Management of post-circumcision necrosis of the penis: the medicolegal aspect.

PURPOSE: To perform a medical evaluation of penile necrosis causes and treatment approaches by examining patients who had penile necrosis after circumcision surgery. METHODS: A total of 24 patients with penile necrosis after circumcision surgery, who presented at various hospitals in Turkey between September 2003 and April 2013 and whose cases were being reviewed at the Institution of Forensic Medicine with regard to malpractice, were evaluated retrospectively. RESULTS: The mean age of the patients was 5 ± 3.7 years, and the mean time of the necrosis diagnosis after circumcision was 5.2 ± 6.3 days. In etiologic terms, the predictive factors were monopolar cautery use in ten (41.6%) patients, post-circumcision infection in eight (33.3%), compartment syndrome due to post-circumcision dressing in three (12.5%), local anesthetic agent used for dorsal nerve blockage in two (8.3%), and methemoglobinemia in one (4.1%) patient. The first approaches to necrosis treatment were surgical intervention in 15 (62.5%) patients, hyperbaric oxygen treatment (HBOT) in 6 (25%), the conservative approach in 2 (8.3%), and HBOT plus surgical intervention in 1 (4.1%) patient. CONCLUSION: Penile necrosis is a preventable complication that requires early intervention. The current study will be helpful in preventing penile necrosis and in guiding surgeons in approaches following its occurrence.

Oncologic results, functional outcomes, and complication rates of robotic-assisted radical prostatectomy: multicenter experience in Turkey including 1,499 patients.

BACKGROUND: Robot-assisted radical prostatectomy (RARP) is a rising minimally invasive treatment of localized prostate cancer (PC). We present our multicenter experience of 1,499 consecutive cases with an analysis of complication rates, oncologic, and functional outcomes. PATIENTS AND METHODS: From March 2005 through December 2012, details of 1,499 patients were retrospectively analyzed. Transperitoneal approach using a da-Vinci robotic system was used to perform RARP. Perioperative characteristics and postoperative oncologic and functional outcomes are reported. RESULTS: The mean age was 61.3 years (37-77). Mean PSA level was 8.3 ng/ml. According to D'Amico classification, the percentage of patients with low-, intermediate-, and high-risk disease cases were 65.0, 30.1, and 4.8 %, respectively. Mean operative time was 181.9 min. Mean estimated blood loss was 225.4 cc (30-1,250). Positive surgical margin (PSM) was detected in 212 (14.1 %) patients. PSM rates in pT2, pT3, and pT4 stages were 6.1, 37.1, and 100 %, respectively. The overall complication rate due to modified Clavien classification was 6.1 %. Mean follow-up time was 26.7 months. Continence, potency, and biochemical recurrence rates were 88.7, 58.2, and 2.9 %, respectively. CONCLUSIONS: Our analyses including high-volume centers, which is the first largest series in Turkey, show that RARP is a safe procedure, has low PSM rates, high continence, and potency rates for the treatment of localized PC at experienced centers.

External validation of the current scoring systems and derivation of a novel scoring system to predict stone free rates after retrograde intrarenal surgery in patients with cumulative stone diameter of 2-4 cm.

OBJECTIVE: Our primary aim is to perform the external validation of the current scoring systems in predicting stone-free status (SFS) after retrograde intrarenal surgery (RIRS) for renal stones 2-4 cm and develop a novel scoring system by re-examining possible predictive factors related to SFS. METHODS: Patients who underwent RIRS due to renal stones with a cumulative stone diameter of 2-4 cm between January 2017 and March 2021 were retrospectively screened. Residual stones ≤2 mm were defined as clinically insignificant, and these cases were considered to have SFS. Possible predictive factors related to SFS were examined using the multivariate logistic regression analysis. A nomogram and a scoring system were developed using independent predictive variables. The prediction ability of the previous and the new scoring system were evaluated with the ROC analysis. RESULTS: The existing scoring systems were found to be insufficient in predicting SFS (AUC < 0.660 for all). The independent predictors of SFS were identified as stone surface area (OR: 0.991, p < 0.001), stone density (OR: 0.998, p < 0.001), number of stones (OR: 0.365, p = 0.033), and stone localization (p = 0.037). Using these predictive markers, a new scoring system with a score ranging between 4 and 15 was developed. The AUC value for this scoring system was 0.802 (0.734-0.870). CONCLUSION: The RUSS, S-ReSC and R.I.R.S. scoring systems and Ito's nomogram failed to predict SFS in stones >2 cm. The SFS predictive ability of our new scoring system was higher in >2 cm stones compared to the other scoring systems.

