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PURPOSE: To evaluate and compare the clinical results of different single-use flexible ureteroscopes (su-fURS) used in retrograde intrarenal surgery (RIRS). MATERIALS AND METHODS: RIRS cases performed identically by an experienced surgeon between 2022 and 2023 in a single center were retrospectively analyzed. These surgeries were performed with three su-fURS (Redpine RP-U-C12, Hugemed HU30, and Pusen Uscope 3022 A). In the study, the age, gender, body mass index, and Charlson comorbidity index of the patients were compared, along with their clinical details, such as the stone size, volume, density, location, and history of hydronephrosis or a double J stent or SWL. Operation time, stone-free rates (SFR), perioperative and postoperative complications, and hospitalization times were also compared. RESULTS: The study included 208 patients. Pusen had 63 cases, Hugemed had 62, and Redpine had 83. The comparison of the patient's demographic and clinical properties with stone-related variables was similar between the groups. The SFR was similar between the groups (p = 0.056). Perioperative, postoperative, and total complication rates and the need for a second intervention showed no significant differences among the three groups (p = 0.324, 0.088, 0.061, and 0.052, respectively). CONCLUSION: In the first study comparing the clinical results of cases in which different su-fURS were used, no difference was observed in surgical outcomes and complications, even though the technical features of these devices were different. Urologists should select su-fURS based on clinical requirements, financial constraints, and personal experiences.
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Desenho de Equipamento , Cálculos Renais , Ureteroscópios , Humanos , Feminino , Masculino , Estudos Retrospectivos , Pessoa de Meia-Idade , Cálculos Renais/cirurgia , Resultado do Tratamento , Adulto , Ureteroscopia/métodos , Complicações Pós-Operatórias/epidemiologia , IdosoRESUMO
INTRODUCTION: There are conflicting results in the literature regarding the efficacy of retrograde intrarenal surgery (RIRS) in lower pole stones. This study aimed to evaluate RIRS outcomes in lower pole stones by forming matched case-control groups. METHODS: The data of 491 patients who were diagnosed with kidney stones and underwent RIRS were retrospectively included in the study. A total of 209 patients with lower pole stones (Group 1) and 282 patients with pelvic stones (Group 2) were matched at a 1:1 ratio in terms of stone burden, stone density, preoperative double-J stenting status, and a previous history of shock wave lithotripsy, yielding 159 patients in each group. A computed tomography scan was performed to evaluate the stone-free status. The primary outcome was stone-free status 1 month after RIRS. RESULTS: After case-control matching, the median age was 49 years (interquartile range [IQR]: 40-58) in Group 1 and 50 years (IQR: 35-60) in Group 2 (p = 0.388). The median stone burden values of Group 1 and Group 2 were 415.3 mm3 (IQR: 176.1-858.2) and 503.3 mm3 (IQR: 282.5-864), respectively (p = 0.100). After RIRS, stone-free status was achieved by 126 of the 159 (79.2%) in Group 1 and 133 of the 159 (83.6%) patients in Group 2 (p = 0.387). The groups were similar in terms of perioperative complications (4.4% in Group 1 and 3.8% in Group 2, p = 0.777), postoperative complications (13.8% in Group 1 and 10.3% in Group 2, p = 0.393), and median operation time (60 min in both, p = 0.230). A longer median fluoroscopy time was noted in Group 1 compared to Group 2 (26 s and 3 s, respectively, p = 0.013). CONCLUSIONS: Stone-free rates and complications were comparable between the patients with lower pole and pelvic stones after RIRS. However, lower pole stones are associated with longer fluoroscopy time. RIRS can be performed effectively for the treatment of lower pole stones.
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INTRODUCTION: The aim of the study was to evaluate the efficacy and safety of retrograde intrarenal surgery (RIRS) in elderly patients by comparing them with propensity score-matched age-groups. METHODS: Patients who underwent RIRS to treat upper urinary tract stone disease at seven centers were included in the study and were divided into four groups. The age intervals of the patients in group 1, group 2, group 3, and group 4 were 18-29 years old, 30-49 years old, 50-64 years old, and over 65 years old, respectively. Propensity score matching analysis was used to homogenize the groups in terms of demographic and clinical properties. Operative results, preoperative complications, perioperative complications, postoperative complications, duration of hospitalization time, and stone-free status were compared between groups. RESULTS: A total of 1,017 patients were included in the study. There were 69 (9.9%) patients in group 1, 324 (46.5%) in group 2, 217 (31.1%) in group 3, and 87 (12.5%) in group 4 after propensity score matching. The operation time and postoperative complication rates were significantly different among groups, whereas the hospitalization time, perioperative complication rates, and stone-free status were similar. The operation time was significantly higher in patients over 65 years old (p = 0.001). The postoperative complication rates were significantly higher in group 1 with Clavien I-II complication predominance (p = 0.003). CONCLUSION: The efficacy and safety of RIRS did not change with aging, and RIRS was an effective option for the treatment of upper urinary system stones in elderly patients.
