Comparing the short - term outcomes and complications of monopolar and bipolar transurethral resection of bladder tumors in patients with coronary artery disese: a prospective, randomized, controlled study.

INTRODUCTION: To compare the perioperative outcomes and complications of monopolar and bipolar transurethral resection of bladder tumors (TURBT) in patients with coronary artery disease (CAD). MATERIALS AND METHODS: A total of 90 CAD patients with newly diagnosed bladder cancer who underwent TURBT were randomized into monopolar TURBT (M-TURBT) and bipolar TURBT (B-TURBT) groups. Primary outcome was safety of the procedures including obturator jerk, bladder perforation, clot retention, febrile urinary tract infection and TUR syndrome. The secondary outcome was the efficacy of TURBT procedures, including complete tumor resection, sampling of the deep muscle tissue and sampling of the qualified tissues without any thermal damage. RESULTS: Mean ages of the patients in M-TURBT and B-TURBT groups were 71.36±7.49 and 73.71±8.15 years, respectively (p=0.157). No significant differences were found between M-TURBT and B-TURBT groups regarding complete tumor resection (76.2% vs. 87.5%, p=0.162) and muscle tissue sampling rates (71.4% vs. 64.6%,p=0.252). Obturator jerk was detected in 16.7% of the patients in M-TURBT group and 2.1% in B-TURBT group (p=0.007). No statistically significant differences were found between the groups regarding intraoperative and postoperative complications. CONCLUSIONS: Both monopolar and bipolar systems can be used safely and effectively during TURBT procedure in CAD patients. Due to the more frequently seen obturator jerk in M-TURBT than B-TURBT, careful surgical approach is needed during M-TURBT.

Do pure squamous cell carcinomas and urothelial carcinomas have similar prognosis after radical cystectomy?

PURPOSE: The purpose of this study was to evaluate the surgical treatment results of urothelial carcinoma (UC) and pure squamous cell carcinoma of the bladder (SCC). METHODS: The records of 460 patients who have undergone radical cystectomy in our department between the years 1991 and 2011 were analyzed retrospectively, and 364 patients with UC and 60 patients with pure SCC were evaluated. RESULTS: Average ages of the patients with UC and SCC were 61.12 ± 8.9 and 59.38 ± 8.6 years, respectively (p = 0.902). UC group had 29 female patients, whereas SCC group had 9 female patients (p = 0.077). The mean follow-up periods were 26.09 ± 24.75 months for UC group and 22.23 ± 31.01 months for SCC group (p = 0.805). The incidence of organ-confined, extravesical, lymph node-positive diseases in UC and SCC cases was 48.9 and 32.2, 29.3 and 32.2 %, 21.8 and 35.6 %, respectively (p = 0.028). Five-year disease-specific survival (DSS) rates were 57.5 % in UC and 39.1 % in SCC group (p = 0.011). Five-year DSS rates were 81.2 % in UC and 75.0 % in SCC group in organ-confined disease (p = 0.534) and 28.2 % in UC and 40.9 % in SCC group in extravesical disease (p = 0.845). In lymph node-positive patients, DSS time was 20.9 ± 2.85 months in UC and 12.8 ± 2.07 months in SCC patients (p = 0.182). In multivariate analysis, pT stage (HR: 2.221; 95 % CI: 1.695-2.911) and lymph node involvement (HR: 2.863; 95 % CI: 1.819-4.509) were independently associated with DSS (p < 0.001), but histological subtype (HR: 1.423; 95 % CI: 0.798-2.538) was not a statistically significant factor (p = 0.232). CONCLUSIONS: Although pure SCC cases are diagnosed at advanced stages of the disease, UC and pure SCC cases have similar prognosis by stages. Lymph node involvement and stages are the most important prognostic factors after radical cystectomy.

Influence of preoperative hydronephrosis and ureteral orifice involvement in the survival of patients undergoing radical cystectomy: A retrospective comparative study.