Potential role of p38-mitogene-activated protein kinase and nuclear factor-kappa B expression in testicular dysfunction associated with varicocele: an experimental study.

The aim of this study was to investigate p38-mitogene-activated protein kinase (p38-MAPK), nuclear factor-kappa B (p65-NF-kB) and inducible nitric oxide synthase (iNOS) expression in an experimental model of varicocele in the rat testis. Male Wistar albino rats (n = 18) were divided into three equal groups: control group, sham operated group and left varicocele-induced group. Malondialdehyde (MDA), nitric oxide (NO) and reduced glutathione (GSH) levels were biochemically assessed, and the p38-MAPK and NF-kB activity, and iNOS expression were immunohistochemically studied in the right and left testicles of rats from each group. The GSH levels were significantly decreased, whereas the level of MDA and NO was significantly increased in the testicular tissues of rats in varicocele group compared with those of the control and sham groups. There was a marked staining for iNOS, p38-MAPK and p65-NF-kB expression in rats of varicocele group compared with the sham group. There was no positive staining in rats of control group. There were significant differences in biochemical, histological and immunohistochemical studies, but no significant differences were noted between other groups. p38-MAPK and p65-NF-kB activation, and iNOS expression have a significant role in varicocele-induced testicular dysfunction.

Optimal patient position for percutaneous nephrolithotomy in horseshoe kidneys: Traditional prone or supine?

OBJECTIVE: Although it was stated that supine percutaneous nephrolithotomy (PCNL) was associated with relatively shorter surgical times and comparable success and complication rates, there is no consensus in the current literature concerning the safety and efficacy of supine PCNL in patients with horseshoe kidneys. We aimed to compare supine and prone PCNL regarding safety and efficacy in patients with horseshoe kidneys. METHODS: Data of the patients with horseshoe kidneys who underwent PCNL for renal stones larger than 2 cm between January 2010 and May 2021 were retrospectively reviewed. The study patients were categorized as Group 1 (i.e., supine PCNL-SPCNL) and Group 2 (i.e., prone PCNL-PPCNL). Both groups were compared regarding demographic, clinical, and surgical data. RESULTS: Sixty-five patients were included. Among these patients, 31 (47.7%) were in Group 1, while 34 (52.3%) were in Group 2. Both groups were statistically similar in terms of demographic data, stone characteristics, perioperative parameters, and complication rates (p > 0.05). There was no statistical difference in terms of additional treatment rates, stone-free rates in the postoperative second-day and third-month evaluations (p > 0.05). Mean surgical time was significantly longer in Group 2 (113 ±â€¯17.1 min) than in Group 1 (90.6 ±â€¯11.3 min) (p = 0.000). CONCLUSION: Although it is traditionally performed in the prone position, the supine approach is as safe and effective as the prone approach. In addition, the supine approach is associated with significantly shorter surgical times.

Comparison of computed tomography and magnetic resonance imaging in the assessment of complex renal cysts by using the Bosniak classification. / Comparación entre tomografía computarizada y resonancia magnética en la evaluación de quistes renales complejos empleando la clasificación de Bosniak.

