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

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

White blood cell counts and neutrophil to lymphocyte ratio in the diagnosis of testicular cancer: a simple secondary serum tumor marker.

PURPOSE: The aim of the study was to investigate white blood cell counts and neutrophil to lymphocyte ratio (NLR) as markers of systemic inflammation in the diagnosis of localized testicular cancer as a malignancy with initially low volume. MATERIALS AND METHODS: Thirty-six patients with localized testicular cancer with a mean age of 34.22±14.89 years and 36 healthy controls with a mean age of 26.67±2.89 years were enrolled in the study. White blood cell counts and NLR were calculated from complete blood cell counts. RESULTS: White blood cell counts and NLR were statistically significantly higher in patients with testicular cancer compared with the control group (p<0.0001 for all). CONCLUSIONS: Both white blood cell counts and NLR can be used as a simple test in the diagnosis of testicular cancer besides the well-known accurate serum tumor markers as AFP (alpha fetoprotein), hCG (human chorionic gonadotropin) and LDH (lactate dehydrogenase).

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

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

Should oncological cases of upper urinary system be excluded at the beginning of the laparoscopic learning curve?

PURPOSE: The place of oncological cases of upper urinary system in the laparoscopic learning curve was investigated. MATERIALS AND METHODS: A total of 139 patients from two different centers underwent laparoscopic operations and were included in this retrospective study. RESULTS: Mean operative times for oncological, and non-oncological cases were 101.3 (range 60-450), and 102.7 (45-490) minutes respectively. Fourty-two (31.3 %) patients were oncological cases. In 4 oncological cases, the surgeons switched to open surgery because of massive bleeding and six (14.2 %) oncological cases required blood transfusions during peri/postoperative periods. Pulmonary embolism was observed in one oncological case. In one non-oncological case, the surgeon switched to open surgery because of intestinal perforation and 10 (9.7 %) non-oncological cases needed blood transfusions during peri/postoperative periods. In addition, some complications such as intestinal perforation (n=1), mechanical ileus (n=1), and pulmonary embolism (n=1) were observed during postoperative period. Intestinal perforation was repaired using laparoscopic (n=1) method. Mechanical ileus was approached with open surgical technique. Mean hospital stay of the patients in the oncological and non-oncological series were 4.5 (3-23) and 4.5 (3-30) days respectively. CONCLUSION: We think that renal oncological cases should be included in the spectrum of laparoscopic indications even at the beginning of the learning curve. Certainly, we still share the opinion that cancer cases which require highly challenging surgeries like radical cystectomy, and prostatectomy should be postponed till to gaining of higher level of experience.

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

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

Comparison of three analgesic treatment protocols for pain management during extracorporeal shock wave lithotripsy.

INTRODUCTION: In this prospective and randomized study, we aimed to compare the efficacy of a eutectic mixture of local anesthetics (EMLA) cream, diclofenac sodium (DS) and EMLA in combination with DS (EMLA+DS) for pain management during extracorporeal shock wave lithotripsy (ESWL). PATIENTS AND METHODS: 120 patients who had undergone ESWL for renal stones were included in the study. The patients were randomized into three groups: the first group was treated with a eutectic mixture of local anesthetics cream (EMLA), while intramuscular DS was applied to the second group and EMLA+DS was applied to the third group. Pain during ESWL was assessed with the 10-score linear and visual analogue pain scale and was compared between groups. RESULTS: Mean age was 44.4 +/- 1.9 years. There was no statistically significant difference between groups regarding patients' mean age, weight, stone size, shock waves, duration of ESWL and energy level values (p > 0.05). The mean pain score during ESWL was 3.90 +/- 0.16 in the EMLA group, 3.28 +/- 0.18 in the DS group and 3.05 +/- 0.18 in EMLA+DS group (p = 0023). CONCLUSION: DS appears to be more efficient than EMLA in reducing pain during ESWL. Using EMLA+DS has no superiority in relieving pain compared to DS-only treatment.

The comparative analysis of the three dilatation techniques in percutaneous nephrolithotomy: Which one is safer?