OBJECTIVE: The aim of the present study was to evaluate the influence of preoperative hydronephrosis and ureteral orifice involvement (UOI) on survival of patients undergoing radical cystectomy (RC) for bladder cancer (BC). MATERIAL AND METHODS: A total of 162 patients with BC underwent RC between January 2006 and March 2017. Patients were divided into two groups for both presences of preoperative hydronephrosis and orifice involvement at final pathology. Additionally, tumors with orifice involvement were subgrouped histopathologically after RC as those with only UOI and those with invasive to the ureter with an additional concurrent site at final pathology. RESULTS: Preoperative hydronephrosis was detected in 57 patients. Preoperative and postoperative creatinine on month 3 were higher in the preoperative hydronephrosis (+) group (p<0.001). In addition, postoperative T stage, surgical margin positivity, invasion of urethra, and pathological upstaging were higher in this group. Cancer-specific survival (CSS) and overall survival (OS) were better in the hydronephrosis (-) group than in the hydronephrosis (+) group (p=0.001 and p=0.001, respectively). Preoperative hydronephrosis was found to be an independent factor in pathological upstaging. Patients were divided into two groups according to the presence of UOI. Group 1 consisted of patients without UOI, and group 2 with UOI. Preoperative hydronephrosis, hydronephrosis grade, and T stage were statistically higher in tumors with UOI. Moreover, CSS and OS were lower in group 2 than in group 1. CONCLUSION: Preoperative hydronephrosis and UOI are predicting factors on survival of patients undergoing RC for BC. Preoperative hydronephrosis was found to be an independent factor in pathological upstaging.

Long-term urodynamic and functional analysis of orthotopic "W" ileal neobladder following radical cystectomy.

OBJECTIVES: In this study, we evaluated the long-term functional outcomes and urodynamic results of the "W" orthotopic ileal neobladder. MATERIALS AND METHODS: Twenty patients whose long-term follow-up data were available and willing to participate in this project were enrolled into the study. The operations were performed between 1997 and 2005. Following standard radical cystoprostatectomy and pelvic lymphadenectomy, "W"-shaped orthotopic ileal neobladder with extramural serous-lined tunnel ureteral implantation was performed. Urodynamic evaluation consisted of standard three-channel filling cystometry with 0.09% sodium chloride solution, and uroflowmetry with postvoiding residual (PVR) urine measurement. RESULTS: All patients were men. The mean duration to postoperative urodynamic study was 38.5 months. Mean cytometric capacity (MCC), compliance, maximal pouch pressure (MPP) and PVR were 584.7 ml, 42.4 ml/cmH2O, 34.8 cmH2O, and 83.5 ml, respectively. Seventeen patients (85%) had complete daytime continence. Total continence (nighttime and daytime) rate was 40%. Three patients (15%) were totally incontinent. Pearson correlation test revealed a positive correlation between MCC and compliance (P<0.05). Compliance and urine volume at first sensation was also positively correlated (P<0.01). Urethrapouch anastomosis stricture was found to be significantly related with increased PVR. Continence status was not correlated with any urodynamic parameter. CONCLUSION: In this study, we found that "W" ileal neobladder reconstruction offers similar storage and voiding functions to normal bladder. Urodynamic evaluation of the "W" neobladder revealed similar results to that of a normal bladder. We conclude that "W" ileal neobladder construction results in a near-normal-functioning orthotopic reservoir that can be safely offered to patients.

Predictive role of neutrophil-to-lymphocyte ratio on upstaging of organ-confined invasive urothelial bladder cancer to non-organ-confined disease.

OBJECTIVE: The aim of this study is to examine the usefulness of preoperative neutrophile-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and lymphocyte-to-monocyte ratios to predict pathological upstaging of invasive bladder cancer who underwent radical cystectomy. MATERIAL AND METHODS: A total of 126 patients who underwent radical cystectomy at our clinic between January 2006 and March 2015 were retrospectively analysed. One hundred and twelve patients with organ-confined invasive bladder tumors (T2) detected at histopathological examination of transuretral resection material were included in the study. Upstaging was seen at histopathological examination of radical cystectomy specimens of 42 patients. We compared preoperative neutrophile-to-lymphocyte ratio, platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio between upstaged and not-upstaged groups. RESULTS: There were no statistically significant correlation between age, time to radical cystectomy, gender, lymphocyte-to-monocyte ratio, platelet-to-lymphocyte ratio ratios and carcinoma in situ in upstaged and non-upstaged groups. Statistical analyses showed that preoperative neutrophile-to-lymphocyte ratio was higher in upstaged patients (p=0.009). In multivariate analysis preoperative neutrophile-to-lymphocyte ratio and positive surgical margin were significantly higher in upstaged group. CONCLUSION: In organ-confined muscle invasive bladder cancer neutrophile-to-lymphocyte ratio seems to be an acceptable parameter to predict locally advanced disease.