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The aim of the study is to evaluate and compare the quality and readability of responses generated by five different artificial intelligence (AI) chatbots-ChatGPT, Bard, Bing, Ernie, and Copilot-to the top searched queries of erectile dysfunction (ED). Google Trends was used to identify ED-related relevant phrases. Each AI chatbot received a specific sequence of 25 frequently searched terms as input. Responses were evaluated using DISCERN, Ensuring Quality Information for Patients (EQIP), and Flesch-Kincaid Grade Level (FKGL) and Reading Ease (FKRE) metrics. The top three most frequently searched phrases were "erectile dysfunction cause", "how to erectile dysfunction," and "erectile dysfunction treatment." Zimbabwe, Zambia, and Ghana exhibited the highest level of interest in ED. None of the AI chatbots achieved the necessary degree of readability. However, Bard exhibited significantly higher FKRE and FKGL ratings (p = 0.001), and Copilot achieved better EQIP and DISCERN ratings than the other chatbots (p = 0.001). Bard exhibited the simplest linguistic framework and posed the least challenge in terms of readability and comprehension, and Copilot's text quality on ED was superior to the other chatbots. As new chatbots are introduced, their understandability and text quality increase, providing better guidance to patients.
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Inteligência Artificial , Disfunção Erétil , Masculino , Humanos , Software , Benchmarking , LinguísticaRESUMO
PURPOSE: The flexible ureterorenoscopy (FURS) is expensive and fragile equipment which easily break down during the surgery. f-URS have yet some problems with their durability that affect survival. One of the most important ways to increase the survival of a device is to improve its use in the right indications. We aimed to investigate whether the durability of the f-URS will be affected due to the volume and location of the stone and some anatomical features of the including infundibulopelvic angle (IPA), and location anomalies. MATERIALS AND METHODS: The collected data from 705 patients' data including their age, sex, stone location, and stone volume, S-ReSC score, Hounsfield unit (HU) as stone density, IPA, BMI, and the usage time of f-URS using 10f-URS were included to study. Exp(B) values and confidence intervals (95% CIs) of parameters were calculated with COX regression and Roc curve analysis was also used to determine the cut-off value. RESULTS: Renal malformation, DJstent use, previous ESL application, and UAS use did not affect contrary to expectations stone volume, HU, IPA, and S-ReSC score were among the factors statistically significant affecting the durability of the device. It was observed, Exp(B) values of the affecting factors to be 0.984, 0.268, 0.894, and 0.607, respectively. We found the most appropriate cutoff value for IPA as 41.25 degrees. CONCLUSION: The mean stone volume broken by each of the subsequent f-URS may increase, while the mean operative time may decrease as time progresses. This result shows us the importance of mastery of the device, such as the deflection maneuver, and the correct use distance of the laser, which improves with the increase in user experience, and makes us interpret that the operation time is shortened with this self-confidence. Factors including stone volume, HU, IPA, S-ReSC score affect the durability of the f-URS device and the as well as manufacturing features.