OBJECTIVES: Introduction of the "access sheet" is one of the most important steps steps of the percutaneous nephrolithotomy (PNL) intervention. In creating the access tract, various dilatators (balloon, metal) are used and different need-based dilatation tools were developed. In this study, we aimed to compare the mechanical Amplatz dilatation (AD), balloon dilatation (BD) and one-shot dilatation (OSD) methods in a retrospective manner. METHODS: A total of 182 patients (127 males and 55 females), who underwent PNL surgery in Urology Department of Fatih Sultan Mehmet Research and Training Hospital between January 2016 and September 2018, were included in this study. RESULTS: The average age was 47.34 ± 12.68 years (age range 15-80) and average BMI was 27.15 ± 5.01 kg/m2 (range between 17.12 and 40.75 kg/m2). There was a prominent difference in terms of operation duration (p = 0.032). Meaningful difference was found among the groups in terms of dilation fluoroscopy time (p = 0.001), with a notable shorter time in OSD group than the others (p < 0.05). Beside this, there was no difference between the AD and BD groups in terms of fluoroscopy times (p > 0.05). Also, there was no difference among the groups by Clavien complication rate (p > 0.05). There was a prominent difference among the groups in terms of hemoglobin decrement (p = 0.012; p < 0.05). The hemoglobin decrease in OSD group was significantly lower than in AD and BD groups (p < 0.05; p < 0.01). On the contrary, there was no meaningful difference between AD and BD groups with this regard (p > 0.05). CONCLUSIONS: As a result, we have concluded that the use of OSD modality in PNL interventions could be superior to other methods with respect to its feasibility, cost-effectiveness, shorter radiation exposure / fluoroscopy time and it could be a preferable way of treatment especially in developing countries.

Our Results of Laparoscopic Partial Nephrectomies Without Pedicle Dissection: Possible Advantages and Disadvantages.

OBJECTIVES: This study aimed to document the surgical and oncologic results of nephron sparing of non-ischemic laparoscopic partial nephrectomy without the step of hilus controlling and even without dissecting to expose the main renal vascularity and directly focusing on mass removal. MATERIALS & METHODS: The records of the patients who underwent our modified laparoscopic partial nephrectomy technique were evaluated retrospectively. The patients' medical records, including tumor complexity calculated via R.E.N.A.L nephrometry scores, operation time, estimated blood loss, blood transfusions, hospital stay, pre- and postoperative serum creatinine levels, complications via the Clavien classification system, pathological status of surgical margin, and follow-up times, were documented. RESULTS: The data of 55 patients with 58 renal units were evaluated. Almost all tumors were in the low complex group (91%), with a mean size of 31.74 ± 7.38 mm (range: 12-46 mm). Mean operation time, estimated blood loss, and transfusion rates were 138.62 ± 38.45 minutes (range: 90-240 min), 242.24 ± 107.12 mL (range: 100-500 mL), and 19%, respectively. The hemoglobin level decreased by a mean of 2.05 ± 0.87 g/dL. Whereas the perioperative complications were Clavien grades I, II, and III (74%, 23%, and 3%, respectively), mean hospital stay and follow-up time were 4.05 ± 1.97 and 19.67 ± 13.57 (ranges: 2-10 days and 1-44 months), respectively. CONCLUSION: Present un-controlled results pointed that tumor-focusing nephron-sparing non-ischemic partial laparoscopic nephrectomy may be preferable for small-sized, low-complex renal masses.

The effect of sleeve gastrectomy technique on women's sexual function: A prospective study.

INTRODUCTION: Obesity may lead to a serious deterioration in general quality of daily life and sexual functionality. Bariatric surgery is the most effective treatment method for obesity and related morbidities so far and it is better than some medical treatment modalities. In this study, we aimed to investigate the effects of bariatric surgery and especially sleeve gastrectomy, which has been currently performed in increasing numbers on female sexual functions and quality of life. MATERIALS AND METHODS: A total of 53 patients were included to the current study. The participants were selected from eligible individuals who have undergone laparoscopic sleeve gastrectomy operation in our center between April 2014 and March 2015 dates. Age, body weights and body mass indexes (BMIs) of the patients were pre-operatively recorded. The patients have completed the Female Sexual Function Index (FSFI), Beck Depression Scale and SF-36 (Short form-36) forms before and after the surgery. Additionally, post-operative decrease in body weights and mean BMI were recorded. RESULTS: Following bariatric surgery, sexual functions of the female patients improved and total FSFI scores increased. When FSFI scores were analyzed, it was observed that sexual desire, sexual arousal, lubrication, orgasm and sexual satisfaction increased, while the pain parameter has not changed. CONCLUSION: Recent literature reveals that unfavorable effects of increasingly prevalent obesity on sexual functions cannot be denied. We think that sleeve gastrectomy can obtain considerable weight loss, improvement in self-esteem, decrease in anxiety, amelioration in sexual functions and general quality of life.