Assessment of the quality of life and sexual functions of patients followed-up for non-muscle invasive bladder cancer: preliminary results of the prospective-descriptive study.

OBJECTIVE: The aim of this study is to evaluate sexual functions and quality life of patients who are followed-up for non-muscle invasive bladder cancer (NMIBC). MATERIAL AND METHODS: Between March 2015-June 2016, 50 patients underwent cystoscopy for NMIBC. At the end of the 1st year follow-up patients were assessed for sexual functions using 5-item version of the International Sexual Function Index (IIEF-5) for male and the Female Sexual Function Index(FSFI) for female; for quality of life (QoL) by the European Organisation for Research and Treatment of Cancer-Non-Muscle Invasiv Bladder Cancer Quality of Life Questionnaire (EORTC QLQ-NMIBC24) and for emotional status by Beck depression inventory. RESULTS: There were 44 male and 6 female patients with the mean age of 57.6±11.5 years. Twenty patients received intravesical treatment after transurethral resection of bladder tumour. The mean Beck (10.7±9.5) IIEF-5 (15.6±5.9), FSFI (19.2±10.9), and the EORTC-QLQ NMBIC 24 (38.2±7.7) scores of the patients were determined as indicated. Among the patients, 42 (84%) of them were not feeling bad about their bladder tumors and 37 (74%) were not worrying about their daily lives. Moreover, 12 (24%) patients were not interested with sexuality, while 27 (54%) of them did not feel comfortable about sexual sincerity. Interestingly, 27 patients receiving intravesical treatment were concerned that the treatment they received for prevention of recurrence and progression of bladder tumor infect their partners during sexual intercourse. CONCLUSION: NMIBC affects patients' sexual functions and QoL negatively. Therefore during the follow-up of these patients, it is important to inform these patients accurately about their treatments to be applied and predicted complications in the follow up period.

Neutrophil to Lymphocyte Ratio as a predictor of early penile prosthesis implant infection.

PURPOSE: To investigate the predictive value of preoperative serum neutrophil-to-lymphocyte ratio (NLR) on the development of postoperative infections in patients undergoing penile prosthesis implantation (PPI). METHODS: We retrospectively analyzed the data of 361 patients who underwent PPI over a 4-year period with at least 1-year follow-up. Demographics, blood results, and postoperative 1-year complications were recorded. Recommended cutoff values of NLR for early postoperative infectious complications were determined using receiver operating characteristic analysis. RESULTS: A total of 153 patients with the mean age of 56.4 ± 8 years were included in the study. Mean follow-up time was 56.7 ± 30.4 months (12-108 months). Early postoperative infectious complications were occured in 18 patients (11.8%). These infections were prosthesis infection in 8 patients (5.2%), wound infection in 6 patients (3.9%), and urinary tract infection in 4 patients (2.6%). All these complications were occured within the first year of the surgery. Mean NLR was statistically higher in patients with postoperative complications when compared with uncomplicated cases (7.2 ± 3.9 vs. 2.2 ± 1.4, p < 0.001, respectively) Using a cut point of 6.2, preoperative NLR predicted postoperative complications with a sensitivity of 67% and specificity of 99%. CONCLUSIONS: This study is the first to investigate the relationship between NLR and early postoperative infection as a complication of PPI. The results demonstrated that the NLR value could be a potential laboratory parameter for predicting early postoperative infectious complications in patients undergoing PPI.

Erection- and ejaculation-preserving cystectomy with orthotopic urinary diversion: is it feasible?