INTRODUCTION AND OBJECTIVES: The Bosniak classification of cystic renal lesions was first published in 1986 based on computed tomography (CT). In the present study, we aimed to investigate the effect of magnetic resonance imaging (MRI) on Bosniak category compared with CT, and to determine how this effect changed the treatment modality in the evaluation of complex renal cysts. MATERIAL AND METHODS: Data of 144 patients were collected retrospectively. After exclusion criteria, 102 cystic renal lesions with a Bosniak category of at least IIF on CT or MRI between 2013 and 2016 were evaluated by 2abdominal radiologists. The demographic data, Bosniak category, interobserver agreement, and pathologic data of patients who underwent surgery were recorded. RESULTS: The coherence between MRI and CT was 75.5%. The Bosniak classification of 17 patients was upgraded with MRI, and the treatment modality changed in 10 patients, and they underwent surgery. The Bosniak category was downgraded from III to IIF in 6 patients out of 8 whose Bosniak category was downgraded with MRI and the treatment modality changed. Surgery was performed in one patient out of these 6 patients, and the pathology was reported as benign. Progression was detected in the follow-up at month 18 of 1 patient out of 5, and surgery was performed. The pathology was reported as renal cell carcinoma. The pathology result was reported as RCC in 35 (68.6%) patients out of 51 who underwent surgery. Progression was detected in 7 patients out of 51 who were followed up (13.7%), and the pathology results were reported as RCC. The majority of the malignant tumors were low stage and grade. CONCLUSIONS: MRI may be successfully used in the evaluation of renal cystic lesions. In particular, the challenging Bosniak IIF and all Bosniak III lesions must be evaluated using MRI before making the decision for surgery. The upgrading of Bosniak category with MRI is more possible compared with CT due to its high-contrast resolution, therefore further studies are required to identify whether it was the cause of overtreatment of Bosniak III lesions.

Acupuncture relieves symptoms in chronic prostatitis/chronic pelvic pain syndrome: a randomized, sham-controlled trial.

BACKGROUND: There are multiple approaches to the management of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS); and lately the data suggesting the ability of acupuncture treatment to decrease pain, positively impact quality of life and potentially modulate inflammation has suggested it as a potential therapeutic option for men with CP/CPPS. We conducted this study to determine whether acupuncture is really an effective therapeutic modality for CP/CPPS in terms of >50% decrease in total National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) score from baseline compared with sham. METHODS: One hundred patients with CP/CPPS (category III B) in an outpatient urology clinic were randomized to receive acupuncture at either seven acupoints bilaterally or sham points adjacent to these points. NIH-CPSI was completed by each patient before and 6, 8, 16, 24 weeks after the treatment. Mean values of total CPSI score and subscores after the treatment and on follow-up following the treatment were compared. RESULTS: Of the acupuncture participants, 92% were NIH-CPSI responders (>50% decrease in total NIH-CPSI score from baseline) compared with 48% of sham participants, 8 weeks after the end of the therapy. Both groups experienced significant decrease in CPSI subscores throughout the whole follow-up period; however, the decline remained significantly greater in the active acupuncture group as compared with the sham group. CONCLUSIONS: Our results show that the use of acupuncture in treatment of men with CP/CPPS symptoms resulted in a significant decrease in total NIH-CPSI scores.

Urinary tuberculosis in a two-year-old boy.

The authors describe a case of genitourinary tuberculosis hitherto unobserved in early childhood.

Ileal orthotopic neobladder in women: the first experiences from Turkey and our modifications.

UNLABELLED: The lower urinary tract reconstruction with an ileal neobladder in woman is not very often but has been recently introduced centers. We report 8 female patients with ileal orthotopic neobladders after cystectomy. PATIENTS AND METHODS: Between 1995 to 1999, 7 female patients with organ confined invasive bladder cancer and 1 female patient with severely contracted bladder secondary to tuberculosis were operated. While standard radical cystectomy was done in 7 patients with bladder cancer, only simple cystectomy was performed in patient with contracted bladder. Detubularized ileal W-neobladder with antirefluxive ureteroileal reimplantation were used as a procedure and reservoirs are connected to the proximal urethra in all patients. Cystoscopy and biopsy was done routinely in the bladder neck and there were no tumour and CIS in any patient. RESULTS: The mean age was 65.4 years (53-70) and the mean postoperative follow-up time was 31.8 months (6-48). There was no perioperative or early postoperative (first one month) mortality. Early postoperative complications included acute renal failure in I patient (12.5%), deep vein thrombosis in 1 patient (12.5%) and leakage from the pouch in 2 patients (25%). In one patient (12.5%), ileo-pouchal fistula was seen in sixth month and reoperated. Although there was not hypercontinence. one patient (12.5%) had totally incontinence. All other patients had normal micturition and no residual urine. Urethral recurrence was not seen in this postoperative follow-up period but pelvic recurrence and then distant metastases were found in one case (12.5%). CONCLUSIONS: The results of ileal orthotopic neobladder after radical or simple cystectomy in appropriate female patients are satisfactory. But certainly, we need the more experiences and studies about this subject.