No-cable and smartphone/tablet: A functional laparoscopic training box "Fu-Lap T-Box".

Because of the long and variable learning curve of laparoscopic surgery, before its actual application, a well-designed practical simulating instruments like laparoscopic training boxes are needed. But because of unfavourable cost-effectiveness and huge sizes of these boxes, surgeons hardly procure, and carry them. We aimed to design a new, cheap, light and handy laparoscopic training box. Our training box is made of aluminium and used with smartphone or tablet. There is no need for a power unit. Our foldable box has dimensions of 52×38×4 cm, and weighs 2.8 kg and foldable. There are 5 working ports in it. Compared to its alternatives "Fu-Lap T-Box" is much cheaper, lighter and more comfortable. In our opinion it is possible to design and use a new cheaper and portable simulator to gain more hands-on experience before the real surgery.

The effect of darbepoetin alfa on renal fibrosis in rats with acute unilateral ureteral obstruction.

OBJECTIVES: The most important treatment strategy for obstructive nephropathy is to protect renal tissue from the deleterious effects of fibrosis. Therefore, we sought to investigate the renoprotective effects of darbepoetin alfa on unilateral ureteral obstructions. METHODS: We used 12 female and 12 male 3-monthold Wistar rats weighing between 250 and 350 g. The rats were divided equally into sham, darbepoetin and control groups. With the exception of the sham group, left unilateral obstructions were applied to all of the rats. The darbepoetin group received perioperative darbepoetin alfa at a dose of 10 mg/kg. The rats were sacrificed on postoperative day 7, and 3-cc blood samples and bilateral renal specimens were collected from each rat. RESULTS: Renal ectasia was observed significantly less frequently in the darbepoetin group than the obstruction group (p<0.001). Additionally, the uptake rates of cortical TNF and medullary SMA in the darbepoetin group were comparable to those in the sham group but lower than those in the ureteral obstruction group (p<0.001 and p<0.008, respectively). When biomarkers of renal injury, including cystatin-C, malondialdehyde, and B2 microglobulin, were evaluated in combination, B2 microglobulin was found at higher levels in the ureteral obstruction group (p<0.004). CONCLUSION: As we know pelvicalyceal ectasia reflects intrapelvic pressure into renal tubular system via renal reflux. Therefore pelvicalyceal ectasia can be used as an indicator of renal tubular pressure. Although as a limitation of our study, renal tubular pressure was not quantitatively evaluated, parallelism between levels of renal ectasia detected in the rats of the sham, and DPO groups can predict that this drug (darbepoetin-a) can decrease renal tubular pressure in acute ureteral obstruction. Moreover, B2 microglobulin levels in the sham, and DPO groups differed from those of ureteral obstruction group, which suggested that DPO does not impair renal perfusion in addition to its decreasing effects on renal tubular pressure. We think that in countries with higher incidence rates of stone disease similar to our country, DPO may be used among medical treatment alternatives, which aim to preserve renal reserve.

Contralateral Ovarian Metastasis of Clear-Cell Renal Carcinoma: A Rare Case Report and Review of the Literature.

Renal cell carcinoma (RCC) constitutes 2-3% of all types of cancers. RCCs metastasize into lungs (50-60%), lymph nodes (36%), bones (30-40%), liver (30-40%), and brain (5%) in respective percentages. RCC rarely metastasizes into ovary. Only 25 cases of ovarian tumor, which metastasized into kidneys, have been presented. In the literature, a kidney-ovary axis has been defined, and its interrelationship begins with embryological life. With this case report, we aimed both to present a very rarely seen metastasis of RCC into contralateral ovary and also to review the literature.

The effect of asymptomatic histological prostatitis on sexual function and lower urinary tract symptoms.

