Efficacy of combination therapy with biofeedback and dapoxetine in lifelong premature ejaculation treatment: a prospective randomized study.

PURPOSE: Premature ejaculation (PE) is a common sexual dysfunction that significantly affects the quality of life of the patient and their partner. We aimed to compare the efficacy and safety of the combination therapy with biofeedback-guided pelvic floor exercise therapy (BFT) and dapoxetine 30 mg. METHODS: Sixty-five patients diagnosed with lifelong PE were included in the study. Patients were divided into three groups as BFT, dapoxetine 30 mg and a combination of BFT and dapoxetine 30 mg. The patients were compared with the intravaginal ejaculatory latency time (IELT) pre-treatment and post-treatment 1st and 3rd months. RESULTS: The mean IELTs of the patients in Group 1 were 40 s in pre-treatment, 115 s at the end of the 4th week and 140 s at the end of the 12th week. The IELT values of the patients in Group 2 were 40 s in pre-treatment, 145 s in the 4th week and 170 s in the 12th week. The IELT values were calculated in Group 3 as 42.5 s in pre-treatment, 185 s in the 4th week and 205 s in the 12th week When the IELT was statistically compared between the groups at 1st and 3rd months, the duration in the combination group was found to increase significantly (p < 0.001). CONCLUSION: Combination therapy with BFT and dapoxetine 30 mg in lifelong PE treatment is a good alternative with a low side effect profile and acceptable continuous efficiency.

Is biofeedback-assisted pelvic floor muscle training superior to pelvic floor muscle training alone in the treatment of dysfunctional voiding in women? A prospective randomized study

ABSTRACT Purpose: To compare the effectiveness of biofeedback-assisted pelvic floor muscle training (PFMT) and PFMT alone on voiding parameters in women with dysfunctional voiding (DV). Materials and Methods: The patients in group 1 (34 patients) were treated with biofeedback-assisted PFMT, and the patients in group 2 (34 patients) were treated with PFMT alone for 12 weeks. The 24-hour frequency, average voided volume, maximum urine flow rate (Qmax), average urine flow rate (Qave), post-void residual urine volume (PVR), and the validated Turkish Urogenital Distress Inventory (UDI-6) symptom scores were recorded before and after 12 weeks of treatment. Results: At the end of treatment sessions, the Qmax and Qave values of the patients in group 1 were significantly higher than those in group 2, and the PVR in the patients in group 1 was significantly lower than those in group 2 (p=.026, .043, and .023, respectively). The average UDI-6 symptom scores of the patients in group 1 were significantly lower than those in group 2 (p=.034). Electromyography activity during voiding, in group 1 was significantly lower than in group 2 (41.2 vs. 64.7, respectively, p=.009). Conclusion: Biofeedback-assisted PFMT is more effective than PFMT alone in improving clinical symptoms, uroflowmetry parameters, and EMG activity during voiding.

Is biofeedback-assisted pelvic floor muscle training superior to pelvic floor muscle training alone in the treatment of dysfunctional voiding in women? A prospective randomized study.

PURPOSE: To compare the effectiveness of biofeedback-assisted pelvic floor muscle training (PFMT) and PFMT alone on voiding parameters in women with dysfunctional voiding (DV). MATERIALS AND METHODS: The patients in group 1 (34 patients) were treated with biofeedback-assisted PFMT, and the patients in group 2 (34 patients) were treated with PFMT alone for 12 weeks. The 24-hour frequency, average voided volume, maximum urine flow rate (Qmax), average urine flow rate (Qave), post-void residual urine volume (PVR), and the validated Turkish Urogenital Distress Inventory (UDI-6) symptom scores were recorded before and after 12 weeks of treatment. RESULTS: At the end of treatment sessions, the Qmax and Qave values of the patients in group 1 were significantly higher than those in group 2, and the PVR in the patients in group 1 was significantly lower than those in group 2 (p=.026, .043, and .023, respectively). The average UDI-6 symptom scores of the patients in group 1 were significantly lower than those in group 2 (p=.034). Electromyography activity during voiding, in group 1 was significantly lower than in group 2 (41.2 vs. 64.7, respectively, p=.009). CONCLUSION: Biofeedback-assisted PFMT is more effective than PFMT alone in improving clinical symptoms, uroflowmetry parameters, and EMG activity during voiding.