Nerve-sparing techniques to preserve sexual function in men undergoing cystoprostatectomy have been documented by different centers. We evaluated the results of the first 4 erection- and ejaculation-preserving cystectomies performed in our department. The ages of patients ranged between 36 and 43 years. In all cases, patients wished to maintain sexual function. Of the cases, 3 patients had pT1 G3 transitional cell carcinoma (TCC) refractory to treatment and one had pT2a adenocarcinoma of the bladder. Extirpation of the bladder and anterior proximal prostate en bloc with preservation of the vasa deferentia, seminal vesicles, posterior prostate, and neurovascular bundles was performed after pelvic lymphadenectomy. W-ileal neobladder was performed by using 40 cm of ileum. All patients had erections at the third month. Of the cases, 2 patients had antegrade ejaculation. The ejaculate volumes were 0.8 and 1.2 mL in patients with antegrade ejaculation. Patients in the other cases had retrograde ejaculation. All patients were continent day and night. We started clean intermittent catheterization in 1 case because of residual urine. There were no local recurrences. One patient with TCC died because of systemic disease in the postoperative 32nd month. The most important drawback of potent cases in cystectomy decision is erectile dysfunction after radical cystectomy. This drawback causes delay of the operation and sometimes mortality. As was the case in other reports, our limited number of cases in this study demonstrated that erection and ejaculation could be preserved in selected groups of patients.

Can immediate second resection be an alternative to standardized second transurethral resection of bladder tumors?

This study analyzed the impact of an immediate second transurethral resection of bladder tumor (TURBT) protocol on residual tumor status at the initial TURBT session and the recurrence rate in the primary resection area. We prospectively evaluated and randomized 47 consecutive patients who underwent TURBT sessions for bladder cancer. In accordance with the inclusion criteria, of the 47 consecutive patients, 19 (Group I) underwent immediate second resection of the tumor bed after complete TUR and 28 (Group II) did not. After standard TURBT, Group I underwent a second cystoscopy and resection of the bed of the tumor or an ignored tumor, which was performed by a different urologist. After 4-6 weeks, delayed second TURB was performed, and all pathological results were evaluated. Tumors were detected in two patients during the immediate second resection. Of these, one was a misdiagnosed tumor, whereas the other was diagnosed at the bed of the tumor by pathological examination. Tumors were detected in nine patients at the delayed second TURB, of which only one was part of Group I, while the others were part of Group II (p = 0.04). The results of this study demonstrated that residual tumors may remain after initial TURB, either in the tumor bed or in a different location within the bladder. Although this was a pilot study enrolling only a small number of patients, our initial results supported the assertion that immediate second resection can be an alternative to standard second TURBT.

Patterns, risks and outcomes of urethral recurrence after radical cystectomy for urothelial cancer; over 20 year single center experience.

PURPOSE: To evaluate the factors affecting urethral recurrence after radical cystectomy for bladder cancer and relationship between urinary diversion type and urethral recurrence rates. PATIENTS AND METHODS: In our 504 radical cystectomy series, 287 male patients whose final pathological were urothelial carcinoma were included in the study. The relationship between urethral recurrence and pathological stage, grade, lymph node involvement and diversion type was researched in addition to risk factors for urethral recurrence. RESULTS: A Total of 287 patients. Orthotopic continent urinary diversion (OCD) and ileal conduit (IC) was performed after radical cystectomy in 141 (49.1%) and 146 (50.9%) patients respectively. Urethral recurrence was observed in 11 (3.8%) patients and urethral recurrence rates in OCD and IC groups were 1.4% and 6.2% (p=0.034). Pathological stages of recurrent patients were 2 pT1, 1 pT2 and 8 pT4 respectively (p<0.001). Urethral recurrence was significantly lower in OCD group when compared to IC group (p=0.036). When all parameters were analyzed using Cox multivariate regression analysis, the most important factor that affects urethral recurrence was pathological T stage (p<0.001). Risk factors for urethral recurrence were present in 92 patients. Urethral recurrence rates in patients with and without risk factors were 8.69% and 1.53% (p<0.01). CONCLUSIONS: In this study, pathological stage was found to be the most important factor affecting urethral recurrence and prostatic stromal invasion was an important prognostic factor in these cases. Although risk factors for urethral recurrence were similar in both groups, urethral recurrence rates were significantly lower in OCD group when compared to IC group.