OBJECTIVE: Prostatitis affects 10-14% of men of all ages and ethnicities. More than 50% of the men experience episodes of prostatitis at one time of their lives. Patients with CP typically have longlasting genitourinary/pelvic pain and obstructive and/or irritative voiding symptoms. Sexual dysfunction and psychological symptoms are frequently added to these symptoms. We also investigated the relationship between sexual functions, and lower urinary system symptoms, and asymptomatic histological prostatitis detected on transrectal ultrasound-guided (TRUS) biopsy performed with the indication of high PSA levels. METHODS: Sixty cases compliant with the study criteria among patients who underwent prostate biopsies between September 2014 and June 2015 with the indication of higher PSA levels were included in the study. All patients were requested to complete IIEF-5 and IPSS forms one day previously. Based on histological analysis of biopsy materials, the patients were allocated into groups of BPH (simple BPH without histological prostatitis) (n:30) and histological chronic prostatitis (combination of BPH and histological prostatitis) (n:30). RESULTS: Mean age of the cases was 65.73±5.01 (range, 56-75 yrs) years. PSA levels ranged between 4-15 ng/ml. A statistically significant intergroup difference was not found regarding mean age, BMIs, PSA levels, incidence rates of hypertension and coronary artery disease (p>0.05). Prostate volumes of the HCP group were higher than those of the BPH group , with statistically significant differences (p:0.001; p<0.01). Questionnaire forms of the patients included in the study were statistically evaluated, and mean IPSS score of the HCP group was found to be higher when compared with that of the BPH group, with statistically significant differences. (p:0.016; p<0.05). However mean IIEF score of the BPH group was higher than that of the HCP group, with statistically significant differences (p:0.039; p<0.05). DISCUSSION: These findings suggested the presence of a correlation between chronic inflammation and lower urinary tract symptoms (LUTS). In addition, statistically significant lower IIEF values in patients with histological chronic prostatitis relative to those without suggested negative effects of even asymptomatic inflammation on sexual functions and mechanism of erection.

Chromosomal aberrations in benign prostatic hyperplasia patients.

PURPOSE: To investigate the chromosomal changes in patients with benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: A total of 54 patients diagnosed with clinical BPH underwent transurethral prostate resection to address their primary urological problem. All patients were evaluated by use of a comprehensive medical history and rectal digital examination. The preoperative evaluation also included serum prostate-specific antigen (PSA) measurement and ultrasonographic measurement of prostate volume. Prostate cancer was detected in one patient, who was then excluded from the study. We performed conventional cytogenetic analyses of short-term cultures of 53 peripheral blood samples obtained from the BPH patients. RESULTS: The mean (±standard deviation) age of the 53 patients was 67.8±9.4 years. The mean PSA value of the patients was 5.8±7.0 ng/mL. The mean prostate volume was 53.6±22.9 mL. Chromosomal abnormalities were noted in 5 of the 53 cases (9.4%). Loss of the Y chromosome was the most frequent chromosomal abnormality and was observed in three patients (5.7%). There was no statistically significant relationship among age, PSA, prostate volume, and chromosomal changes. CONCLUSIONS: Loss of the Y chromosome was the main chromosomal abnormality found in our study. However, this coexistence did not reach a significant level. Our study concluded that loss of the Y chromosome cannot be considered relevant for the diagnosis of BPH as it is for prostate cancer. Because BPH usually occurs in aging men, loss of the Y chromosome in BPH patients may instead be related to the aging process.

Androgen secreting giant adrenocortical carcinoma with no metastases: A case report and review of the literature.

Functional adrenocortical carcinoma (ACC) is a very rare disease with a poor prognosis. Over half (60%) of ACCs bigger than 6 cm synthesize hormones; hormone-secreting ACCs generally include virilization, feminization or Cushing syndrome. Besides, 82% of ACCs are metastatic at the time of diagnosis. While a 48-year-old female patient was examined for abdominal pain and flushing, we detected a non-metastasizing mass (23 × 18 × 16 cm) in the adrenal lodge. The mass was extracted en bloc during open exploration and its histopathology was reported as ACC. We review the literature and report the largest androgen-producing, clinically silent ACC mass cited in the literature so far.

A standardized scoring system in the prediction of success and complications of percutaneous nephrolithotomy: Guy's stone scoring system.