Desires and attitudes of outpatients and physicians regarding the use of teleurology during the pandemic: a prospective survey study.

OBJECTIVE: It is not known to date how many patients admitted to urology outpatient clinics are willing to use telemedicine. We aimed to investigate knowledge levels and attitudes concerning the utilization of teleurology by patients applying to urology outpatient clinics. METHODS: This prospective multicentre survey study included 334 patients aged 18-65 years who applied to an urology outpatient clinics. The patients were asked questions about their attitudes and expectations regarding teleurology. Diseases were divided into seven subgroups due to the broad spectrum of diagnoses. Physicians' and patients' opinions on whether it was possible to manage the current medical condition via teleurology were recorded. RESULTS: 69.5% of patients stated that they had sufficient technical skills to use teleurology by themselves for medical examination. 55.4% of patients and 78.4% of physicians responded that the existing complaints were suitable for teleurology. Both patients and physicians deemed genital system diseases and urinary tract infections suitable for teleurology (p<0.001, p<0.001 for physicians, and p<0.001, p<0.001 for patients), whereas urine transport, storage and emptying disorders (p=0.003) and benign prostatic hyperplasia (p=0.029) were deemed to be suitable for teleurology only by the physicians. CONCLUSION: Our study shows that (i) the majority of our patient population has a telecommunications infrastructure suitable for teleurology, (ii) teleurology has aroused interest among patients, particularly during the pandemic period, and (iii) physicians and patients have high expectations that the problem can be solved with teleurology in suitable patients.

Comparison of Perioperative, Oncological, and Functional Outcomes of Three-Dimensional Versus Robot-Assisted Laparoscopic Radical Prostatectomy: A Preliminary Study.

Background: Radical prostatectomy (RP) is the first-line treatment modality for prostate cancer and can be performed using retropubic or minimally invasive techniques. New technologies such as the da Vinci robotic system and three-dimensional (3D) laparoscopic imaging system have been developed to overcome the challenges of conventional laparoscopy. This study aimed to compare the perioperative, oncological, and functional outcomes of robot-assisted laparoscopic RP (RALP) and 3D laparoscopic RP (3D LRP). Materials and Methods: The study was approved by the local ethics committee and included 65 patients (38 RALP, 27 3D LRP) who underwent RP with the diagnosis of localized prostate cancer between May 2019 and January 2020. All demographic, clinical, perioperative, pathological, and postoperative variables were recorded. Results: There was no statistically significant difference between the two groups in terms of preoperative patient characteristics. The mean operative times of the RALP and 3D LRP groups were 135.74 ± 11.51 and 165.37 ± 15.86 minutes, respectively, with a statistically significant difference between the two groups (P = .001). The mean estimated blood loss was 237 ± 71 mL in the RALP group and 257 ± 54 mL in the 3D LRP group, with no statistically significant difference between the two groups (P = .236). In the 6 months of follow-up, there was no statistically significant difference between the two groups in terms of biochemical recurrence, continence, and potency. Conclusion: RALP and 3D LRP have similar perioperative, short-term oncological and functional outcomes other than the operative time. There is a need for prospective, randomized studies with larger populations evaluating long-term oncological and functional outcomes.

Ultra-mini flexible percutaneous nephrolithotomy in the treatment of moderate-size kidney stones: a new instrument, a preliminary prospective study.