Plasma kinetic vaporization of the prostate: clinical evaluation of a new technique.

PURPOSE: We evaluated our results with bipolar plasma kinetic electrovaporization in the treatment of benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: Twenty-one patients with infravesical obstruction by BPH have been treated with bipolar plasma kinetic electrovaporization. International Prostate Symptom Score (IPSS) with a quality of life (QOL) scoring questionnaire, uroflowmetry (maximum flow rate; Qmax), transrectal ultrasonography (TRUS), and residual urine volume and prostate specific antigen (PSA) measurements had been performed before surgery. The IPSS scores, prostate volumes, and residual urine volumes were reevaluated during the third postoperative month. Uroflowmetry was repeated on postoperative days 7, 15, 30, and 90. Total PSA and free PSA measurements were repeated on postoperative days 3, 5, 7, 15, 30, and 90. RESULTS: The results of 20 patients could be evaluated. The median age of these patients was 61 years. The median volume of the prostates was 42 cc (95% CI 56-53). The median operation time and postoperative hospitalization were 55 minutes (95% CI 40-65) and 3 days (95% CI 3-5), respectively. The mean period of time needed for vaporizing 1 g of tissue was calculated as 2.8 +/- 1.3 minutes. Postoperative day 90 values of IPSS, QOL, prostate volume, residual urine volume, and Qmax showed significant improvement compared with preoperative values (p < 0.05). The median preoperative PSA value was 1.64 mg/mL (95% CI 1-3.6). The value showed a statistically significant increase 24 hours after the intervention (p < 0.0001), but the PSA values on the 30th (p = 0.041) and 90th (p = 0.025) days were below preoperative values. CONCLUSION: The IPSS with QOL scores, prostate volumes, and residual urine volumes showed significant decreases and Qmax values showed a significant increase after bipolar plasma kinetic electrovaporization. This treatment modality causes a temporary increase in the PSA concentration, as do other interventional treatment methods, but the measurements on the 30th and 90th days were below preoperative values.

Effect of retroperitoneoscopic donor nephrectomy on tissue oxidative stress markers in rabbit pneumoretroperitoneum model.

BACKGROUND AND PURPOSE: Laparoscopic donor nephrectomy causes increased renal oxidative stress. There are no data about the effects of the retroperitoneoscopic route. The aim of our study was to evaluate the oxidative stress occurring in renal tissues during retroperitoneoscopic donor nephrectomy in a rabbit model. MATERIALS AND METHODS: Eighteen adult rabbits were randomized to three groups, each consisting of six rabbits. Group I (control) underwent 50-mL balloon dissection of the left retroperitoneal space without CO(2) insufflation. Group II (pneumoretroperitoneum) received a 3-hour CO(2) insufflation at a pressure of 10 mm Hg in the retroperitoneal space after balloon dissection. Group III (pneumoretroperitoneum with warm ischemia), in addition to the procedure applied in Group II, underwent left renal artery clamping for 3 minutes and reperfusion for the next 5 minutes. Bilateral nephrectomy was performed in all animals for analysis of oxidative stress markers. Concentrations of malonyldialdehyde (MDA), protein carbonyl, and reduced glutathione (GSH) were measured in renal tissue samples. RESULTS: The MDA and protein carbonyl content were increased both in the donor (P = 0.004 and P = 0.004, respectively) and in the remaining kidneys (P = 0.009 and P = 0.028, respectively) in Group II compared with Group I. There were no statistically significant increases in oxidative stress markers between Group II and Group III in donor kidneys. However, there were statistically significant decreases in MDA in the remaining kidneys in Group III compared with Group II (P = 0.009). CONCLUSION: Pneumoretroperitoneum causes increased oxidative stress in both donor and remaining kidneys. Short-term warm ischemia and reperfusion do not exert an additive effect on pneumoretroperitoneum-associated oxidative stress in donor kidneys.