OBJECTIVES: In this study, our aim was to determine the role of Guy's stone scoring system (GSS) in the prediction of percutaneous nephrolithotomy (PNL) success and its ability to foresee potential complications in consideration of Clavien grading system (CGS). MATERIAL AND METHODS: The data of 244 patients who underwent PNL between January 2009 and May 2014 were retrospectively examined. Renal stones were evaluated using GSS with the aid of the patients' preoperative radiological evaluations and their postoperative complications were assessed with CGS. RESULTS: Mean age of the patients (men, n=166; 68% and women, n=78; 32%) was 46.50±13.12 years (range, 16-80 yrs). Clinically significant residual stones were not detected in 195 (79.9%) patients, while they were found in 49 (20.1%) patients. Guy's stone scores of 1, 2, 3 and 4 points were estimated in 21.3, 37.7, 29.9, and 11.1% of the cases, respectively. Based on modified Clavien complication grading system, complications were categorized as Clavien grade 1, 2 and 3 in 81.9, 17.2, and 0.8% of the cases, respectively. Clavien Grade 4 and 5 complications were not encountered. A statistically significant correlation was found between Guy's Stone scores and Clavien grades (p<0.02). A statistically and highly significant difference was detected between Guy's stone scores of the cases with respect to residual stones (p=0.001; p<0.01). CONCLUSION: Our study findings have revealed that GSS is a successful and easily applicable method for the prediction of success and likelihood of complications of PNL.

Are Helicobacter Pylori and Benign Prostatic Hyperplasia Related, and If So, How?

PURPOSE: Although many virulence factors have been defined for Helicobacter pylori (HP), vacuolating cytotoxin A (VacA) is known to be associated with apoptosis, the cag pathogenicity island protein (Cag-PAI), and growth factors. Both apoptosis and growth factors are thought to be related to the etiology of benign prostatic hyperpla­sia (BPH). Additionally, the relation between atherosclerosis-BPH and atherosclerosis-HP has also been reported in a limited number of studies. The aim of this pioneering study was to investigate the presence of HP in BPH patients who had undergone transurethral resection of prostate (TURP) and to discuss the potential pathophysiologic effects of HP on BPH. MATERIALS AND METHODS: A total of 113 cases who underwent TURP due to infravesical obstruction due to BPH were included in the study. Preoperatively, parameters including, age, height, body weight, body mass index (BMI), prostate specific antigen (PSA), prostate volume (PVo), maximum urinary flow rate (Qmax), fasting plasma insu­lin, and International Prostate Symptom Score (IPSS)values were evaluated. The presence of HP was investigated in the prostate specimens with real-time polymerase chain reaction (RT-PCR) method. Postoperatively, histo­pathological evidence of chronic prostatitis (hCP) was also analyzed. RESULTS: HP was detected in 1.8% (n = 2) of the participants. Additionally, hCP was observed in 58.4% (n = 66) of the 113 patients. The demographic and clinical parameters confirmed the presence of BPH disease. CONCLUSION: Although BPH is a common disease, its physiologic etiology mechanisms are not clear. Based on our pilot study, despite its gastric location, we believe that HP should be considered in cases with clinical BPH because HP induces apoptosis and alterations in the equilibrium between apoptosis and local growth factors in addition to its recently demonstrated extragastric effects mediated via the atherosclerotic pathway. Although our uncontrolled pioneer study was not designed to investigate the pathophysiologic mechanism, the isolation of HP from prostatic adenoma suggests the need for further well-designed studies on this topic.

Emphysematous pyelonephritis: Our experience in managing these cases.

INTRODUCTION: Emphysematous pyelonephritis (EPN) is a rare acute necrotising infection of renal parenchyma. We discuss clinical details and treatment strategies of 8 patients with EPN followed at our clinic. METHODS: We retrospectively reviewed the clinical, laboratory, radiological findings and treatment modalities of 8 patients with EPN followed at our urology clinic between 2012 and 2015. RESULTS: The mean patient age (female: 5; male: 3) was 62 (range: 51-82) years. Based on computed tomographic findings, EPN was classified as class 1 (n = 3), class 2 (n = 3) and class 3a (n = 2). All patients had fever, flank pain, nausea, and vomiting. Five patients had type 2 diabetes mellitus and 3 diabetic patients also had renal stones. Escherichia coli (n = 6), Klebsiella species (n = 1), and Proteus species (n = 1) were grown in urine cultures. All patients had unilateral involvement. Increased white blood cell counts, sedimentation rate, and C-reactive protein levels were detected in all cases. In addition to medical treatment, 2 patients underwent a nephrostomy catheter placement and another 2 patients underwent nephrectomy upon deterioration of her general health state. After achieving clinical stabilization with medical treatment, 1 patient underwent endoscopic ureteral stone treatment. The remaining 3 cases were treated only with antibiotherapy. All patients were discharged with clinical cure. CONCLUSION: Mortality rates of EPN are gradually decreasing. Preservation of renal reserve is possible due to early diagnosis, appropriate antibiotherapy, and drainage.