Ultra-mini PNL is increasingly preferred in the treatment of kidney stones. Unlike routine applications of the ultra-mini PNL technique, we aimed to perform kidney stones treatment with an epiduroscopic device that can pass through 11-13-Fr ureteral access sheaths with a flexible structure and which is routine in neurosurgical practice. The study was planned prospectively. The study included 52 patients with mid-sized kidney stones who had presented to our clinic between July 2017 and January 2019. The ultra-mini percutaneous nephrolithotomy was carried out with epiduroscopy routinely used in neurosurgery practice, which can pass through 11-13-Fr ureteral access and has a flexible structure. The perioperative and postoperative parameters were analyzed. The mean operation time was 45.6 ± 4.8 min and entry was provided through a single entry (from the calyx appropriate to the lower pole) in all patients; a second entry tract was not required. No DJ catheter or nephrostomy tube was installed in any patient and the procedures were completed totally without a tube. The mean reduction in hemoglobin values was determined as 0.33 (0.1-1.1) g/dL. None of the patients needed transfusion and no patient developed acute kidney injury. Clinically significant (≥ 3 mm) residual stone was observed in 2 (4%) of the 52 patients, while clinically insignificant (≤ 3 mm) stones were observed in 50 patients (96%). The mean length of hospital stay was 2.5 ± 0.9 days. Ultra-mini flexible percutaneous nephrolithotomy is an effective and safe method in the treatment of medium-sized kidney stones.

A review of hypogonadotropic hypogonadism cases followed up in our clinic in the last decade.

INTRODUCTION: The aim of the present study was to evaluate, with this retrospective study, the patients with hypogonadotropic hypogonadism, who were followed up in our clinic in the last decade and were reviewed in terms of the incidence of the disease, diagnostic methods and differential diagnoses, treatment modalities, fertility rates, and treatment success. METHODS: After a very careful differential diagnosis, 81 patients (1.5% of infertile men presenting to the outpatient clinic) were diagnosed with hypogonadotropic hypogonadism. This study only included patients diagnosed with idiopathic hypogonadotropic hypogonadism. The treatment was undertaken in two periods depending on whether or not the patients wanted to have children at that time: testosterone replacement therapy and gonadotropin therapy. To induce spermatogenesis, the patients were treated using human chorionic gonadotropin and urinary or recombinant follicle-stimulating hormone. RESULTS: The pregnancy rates of the spouses of the patients were as follows: spontaneous 64.6% (n = 42), intrauterine insemination 12.3% (n = 8), in vitro fertilization 15.3% (n = 10), and microscopic testicular sperm extraction + intracytoplasmic sperm injection 4.6% (n = 3). CONCLUSION: Idiopathic hypogonadotropic hypogonadism is a rare but easily diagnosable and treatable cause of male infertility. After a long period of the treatment, almost all idiopathic hypogonadotropic hypogonadism patients can be treated with gonadotropins (human chorionic gonadotropin + follicle-stimulating hormone) in order to have children. The most important issue in the treatment is the dose of the drugs used in the treatment and the duration of the treatment. The most important result is that the required gonadotropin dose varies according to each patient. Therefore, the treatment dose and duration should be increased until patients have children.

Surgical results in penile fracture: Our single center experience.

INTRODUCTION: Penile fracture arises as a result of a unilateral or bilateral rupture of the tunica albuginea of the corpus cavernosum. It is a rare condition that requires urgent surgical intervention. In this study, we aimed to determine the effectiveness of surgical treatment in penile fracture and its effect on complications. METHODS: The data of 21 patients who were admitted to the emergency department of our clinic between 2012 and 2019 and underwent emergency surgical repair with the diagnosis of penile fracture were collected retrospectively. The diagnosis of penile fracture was established by anamnesis and physical examination. Age, etiology, duration from trauma to surgery, physical examination findings,length and localization of the tunica albuginea defect, length of hospital stay, and postoperative first-, third- and sixth-month follow-up results were analyzed. Erectile function was evaluated using the International Index of Erectile Function (IIEF-5). Complications such as penile curvature, penile nodule and painful erection were evaluated. RESULTS: The mean age of the patients was 36.8 ± 8.3 years. The most common reason of penile fracture was manually bending the penis for detumescence. All patients underwent surgery. The mean duration from trauma to surgery was 7.6 ± 3.1 h. The mean length of the tunica albuginea defect was 11 ± 2.5 mm. The mean length of hospital stay was 2.5 ± 0.5 days. The mean IIEF-5 scores in the postoperative first, third and sixth months were 20.5 ± 2.6, 22 ± 2.2, 22.1 ± 1.7, respectively. CONCLUSION: Penile fracture is a urological emergency, and timely surgery is an effective treatment method for preventing postoperative complications.