Comparison of changes in tissue oxidative-stress markers in experimental model of open, laparoscopic, and retroperitoneoscopic donor nephrectomy.

PURPOSE: We evaluated the oxidative stress in renal tissue during three types of surgery: open donor nephrectomy (ODN), laparoscopic donor nephrectomy (LDN), and retroperitoneoscopic donor nephrectomy (RDN). The aim was to find out which is the appropriate procedure for harvesting a donor kidney. MATERIALS AND METHODS: Twenty-four New Zealand White rabbits were randomized to four groups, each consisting of six rabbits. Group I (control) was subjected to 180 minutes of anesthesia, and transperitoneal nephrectomy was performed without creation of warm ischemia. In group II (ODN), after 180 minutes of anesthesia, warm ischemia was created for 5 minutes, and nephrectomy was performed. Group III (LDN) was subjected to 5 minutes of warm ischemia after 180 minutes of pneumoperitoneum at 12 mm Hg, and the kidney was removed. In group IV (RDN), after pneumoretroperitoneum at 12 mm Hg for 180 minutes, warm ischemia was created for 5 minutes, and nephrectomy was performed. Renal tissues were analyzed to determine malondialdehyde (MDA) and reduced glutathione (GSH) as oxidative-stress markers. RESULTS: Renal tissue GSH levels were decreased, whereas MDA levels were increased in groups II through IV compared with the control group (p<0.05). There was no statistically significant difference between the ODN, LDN, and RDN groups in the renal oxidative-stress markers. CONCLUSION: No differences were detected in oxidative-stress markers in renal tissue samples between ODN, LDN, and RDN. Therefore, we believe LDN and RDN can be used for live donor kidney harvesting as effectively as ODN without creating greater oxidative stress, which can have deleterious effects on a donor kidney.

Effects of carbon dioxide pneumoretroperitoneum on free radical formation in remote organs and use of verapamil as an antioxidant.

BACKGROUND AND PURPOSE: Pneumoretroperitoneum (Prp) acts as an ischemia/reperfusion (I/R) model. Ischemia/reperfusion (I/R) injury causes production of reactive oxygen species, which affect organs remote from the sites of I/R. The aim of this study was to assess the remote organ changes after Prp and to explore the effects of antioxidants. MATERIALS AND METHODS: Eighteen adult rabbits were randomized to three groups, each consisting of six rabbits. Group I (control) underwent balloon dissection of the left retroperitoneal space without gas insufflation. In group II (Prp), carbon dioxide at 10 mm Hg was applied for 2 hours after the balloon dissection (ischemia period) and for 1 hour after desufflation (reperfusion period). In group III (Prp + antioxidant), 5 minutes before the experiment, verapamil at 0.2 mg/kg was given intravenously and the same procedure was employed as in group II. Hepatic, pulmonary, opposite kidney, and treated kidney malondialdehyde (MDA) and reduced glutathione (GSH) levels were evaluated to show response to Prp. RESULTS: Pneumoretroperitoneum exerted oxidative stress on all tissues with an increase of MDA (P < 0.05) and a decrease of GSH (P < 0.05). The verapamil-treated group showed lower values of MDA (P < 0.05) and higher values of GSH (P < 0.05) than group II. CONCLUSION: Pneumoretroperitoneum increased oxidative stress in all remote organs tested. Verapamil reduced the oxidative stress. We concluded that Prp should be employed carefully in patients with limited vital organ capacity. Verapamil administration may be considered for protection against tissue injury attributable to oxidative stress in these patients.

Local and systemic recurrence patterns of urothelial cancer after radical cystectomy.