Staging error in the bladder tumor: the correlation between stage of TUR and cystectomy.

OBJECTIVES: Because tumor stage is very important in determining therapy, accurate staging of bladder cancer must be estimated. For this aim, we examined the stage of TUR and compared it with the stage of cystectomy. MATERIALS AND METHODS: From 1992 to 1999, operations were performed on 127 patients with local invasive bladder cancer. Eight cases (74 male, 6 female) underwent complete TUR of the tumor and then radical cystectomy. There was no residual macroscopic tumor after TUR in the bladder. The pathological staging of TUR and cystectomy were estimated and compared in these 80 cases. All pathologies were evaluated by the same pathology center. RESULTS: There was correlation in only 20 patients (25%; 15 were T1, 5 were T2) while there was global error and discordance in 60 patients (75%). All of these 60 cases were overstaging in cystectomy specimens and downstaging was not found in any case. Fifty per cent of 10 T1 tumors were T1, while 50% were T3a; 21.4% of T2 tumors were T2, 35.7% were T3a and 42.8% were T3b. CONCLUSIONS: The staging error of TUR in the bladder tumor may cause severe mistakes on deciding about radical surgery. However, although there was no understaging, which is more risky for false cystectomy indication, urologists must be careful about overstage/understage in the staging of TUR.

Fracture of the penis.

Fracture of the penis is a rare condition. The fracture is easy to recognize but treatment remains controversial. Between December 1991 and January 1997, eleven patients underwent emergency operation on the first day after penile fracture. Our operative plan consisted of immediate exploration, identification, debridement and primary repair of the tear in the tunica albuginea. The patients' mean age was 27 years (range 21-38 yrs.). Penile fracture was due to sexual manoeuvres in 8, manipulation in 2 and fall onto erect penis in one of 11 patients. The mean hospitalization time was 2.2 days (range 1 to 3 days). There was no significant early postoperative complication except wound infection in one patient. In the first postoperative month, there was a residual fibrosis due to nonabsorbable sutures in one patient and mild pain during coitus in the other one. All patients had full erection and no patient needed additional treatment. To avoid serious complications and preserve penile functions immediate surgical intervention is recommended.

Immature germ cells in semen and their correlations with other semen parameters.

PURPOSE: The significance of the presence of leukocytes and immature germ cells in semen and other parameters of semen is currently a subject of controversy. MATERIALS AND METHODS: Semen from 572 subfertile patients was analyzed according to WHO criteria and leukocytes as well as immature germ cells were assessed by identifying the round cells in semen by peroxidase staining. Microbiological investigation was carried out in cases with leukocyte counts of >1,000,000/ml. RESULTS: It was found that as the concentration of spermatozoa decreased the rate of immature germ cells increased and this increase was accompanied by a decrease in motility and in the number of spermatozoa with normal morphology. As the sperm count increased, motility, number of spermatozoa with normal morphology and of immature germ cells also increased whereas an increase in sperm motility was accompanied by an increase in the percentage of spermatozoa with normal morphology. Microbiological investigations were negative in patients with semen leukocyte counts of >l,000,000/ml. CONCLUSIONS: Although it is possible to establish that the leukocyte and immature germ cell counts correlate with other parameters of semen, these correlations are not statistically significant. The most significant finding is that as the number of sperms decreases, the ratio of immature germ cells to total germ cells increases. While assessing immature germ cells instead of giving special attention to the number of immature germ cells in semen, the ratio of immature germ cells to total germ cells should be considered. The increase of leukocyte count in the semen of oligospermic patients may not always mean leukospermia.