The Effect of the Presence of Lower Urinary System Symptoms on the Prognosis of COVID-19: Preliminary Results of a Prospective Study.

PURPOSE: To investigate the effectiveness of benign prostatic hyperplasia (BPH)-related lower urinary tract symptoms (LUTS), which occur as a natural result of aging and androgen exposure, in predicting disease prognosis in male patients diagnosed with COVID-19. METHODS: The study was planned prospectively. The study included 63 male patients over 40 years of age diagnosed with COVID-19. The patients were diagnosed with COVID-19 based on the results of reverse transcription polymerase chain reaction tests of oropharyngeal and nasopharyngeal swabs obtained as per the World Health Organization guidelines. The presence of LUTS was assessed by the International Prostate Symptom Score (I-PSS), a subjective assessment, and the I-PSS was filled for the patients included in the study. The patients were divided into three groups based on their scores in the I-PSS survey: group 1: mild (0-7), group 2: moderate (8-19), and group 3: severe (20-35). The data of all three groups were statistically analyzed. RESULTS: In the assessment performed between the groups, it was identified that for patients in group 3, the length of hospital stay was longer, intensive care requirement was more frequent, and their mortality rates were numerically higher. In the evaluation made regarding the time to intensive care admittance, this was identified to be the shortest in group 3. CONCLUSION: As a result of our study, we think that in patients with COVID-19, BPH-related LUTS can guide clinicians in predicting prognosis.

Effect of Reconstructive Techniques on Continence in Robot-Assisted Laparoscopic Prostatectomy: Novel Combination of Long Urethral Stump and Anterior Suspension Suture.

OBJECTIVE: To investigate the effects of the novel combination of a long urethral stump and anterior suspension suture in patients who underwent Robot-Assisted Laparoscopic Prostatectomy (RALP) for localized prostate cancer. MATERIALS AND METHODS: Of the 40 participating patients, 20 did not undergo any reconstructive technique, whereas the remaining 20 patients underwent reconstructive technique that included the combination of long urethral stump and anterior suspension suture. Body mass index (BMI) (kg/m2), age, preoperative prostate-specific antigen (PSA) levels, prostate volume, Gleason score, D'Amico risk class, clinical stage, operation type and the application of either perioperative or postoperative reconstructive techniques, and the duration of catheterization were the parameters investigated. Continence rate was measured in the 3rd, 6th, and 12th month after the removal of the catheter. Both techniques were compared statistically. RESULTS: The control and reconstructive groups each comprised 20 patients. Between the groups, no statistically significant differences were observed in age, BMI, American Society of Anesthesiologists class, risk group, prostate weight, perioperative PSA, duration of surgery, duration of hospitalization, surgical margins, and the total amount of bleeding (p>0.05). Continence rate was significantly higher in the reconstructive group in the 3rd and 6th months compared with the control group (p<0.05). CONCLUSION: The combination of anterior suspension suture and long urethral stump contributed to early improvement in the continence rates.

A new method in robotic-assisted laparoscopic radical prostatectomy: personalised neuroprotective surgery with neuromonitoring system-randomised controlled study.