The aim of this study was to evaluate the local recurrence and distant metastasis rates for urothelial carcinoma of the bladder after radical cystectomy and to identify the predictive factors for local recurrence and distant metastasis. The study population was 347 consecutive patients treated with radical cystectomy for urothelial carcinoma of the bladder at our institution. Local recurrence, distant metastasis, and both local and distant recurrence rates were 49 (14.1%) months, 96 (27.7%) months, and 17 (4.9%) months, respectively. The mean follow-up times to recurrence were 14.37 ± 13.25 months (range, 2-60 months) and 14.43 ± 15.72 months (range, 2-109 months) for local recurrence and distant metastasis, respectively (p = 0.808). The mean post-recurrence disease-specific survival (PRDSS) times for local, distant, and both local and distant recurrences were 17.82 ± 3.18 months, 4.16 ± 0.39 months, and 11.41 ± 2.73 months, respectively (p < 0.001). The predictive factors for local recurrence and distant metastasis were stage and nodal involvement (p < 0.001). Sex, grade, lymphovascular invasion (LVI), carcinoma in situ (CIS), and lymph node density (LND; 10% cut-off value) were not predictors for recurrence in the results of the multivariate analysis. The current study demonstrated that stage and pathological nodal involvement were independent predictors of local recurrence and distant metastasis. The results of this study suggest that the early diagnosis and intervention of invasive bladder cancer cases may decrease the number of high stage and lymph node positive cases that have a high risk of local and distant recurrences. The adjuvant treatment options in the presence of risk factors for recurrence may improve survival outcomes.

Splenogonadal fusion: a very rare congenital anomaly in the differential diagnosis of a testicular mass.

Splenogonadal fusion is a rare congenital anomaly characterized by congenital fusion between the spleen and testicular tissue. In the literature, there are approximately 175 reported cases, and most of them are associated with cryptorchidism. In this article, we report an unusual case of splenogonadal fusion that was pre-diagnosed as a solid testicular mass in a patient who underwent orchiectomy.

The feasibility of radical cystectomy in elderly patients.

OBJECTIVE: In this study, we aimed to investigate the relationship between age and tumor characteristics and to evaluate oncologic results after radical cystectomy in bladder cancer with respect to age. MATERIAL AND METHODS: We reviewed 460 patients retrospectively who underwent radical cystectomy. Patients were divided into two groups according to age: ≥70 (Group 1), and <70 (Group 2). We compared tumor pathological characteristics and the results of long-term follow-up in both groups. The first group included 76 (16.7%), and the second group 379 (83.3%) patients. The mean age of the patients was 73.3±3.01 years (70-85) in Group 1 and 58.3±7.47 years (34-69) in Group 2. The American Society of Anesthesiologists (ASA) score was less than three in all of the patients, and there was no risk for major surgery. RESULTS: No statistically significant difference was found between groups with respect to pathological T stage (p=0.567), lymph node involvement (p=0.179), or histological grade (p=0.567). Perioperative mortality rates were 3.9, and 3.4% in groups 1 and 2, respectively (p=0.218). Perioperative complication rates were 14.7, and 17.5% for groups 1, and 2 respectively (p=0.578). Five-year disease-specific survival (DSS) rates were 57.0, and 51.6% Groups 1, and 2, respectively. The mean DSS periods were 82.05±4.88 and 71.68±8.53 months for Groups 1, and 2, respectively. Five-year overall survival rates were 43.9% for Group 1 and 45.9% for Group 2. The mean overall survival times were 54.02±8.47, and 69.25±4.97 months for Groups 1, and 2, respectively. In Cox regression analysis, tumor stage (p=0.012) and lymph node involvement (p<0.001) were significant factors that affected the survival in both groups. None of the patients received neoadjuvant radiotherapy or chemotherapy. CONCLUSION: We found that oncological outcomes of radical cystectomy performed with the indication of bladder tumor were comparable between young and elderly. We believe that age per se should not constitute a contraindication for radical cystectomy operations.

A comparison of balloon and amplatz dilators in percutaneous nephrolithotomy: a retrospective evaluation.