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Cálculos Renais , Humanos , Cálculos Renais/cirurgia , Ureteroscópios , Estudos Retrospectivos , Ureteroscopia , Duração da Cirurgia , Resultado do TratamentoRESUMO
INTRODUCTION: COVID-19 is a disease that may cause anxiety, depression, and stress. Bladder pain syndrome (BPS) is a disease in which stress and psychological factors might negatively affect its course. In this study, we aimed to examine the possible clinical aggregation of the pandemic period on BPS patients. MATERIALS AND METHODS: A total of 35 BPS patients diagnosed between 2010 and 2018 were included. All patients were using medical treatment, and the follow-up period was at least 6 months. According to our clinical follow-up protocol, the BPS patients were given the King's Health Questionnaire (KHQ), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Overactive Bladder Form V8 (OAB-V8), and Visual Analog Score (VAS) in every visit. In the sixth month of the pandemic, the clinical course of the patients was questioned by telephone or video interview, and their treatment continuities were questioned. Information was received about the delays in their follow-up and the difficulties in accessing healthcare opportunities. The same questionnaires were filled out and compared with pre-pandemic scores. RESULTS: The mean age of the patients included in the study was 50.2 ± 13.32 (min:20, max:74), 11 were males and 24 were females. The mean follow-up periods were 71.8 ± 35.6 months. All questionnaire scores showed an increase compared to the pre-pandemic period. A statistically significant increase was detected during the pandemic in all sub-units of the KHQ. The VAS and OAB-V8 scores of 16 patients who requested hospital admission were significantly higher than before the pandemic. However, there was no statistically significant difference in the increase in VAS and OAB-V8 scores of the 19 patients who refused to come to the hospital. CONCLUSION: BPS patients have been negatively affected by the emotional effects of the COVID-19 pandemic. Due to the fear, stress, anxiety, and depression, the symptoms of BPS patients exacerbated, and the patients could not receive the necessary support due to a lack of regular follow-ups.
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COVID-19 , Cistite Intersticial , Bexiga Urinária Hiperativa , Masculino , Feminino , Humanos , Cistite Intersticial/tratamento farmacológico , Cistite Intersticial/epidemiologia , Cistite Intersticial/diagnóstico , Amitriptilina/uso terapêutico , Pandemias , Bexiga Urinária Hiperativa/tratamento farmacológicoRESUMO
INTRODUCTION: Although retrograde intrarenal surgery (RIRS) is being performed with increasing frequency, there are only a limited number of studies about the learning curve (LC). This study aimed to analyze the LC of RIRS for five surgeons who underwent the same training. MATERIALS AND METHODS: The data of the 410 patients who underwent RIRS between April 2017 and 2022 in a single institution, which were performed consecutively by five surgeons, were analyzed. All 50 cases performed by each surgeon were included and numbered consecutively and separately, according to the date of the operation. The combined stone-free rate (SFR) was calculated for each surgeon's cases in the same row, and the LCs were created using moving average and cumulative sum (CUSUM) analyses. Separate multivariable analyses identified each period's (LC vs. beyond) characteristics. RESULTS: The LCs from the combined SFRs reached a plateau after approximately 50 cases for both the CUSUM and the moving average. The effect of stone burden on SFR was more evident in the first 50 cases compared to subsequent cases in the multivariable analyses (p = 0.001 and p = 0.047, respectively). Case order and stone density were independent factors in the first 50 cases (OR: 1.02 [95% CI 1.00-1.04], p = 0.04 and OR: 0.99 [95% CI 0.99-1.00], p = 0.04) but not significant in subsequent cases (OR: 0.97 [95% CI 0.94-1.00], p = 0.1 and OR: 1.00 [95% CI 0.99-1.00], p = 0.7, respectively). Compared to single locations except the lower calyx, the unfavorable effect of the multiple-stone localization on SFR grew in strength after the 50th case (OR: 0.42 [95% CI 0.23-0.78], p = 0.01 and OR: 0.20 [95% CI 0.09-0.46], p < 0.001, respectively). CONCLUSIONS: This is the first study reporting on the RIRS LCs of urology residents. While stone burden, density, and multiple-stone localization were the factors determining SFR in the learning period, after completing the LC, the effect of stone burden weakened and multiple-stone localization became stronger.
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Cálculos Renais , Cirurgiões , Urologia , Humanos , Cálculos Renais/cirurgia , Curva de Aprendizado , Resultado do Tratamento , Estudos RetrospectivosRESUMO
Objective: To determine the shrinkage effect of formalin on renal cell carcinoma. METHODS: The retrospective study was conducted from October to November 2020 at Tekirdag Namik Kemal University, Turkey, and comprised all radical and partial nephrectomy cases performed by a single surgeon in a single clinic between January 2014 and August 2020. Pre-operative images and post-operative pathology were reviewed by the same clinician. Pre-operative longest tumour diameter of radiological images and pathological specimens measured after formalin fixation shrinkage were compared, and the effect of the difference between the two measurements on the circumference of the tumour was examined. The formalin-related shrinkage rates of renal tumours according to the tumour size and the tumour types were also analysed. Data was analysed using SPSS 20. RESULTS: Of the 101 cases, 58(57.4%) were of radical and 43(42.6%) of partial nephrectomy. Also, there were 77(76.2%) renal cell carcinoma cases, 22(21.8%) benign renal tumours and 2(1.9%) had other malignant tumours. There were 59(58.4%) males and 42(41.6%) females with an overall mean age of 58.1±12,2 years (range: 30-82 years). The mean radiological size of the renal tumours was 55.3±30.4 mm and it was 52.9±31.6 mm at pathological examination (p>0.05). Conclusion: Formalin fixation of tissues post-surgery caused a difference between the radiological and pathological dimensions. Though the difference was no significant, under-staging due to the shrinkage post-surgery should be considered.