PURPOSE: Erectile dysfunction is one of the important morbidities following the radical prostatectomy (RP) surgeries. The goal of this research is to investigate the contribution of intraoperative neuromonitorisation method (IONM) on postoperative erectile function in patients who underwent robotic-assisted laparoscopic radical prostatectomy (RALP) with the localise prostate cancer (LPCa). MATERIALS AND METHODS: In this randomised controlled study contains 88 patients with LPCa were classified based on D'Amico Risk Classification. 61 patients who met the necessary criteria were divided into two groups as neuromonitorisation group (n = 30) and control group (n = 31). All patients were operated under general anaesthesia. All patients included in the study underwent RALP by robotic-assisted system. For the neuromonitorisation, IONM electromyography electrodes were placed to the right and left cavernous bodies in neuromonitorisation group. Impulses in the corpora cavernosa were considered significant. Postoperative erectile functions were determined according to the 3th and 6th month IIEF-5 scores. Demographic data, operative procedures, Gleason scores, final pathology, surgery border, PSA, and IIEF-5 score of patients were recorded. RESULTS: No statistically difference was found between the groups in terms of demographic data, operative procedures, Gleason scores, final pathology, surgery border, and third-month PSA levels (p > 0.05). There was statistically difference between the postoperative third and 6-month IIEF-5 score in neuromonitorisation group (p < 0.05). CONCLUSION: In the IONM technique, high rate of improvement in erectile function was observed in the early period thanks to personalised neuroprotective surgery applied to patients.

Evaluation of testicular catch-up growth in adolescent microsurgical varicocelectomy.

OBJECTIVE: The incidence of varicocele is approximately 15% in adolecent men. Early treatment with varicocele is aimed to resolve testicular hypotrophy and ensure catch-up growth. The aim of this study was to evaluate ipsilateral catch-up growth rates relative to contralateral testicular growth in adolescents with varicocele undergoing microsurgical subinguinal varicocelectomy. MATERIAL AND METHODS: Fifty adolescents with unilateral grade 2-3 varicoceles were included in the study. All patients underwent microsurgical subinguinal left varicocelectomies performed by the same experienced surgeon. All patients were evaluated clinically and using orchidometric measurements to define the grade of varicocele and testicular volume at presentation and follow-up. The number of internal and external spermatic veins, testicular arteries and lymphatic vessels preserved during the subinguinal microsurgical varicocelectomy were recorded. The mean follow-up period was 26 months (range 6-48 months). RESULTS: At presentation, mean patient age was 12.9±2.1 years. Mean testicular preoperative volumes were 7.1±4.3 mL for the right and 5.4±3.4 mL for the left testis. There were significant differences between mean volumes of the right and left testis (p=0.002). At the final postoperative follow-up visit, mean testicular volumes were 10.8±5.1 mL (range 3-25) for the right and 9.9±4.3 mL (range 2-20) for the left, and the difference between the right and left testicular volumes was insignificant (p=0.47). In our series, catch-up growth was observed in 70% (35/50) of our patients. CONCLUSION: Adolescent varicocelectomy is associated with a higher percentage of patients showing testicular catch-up growth. In our study, similarly to the available literature the catch-up growth rate was found as 70% and observed to have positive effects of adolescent varicocelectomy on testicular growth.

Rigid Ureteroscope Aided Insertion of Ureteral Access Sheath in Retrograde Intrarenal Surgery.

OBJECTIVE: To compare the outcomes of the ureteral access sheath (UAS) placement techniques in patients undergoing retrograde intrarenal surgery. MATERIALS AND METHODS: The patients were divided into two groups with respect to placement method of UAS. UAS was placed with the classical method, through the guidewire, in the first group of the patients (group I). The outer sheath of UAS was worn on the semirigid endoscope and placed into the ureter under direct vision in the second group (group II). The number of patients was the same in two groups (n = 42). RESULTS: Overall, 70 of 84 (83.3%) patients were stone free after the initial treatment. The success rates were comparable between the two groups (80.9% vs 85.7%, P = .859) 1 month after surgery. Fluoroscopy screening time (11.7 ± 5.7 seconds vs 0 second), UAS placement time (245 ± 138.4 seconds vs 40 ± 17.9 seconds; P < .001), and operation time (58.7 ± 17.1 minutes vs 51.2 ± 16.7 minutes; P = .046) were significantly longer in group I when compared to group II. The complication rate was higher in group I when compared to group II (23.8% vs 9.5%), but the difference was not statistically significant (P = .079). CONCLUSION: Introducing UAS into ureter under direct vision while it was precisely worn on ureteroscope makes this step safer, and protects the surgeon and patient from radiation exposure by shortening fluoroscopy and operation times.