OBJECTIVE: In this study, we compared our experience using balloon and amplatz dilatation in percutaneous nephrolithotomy (PCNL). We also evaluated peri- and postoperative variables, including success rates. MATERIAL AND METHODS: Two hundred renal stone patients (123 men/77 women) underwent PCNL at the Urology Clinic of Izmir Atatürk Training and Research Hospital from September 2005 to May 2011. The nephrostomy tract was dilated using a balloon (128 patients) or amplatz (72 patients) dilator. The groups were compared by age, total operating time, treatment success rate, retreatment rate, pre- and postoperative hematocrit values, mean decrease in hematocrit values, blood transfusion rate, stone burden, tract dilatation failure, hospital stay and nephrostomy removal times, stone localization, previous stone operation and the cost of the dilatation system. RESULTS: There was no statistically significant difference in the operative time (97.9±45.3 minutes in balloon group vs. 98.5±43.4 minutes in the amplatz group; p=0.43), preoperative hematocrit value (39.04±4.21 vs. 38.94±4.49; p=0.87), postoperative hematocrit value (32.74±4.86 vs. 32.48±5.43; p=0.73), decrease in hematocrit values (6.30±2.60 vs. 6.45±2.64; p=0.68), blood transfusion rate (15.6% vs. 16.7%; p=0.84) or treatment success rate (78.9% vs. 79.2%; p=0.96) between balloon and amplatz groups. Differences in other variables were also not observed between the two groups. CONCLUSION: The balloon or amplatz dilatation methods have similar results with regard to efficacy, speed, and safety. However, the cost of the balloon dilator is higher than that of the amplatz dilator.

Comparing the short - term outcomes and complications of monopolar and bipolar transurethral resection of bladder tumors in patients with coronary artery disese: a prospective, randomized, controlled study

ABSTRACT Introduction: To compare the perioperative outcomes and complications of monopolar and bipolar transurethral resection of bladder tumors (TURBT) in patients with coronary artery disease (CAD). Materials and Methods: A total of 90 CAD patients with newly diagnosed bladder cancer who underwent TURBT were randomized into monopolar TURBT (M-TURBT) and bipolar TURBT (B-TURBT) groups. Primary outcome was safety of the procedures including obturator jerk, bladder perforation, clot retention, febrile urinary tract infection and TUR syndrome. The secondary outcome was the efficacy of TURBT procedures, including complete tumor resection, sampling of the deep muscle tissue and sampling of the qualified tissues without any thermal damage. Results: Mean ages of the patients in M-TURBT and B-TURBT groups were 71.36±7.49 and 73.71±8.15 years, respectively (p=0.157). No significant differences were found between M-TURBT and B-TURBT groups regarding complete tumor resection (76.2% vs. 87.5%, p=0.162) and muscle tissue sampling rates (71.4% vs. 64.6%,p=0.252). Obturator jerk was detected in 16.7% of the patients in M-TURBT group and 2.1% in B-TURBT group (p=0.007). No statistically significant differences were found between the groups regarding intraoperative and postoperative complications. Conclusions: Both monopolar and bipolar systems can be used safely and effectively during TURBT procedure in CAD patients. Due to the more frequently seen obturator jerk in M-TURBT than B-TURBT, careful surgical approach is needed during M-TURBT.

Comparison of microscopic (pT3a) and gross extravesical extension (pT3b) in pathological staging of bladder cancer: analysis of patient outcomes.

OBJECTIVE: To determine the prognostic value of pT3 bladder urothelial carcinoma substaging in patients without lymphatic involvement. PATIENTS AND METHODS: Pathologic and clinical data were reviewed on patients who underwent radical cystectomy for urothelial carcinoma between 1991 and 2010. Of the 460 reviewed patients, 74 patients were diagnosed with pathologic T3No urothelial carcinoma of the bladder. The impact of pathologic substaging (pT3a vs. pT3b) was examined to determine the effect on overall and disease-specific survival. RESULTS: Five years disease-specific and overall survival rates were 46.9 % and 39.6 % for patients with pT3aNo tumor, whereas these ratios were 34.4 and 30.3 %, respectively, for patients with pT3bNo tumor (p > 0.05). Mean disease-specific survival time was 43.94 ± 6.50 months for pT3aNo, while it was 39.01 ± 7.19 months for pT3bNo (p = 0.539). In multivariate cox regression analysis, age (p = 0.459), gender (p = 0.710), urinary diversion type (p = 0.088), and pT3 substaging (p = 0.554) were not noticed as an independent predictive factor for survival. CONCLUSION: Macroscopic extravesical extension (pT3b) is not associated with a worse outcome than pT3a disease in lymph node-negative cases of bladder urothelial carcinoma.