Prospective evaluation of prostate specific antigen (PSA), PSA density, free-to-total PSA ratio and a new formula (prostate malignancy index) for detecting prostate cancer and preventing negative biopsies in patients with normal rectal examinations and intermediate PSA levels.

OBJECTIVE: To improve the specificity and sensitivity of prostatic cancer detection, we prospectively evaluated total prostate specific antigen (PSA) level, PSA density, free-to-total PSA ratio and a new formula called prostate malignancy index (PMI) as a discriminator of prostate cancer in patients with intermediate PSA levels and normal digital rectal examinations. MATERIALS AND METHODS: Between November 1995 and October 1997, 95 patients who had serum PSA levels of 4.0 to 10.0 ng/ml with normal digital rectal examinations were prospectively evaluated. All patients underwent one or two times transrectal ultrasound guided prostate biopsies. Based on age specific reference range of PSA, PSA density and % free PSA ratio, PMI was calculated for each patient. The free and total serum PSA concentrations were determined by an Immulite assay system. (Diagnostic Product Corp., Los Angeles, California). RESULTS: Overall 20 of 95 (21%) patients had prostate cancer. There were no significant differences in patient mean age and mean total PSA between those with benign and those with malignant biopsies (p>0.05). However, there were significant differences in mean PSAD, mean free-to-total PSA ratio and mean PMI (p<0.01, p<0.05, p<0.01, respectively). Benign condition specificities for PM index, percent free PSA, PSA density and total PSA at a 90% sensitivity for prostate cancer were 48%, 10.6%, 8% and 4%, respectively. Of 95 patients, 27 (28.4%) had a PMI of equal or more than 3.1, including 12 of 75 (16%) with negative biopsy and 15 of 20 (75%) with positive biopsy. Furthermore a cutoff MI 0.86 P correctly identified 24% of benign cases without missing any prostate cancer cases. The comparison of receiver operating characteristic (ROC) curve areas showed that PMI was better than total PSA (p<0.01). Although, the area under the ROC curve of % free PSA and PSAD were higher than the area of total PSA, these differences were not statistically significant (p>0.05). CONCLUSIONS: We concluded that the prostate malignancy index could be utilized to differentiate benign conditions from prostate cancer in patients with intermediate PSA levels and normal digital rectal examination. Also significant numbers of negative biopsies can be prevented in these patients.

[Rehabilitation of patients after cystectomy and construction of a continent intestinal reservoir]. / Réinsertion des patients après cystectomie et confection d'un réservoir intestinal continent.

Close follow-up and rehabilitation are necessary in order to ensure a good life quality for patients who have undergone cystectomy operations combined with continent reservoir operations. A questionnaire survey was carried out on 19 of our patients with continent reservoirs of different types. Furthermore a number of the leading clinics and urologists were consulted in an effort to find out a common and reliable method for rehabilitation. The most frequently encountered problems were the sexual (13 cases: 72.2%) and psychosocial adaptation (11 cases: 61.1%) among our patients. These figures were lowered to 50% (9 cases) and 33.3% (6 cases) respectively after organizing a special club for these patients in our hospital.

Can ischemia-modified albumin be used as an objective biomarker for renal ischemic damage? An experimental study with Wistar albino rats.

INTRODUCTION: This study sought to evaluate the correlation of ischemia-modified albumin (IMA) with time-dependent renal ischemic injury. METHODS: We established 5 groups of 8 Wistar albino rats as follows: sham, 10 minutes of renal ischemia, 20 minutes of renal ischemia, 30 minutes of renal ischemia, and 40 minutes of renal ischemia. Renal ischemia was established by occlusion of the right renal pedicle. Blood samples were obtained after exploration of the renal pedicle in the sham group and after thoracotomy and directly from the cardiac chambers at the end of the ischemic period in the other groups. The ischemic kidneys were removed for histopathological evaluation, and the rats were killed. RESULTS: There were significant differences among the IMA levels of the 5 groups (P = .0013). Pathological examination showed that renal ischemic injury corresponded to the duration of ischemia. In the group analysis, the pathological evaluation scores were significantly different among the groups (P < .001). CONCLUSIONS: This study shows that IMA levels can be used as a nonselective biomarker for renal ischemic injury. However, further studies are needed to support our findings.

