stepwise linear regression model showed that breastfeeding for five months or less and family history could affect the age of SRME. The regression formula was: age of SRME=9.599 + (3.807×five months or less of breastfeeding) + (1.258×positive family history). Conclusions It was found that when breastfeeding lasted for more than 5 months, there was a positive contribution to SRME.