Management of Priapism: Results of a Nationwide Survey and Comparison with International Guidelines.

OBJECTIVE: The aim of this study is to evaluate current urologic practice regarding the management of priapism in Turkey and compare with international guidelines. METHODS: Urologists and urology residents were invited to an online survey consisting of 30 multiple-choice questions on priapism-related clinical practices that were consid- ered most important and relevant to practices by using Google Forms. RESULTS: Total number of responses was 340. Respondents reported that they recorded a detailed patient's medical history and physical examination findings (n = 340, 100%) and laboratory testing, which includes corporal blood gas analysis (n=323, 95%). Participants announced that they performed Doppler ultrasound for 1/4 cases (n = 106, 31%), but 22% of the participants (n=75) replied that they performed in >75% of cases. Participants (n=311, 91%) responded that the first-line treatment of ischemic priapism is decompression of the corpus cavernosum. Moreover, most respondents (n = 320, 94%) stated that sympathomimetic injection drugs should be applied as the second step. About three-quarters of respondents (n = 247, 73%) indicated adrenaline as their drug of choice. Phosphodiesterase type 5 inhibitors seems to be the most pre- ferred drug for stuttering priapism (n=141, 41%). Participants (n=284, 84%) replied that corpora-glanular shunts should be preferred as the first. A large number of par- ticipants (n = 239, 70%) declared that magnetic resonance imaging can be performed in cases with delayed (>24 hours) priapism to diagnose corporal necrosis. Most of the participants (84%) responded that penile prosthesis should be preferred to shunts in cases with delayed (>48 hours) priapism. CONCLUSION: It would be appropriate to improve the training offered by professional associations and to give more training time to the management of priapism during residency.

Prognostic Role of Long-Chain Acyl-Coenzyme A Synthetase Family Genes in Patients with Clear Cell Renal Cell Carcinoma: A Comprehensive Bioinformatics Analysis Confirmed with External Validation Cohorts.

INTRODUCTION: We aimed to determine the prognostic role of long-chain acyl-CoA synthetases (ACSLs) as a disease marker for kidney clear cell carcinoma (KIRC). PATIENTS AND METHODS: The Cancer Genome Atlas (TCGA) data were accessed via open access LinkedOmics database for KIRC. Provisional datasets were used for analysis as previously described and gene expression quantification data were downloaded. The corresponding clinical information of patients also were obtained from the database. Five ACSL family members, ACSL1, ACSL3, ACSL4, ACSL5, and ACSL6, were investigated in the TCGA-KIRC cohort. Xena browser, cBioPortal and UALCAN, and Cancer Cell Line Encyclopedia (CCLE) databases were also used to confirm the results. External validation was performed using patient cohorts from the Gene Expression Omnibus (GEO-NCBI) database. Finally, the protein-protein interaction (PPI) was constructed based on the Search Tool for the Retrieval of Interacting Genes (STRING) database and visualized using Cytoscape software. RESULTS: Pathological T3-T4 stage tumors had significantly lower ACSL1 mRNA expression (P = .009). Patients with pathologically confirmed metastasis exhibited significantly lower expression, as well (P = .02). ACSL1 mRNA expression was associated with overall survival (OS) and negatively correlated with OS time. Univariate and multivariate analyses showed that lower ACSL1 mRNA expression level was associated with mortality. Moreover, ACSL1 mRNA expression was exhibited significant difference in some VHL gene region mutations and PBRM1_p.R1010 mutation, and negatively correlated with HIF1-alpha mRNA expression (P < .001). Confirmatory analyses and external validation also revealed similar findings. CONCLUSION: Lowered ACSL1 mRNA expression is associated with worse tumor histopathology and poor overall survival in KIRC. It may be used for prognostic marker for KIRC.

Quality and utility of YouTube videos about mPCNL.

This study assessed the reliability, efficacy, and quality of YouTube videos on miniaturized PCNL procedures using a scoring system. Video searches were conducted using the keywords miniaturized percutaneous nephrolithotomy (mPCNL), ultra-mini-PCNL (UMP), and super-mini-PCNL (SMP) via https://www.youtube.com . All videos > 2 min in English containing the procedure of mPCNL were ordered and listed according to relevance and popularity. Global quality scores (GQS) and reliability scales were used for quality and content analysis of the videos. The confirmed video power index (VPI) was used to assess video popularity, and the mPCNL score, developed by three endourologists, was used to measure the informational and educational value of the videos. While specialists (61.9%) were the main source for uploading 63 videos included in the study, the largest target group was patients (61.9%). Operational procedures (68.3%) were the main content, and the highest upload region was Asian continent (66.7%). The majority of videos were in English (60.3%), focused on standard mPCNL rather than miniaturization subtypes (77.8%). The mean VPI, GQS, reliability, and mPCNL scores were 4.61, 2.86, 2.61, 9.58, respectively. These parameters, which were positively correlated, were found to be statistically significantly higher for videos of 'academic' origin, 'Physicians' target audience and 'English audio' language format (p < 0.05). Because mPCNL videos, which are popular and have high informational and educational value, are aimed at medical professionals rather than patients, they are not functional in treatment selection and explaining the procedure. By raising its standards, video portals can make the treatment process practical as a functional bridge between patients and health care professionals.