Abdominal wall haemorrhage after robotic-assisted radical prostatectomy: is it a complication of robotic surgery?

OBJECTIVE: Robotic-assisted radical prostatectomy (RARP) is the minimally invasive surgical treatment for patients with localized prostate cancer. Perioperative or postoperative complications following RARP have been reported in some studies and severe postoperative bleeding after RARP is rare, but hemodynamic instability may necessitate open surgical exploration and be associated with considerable morbidity. We reported postoperative bleeding cases, which is a kind of complication associated with robotic surgery and requiring massive transfusion after RARP. PATIENTS AND METHODS: From August 2009 to May 2012, 317 consecutive patients who underwent RARP performed at our institution were analyzed. Patients with serious postoperative bleeding that caused hemodynamic instability after surgery were enrolled. RESULTS: A total of 5 among 317 (1.6%) patients had bleeding requiring postoperative transfusion. In these cases, mean operative time was 114 min. The mean estimated blood loss was 110 ml during operation. In these patients, hematocrit (Hct) levels gradually fell after surgery and ecchymosis was detected on the side and posterior walls of the abdomen on the second day. The mean preoperative Hct was 44.3% and mean lowest Hct was 23.1%. All patients were successfully treatment without surgical exploration. CONCLUSIONS: Robotic radical prostatectomy has proven to be a safe surgical treatment with low morbidity. However, postoperative bleeding can reach serious problems. This is the first study to explain haemorrhage, associated with possible risk of robotic surgery.

Validación externa de los sistemas de puntuación actuales y desarrollo de un nuevo sistema de puntuación para la predicción de la tasa libre de cálculos tras la cirugía intrarrenal retrógrada en pacientes con un diámetro acumulado del cálculo de 2-4 cm / External validation of the current scoring systems and development of a novel scoring system to predict stone-free rates after retrograde intrarenal surgery in patients with cumulative stone diameter of 2-4 cm

Objetivo Nuestro objetivo principal es realizar la validación externa de los sistemas de puntuación actuales para predecir el estado libre de cálculos (ELC) después de la cirugía intrarrenal retrógrada (CRIR) para cálculos renales de 2-4 cm y desarrollar un nuevo sistema de puntuación reexaminando los posibles factores predictivos relacionados con el ELC. Métodos Se evaluaron retrospectivamente los pacientes que recibieron CRIR para el tratamiento de cálculos renales con diámetro acumulado de 2-4 cm, entre enero de 2017 y marzo de 2021. Los cálculos residuales ≤ 2 mm se definieron como clínicamente insignificantes, y estos casos se consideraron como ELC. Se examinaron los posibles factores predictivos relacionados con el ELC mediante el análisis de regresión logística multivariante. Se elaboró un nomograma y se creó un sistema de puntuación utilizando variables predictivas independientes. Mediante el análisis ROC se evaluó la capacidad de predicción de los sistemas de puntuación actuales y del recién desarrollado. Resultados Los sistemas de puntuación existentes resultaron insuficientes para predecir el ELC (AUC < 0,660 en todos los casos). Se identificaron como predictores independientes del ELC el área de superficie (OR: 0,991, p < 0,001), la densidad (OR: 0,998, p < 0,001), el número (OR: 0,365, p = 0,033) y la localización de los cálculos (p = 0,037). Utilizando estos marcadores predictivos, se desarrolló un nuevo sistema de puntuación cuyos resultados oscilan entre 4 y 15. El valor AUC de este sistema de puntuación fue de 0,802 (0,734-0,870). Conclusión Los sistemas de puntuación RUSS, S-ReSC y RIRS y el nomograma de Ito no lograron predecir el ELC en cálculos de > 2 cm. Nuestro nuevo sistema de puntuación tuvo una capacidad predictiva del ELC mayor en cálculos de > 2 cm, en comparación con los otros sistemas de puntuación (AU)

Objective Our primary aim is to perform the external validation of the current scoring systems in predicting stone-free status (SFS) after retrograde intrarenal surgery (RIRS) for renal stones 2-4 cm and develop a novel scoring system by re-examining possible predictive factors related to SFS. Methods Patients who underwent RIRS due to renal stones with a cumulative stone diameter of 2-4 cm between January 2017 and March 2021 were retrospectively screened. Residual stones ≤ 2 mm were defined as clinically insignificant, and these cases were considered to have SFS. Possible predictive factors related to SFS were examined using the multivariate logistic regression analysis. A nomogram and a scoring system were developed using independent predictive variables. The prediction ability of the previous and the new scoring system were evaluated with the ROC analysis. Results The existing scoring systems were found to be insufficient in predicting SFS (AUC < 0.660 for all). The independent predictors of SFS were identified as stone surface area (OR: 0.991, p < 0.001), stone density (OR: 0.998, p < 0.001), number of stones (OR: 0.365, p = 0.033), and stone localization (p = 0.037). Using these predictive markers, a new scoring system with a score ranging between 4 and 15 was developed. The AUC value for this scoring system was 0.802 (0.734-0.870). Conclusion The RUSS, S-ReSC and RIRS scoring systems and Ito's nomogram failed to predict SFS in stones > 2 cm. The SFS predictive ability of our new scoring system was higher in > 2 cm stones compared to the other scoring systems (AU)

Color doppler ultrasonography and spectral analysis of venous flow in diagnosis of varicocele.

OBJECTIVE: The standardization of diagnostic criteria for varicocele has not yet been established. This causes difficulty in evaluating both the incidence and clinical studies. Our aim was to establish diagnostic criteria for varicocele in Doppler procedures. METHODS: The characteristics of blood flow in the internal spermatic vein were investigated with color Doppler ultrasonography (CDU) and venous flow spectral analysis in 100 infertile men without clinical varicocele (group I), 100 infertile men with clinical left varicocele (group II), and 50 fertile men without clinical varicocele served as controls (group III). RESULTS: Three types of flow pattern were found in the spectral analysis of venous flow. If the venous flow was directed to the heart and did not change direction with an intra-abdominal pressure increase, it was classified as type I; venous flow directed to the heart, but changing direction with an intra-abdominal pressure increase, was classified as type II, and blood flow directed to the testicles and augmenting with an intra-abdominal pressure increase, was classified as type III. In group I, flow patterns were 39, 56 and 5% on the left side and 55, 42 and 3% on the right side for types I, II and III, respectively. In group II, flow patterns were 0, 35 and 65% on the left side and 61, 38 and 1% on the right side for type I, II and III patterns, respectively. In group III, the figures were 44, 54 and 2% for the left and 54, 46 and 0% for the right. Type II and III flow patterns were seen more frequently than type I in patients with clinical left varicocele (p<0.001). Whereas type I and II flow patterns were more common than type III in subjects without clinical varicocele (p<0.05). A type II flow pattern during normal breathing was seen at a lower rate in the control group than in the other groups (p<0.05). CONCLUSION: Spectral analysis of Doppler waves should be used in combination with CDU for the diagnosis of varicocele. Varicocele should not only be diagnosed with a type II flow pattern which occurs during valsalva. For the diagnosis of varicocele, the main criterion must be a type III pattern flow, as well as a type II pattern during normal breathing.

Acupuncture and hypnotic suggestions in the treatment of non-organic male sexual dysfunction.

We have examined the effects of acupuncture and hypnotic suggestions, and compared them with placebo in the treatment of male sexual dysfunction with no detectable organic cause. The study comprised 15 men (mean age 36.7 +/- 10.43 years) who received acupuncture treatment, 16 men (mean age 38.4 +/- 10.75 years) who underwent hypnosis (mean age 35.3 +/- 11.52 years) and 29 men (mean age 36.2 +/- 11.38 years) who served as controls. They were interviewed periodically; the patients' reports were verified by interviewing their partners. Men who received placebo had a 43-47% improvement in sexual function, while the rates of improvement in the treated groups were higher, but not significantly so. The success rates of acupuncture and hypnotic suggestions were 60% and 75% respectively. Although the improvement was not statistically significant, treatment with acupuncture could be used as an adjuvant therapy in non-organic male sexual dysfunction. The only treatment superior to placebo seemed to be hypnosis. A more effective treatment may be obtained by combining these therapeutic modalities, but this needs further study.

Hemorragia de la pared abdominal después de prostatectomía radical asistida por robot: ¿es una complicación de la cirugía robótica? / Abdominal Wall Haemorrhage After Robotic-Assisted Radical Prostatectomy: Is it a Complication of Robotic Surgery?

Objetivo: La prostatectomía radical asistida por robot (PRAR) es el tratamiento quirúrgico mínimamente invasivo para los pacientes con cáncer de próstata localizado. Se han notificado complicaciones perioperatorias o postoperatorias después de PRAR en algunos estudios, y el sangrado postoperatorio severo después de PRAR es poco común, pero puede ser que la inestabilidad hemodinámica requiera exploración quirúrgica abierta y se asocie con una morbilidad considerable. Informamos de casos de sangrado postoperatorio, que es una especie de complicación asociada con la cirugía robótica, y la necesidad de transfusión masiva después de PRAR. Pacientes y métodos: Desde agosto de 2009 hasta mayo de 2012 317 pacientes consecutivos sometidos a PRAR en nuestra institución fueron analizados. Los pacientes con hemorragia postoperatoria grave, que causó inestabilidad hemodinámica después de la cirugía, fueron estudiados. Resultados: Un total de 5 de entre 317 (1,6%) pacientes tuvieron hemorragia que requería transfusión postoperatoria. En estos casos la media de tiempo operatorio fue de 114 min. La media de pérdida estimada de sangre fue de 110 ml durante la operación. En estos pacientes los niveles de hematocrito (Hct) gradualmente disminuyeron después de la cirugía, y se detectó equimosis en las paredes laterales y posteriores del abdomen en el segundo día. El Hct preoperatorio medio fue de 44,3% y el Hct medio más bajo fue de 23,1%. Todos los pacientes fueron tratados exitosamente sin exploración quirúrgica. Conclusiones: La prostatectomía radical robótica ha demostrado ser un tratamiento quirúrgico seguro con baja morbilidad. Sin embargo, el sangrado postoperatorio puede llegar a problemas serios. Este es el primer estudio para explicar la hemorragia asociada con el posible riesgo de la cirugía robótica (AU)

Objective: Robotic-assisted radical prostatectomy (RARP) is the minimally invasive surgical treatment for patients with localized prostate cancer. Perioperative or postoperative complications following RARP have been reported in some studies and severe postoperative bleeding after RARP is rare, but haemodynamic instability may necessitate open surgical exploration and be associated with considerable morbidity. We reported postoperative bleeding cases, which is a kind of complication associated with robotic surgery and requiring massive transfusion after RARP. Patients and methods: From August 2009 to May 2012, 317 consecutive patients who underwent RARP performed at our institution were analyzed. Patients with serious postoperative bleeding that caused haemodynamic instability after surgery were enrolled. Results: A total of 5 among 317 (1.6%) patients had bleeding requiring postoperative transfusion. In these cases, mean operative time was 114 min. The mean estimated blood loss was 110 ml during operation. In these patients, hematocrit (Hct) levels gradually fell after surgery and ecchymosis was detected on the side and posterior walls of the abdomen on the second day. The mean preoperative Hct was 44.3% and mean lowest Hct was 23.1%. All patients were successfully treated without surgical exploration. Conclusions: Robotic radical prostatectomy has proven to be a safe surgical treatment with low morbidity. However, postoperative bleeding can reach serious problems. This is the first study to explain haemorrhage, associated with possible risk of robotic surgery (AU)