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Carcinoma de Células Renais , Neoplasias Renais , Masculino , Feminino , Humanos , Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/cirurgia , Formaldeído/farmacologia , Estudos Retrospectivos , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/cirurgia , Neoplasias Renais/patologia , Nefrectomia/métodosRESUMO
INTRODUCTION: The Modified Seoul National University Renal Stone Complexity Score (S-ReSC) is a simple model based solely on stone location regardless of stone burden. The aims of this study were to validate S-ReSC for outcomes and complications of retrograde intrarenal surgery (RIRS) and to evaluate its predictive power against the stone burden. MATERIAL AND METHODS: Data of 1007 patients with kidney stones who had undergone RIRS were collected from our RIRSearch database. Linear-by-linear association, logistic regression, ANOVA/post hoc analysis and ROC curve (with Hanley and McNeil's test) were used for evaluation. The main outcomes were stone-free status and complications of RIRS. RESULTS: The overall stone-free rate was 76.8% (773/1007). Higher S-ReSC scores were related to lower stone-free rates and higher total, perioperative and postoperative complication rates (p<.001, p<.001, p=.008 and p<.001, respectively). S-ReSC score (p=.02) and stone burden (p<.001) were independent predictors of stone-free status. But stone burden (AUC = 0.718) had a more powerful discriminating ability than the S-ReSC score (AUC = 0.618). CONCLUSIONS: The S-ReSC score is able to predict not only stone-free status but also complications of RIRS. Although this location-only based scoring system has a fair discriminative ability, stone burden is a more powerful predictor of stone-free status after RIRS. An ideal scoring system aiming to predict outcomes of RIRS must include stone burden as a parameter.
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Cálculos Renais , Humanos , Cálculos Renais/cirurgia , Modelos Logísticos , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Seul , Resultado do Tratamento , UniversidadesRESUMO
AIMS: To evaluate the effect of pre-RIRS ESWL on the efficiency and safety of RIRS in the treatment of proximal ureter stones. METHODS: The patients in the study population were divided into two groups. Group-1 was composed of patients who had undergone ESWL for proximal ureter stones before RIRS and Group-2 was composed of patients who directly underwent RIRS without any prior ESWL. The clinical and demographic properties of the patients were analysed in the RIRSearch database. The operative outcomes, peroperative complications, postoperative complications, hospitalisation time and stone-free rates were compared between the groups. RESULTS: There were 56 patients in Group 1 and 95 patients in Group 2. The demographic and clinical properties were similar between the groups. The stone-free rates, peroperative complications and postoperative complications were also similar between the groups; however, the fluoroscopy time was significantly higher in Group 1 (P = .043). The cut-off duration of 10 weeks between ESWL and RIRS had reasonable/favourable discriminating ability, with a 51% sensitivity and 88% specificity rate for stone-free status. CONCLUSION: Performing ESWL on the proximal ureter stones before RIRS did not change the efficacy and safety of RIRS. The time between the patient's last ESWL session and RIRS had a predictive value for stone-free status, but did not have any effect on complications.
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Cálculos Renais , Litotripsia , Ureter , Bases de Dados Factuais , Humanos , Cálculos Renais/cirurgia , Litotripsia/efeitos adversos , Complicações Pós-Operatórias , Resultado do TratamentoRESUMO
AIM: The guidelines propose optical dilatation before retrograde intrarenal surgery (RIRS), but there are currently no evidence-based studies concerning the impact of optical dilatation with semirigid ureteroscopy (sURS). The aim of this study was to evaluate the effect of optical dilatation through sURS prior to the RIRS procedure on the success and complications of RIRS. METHODS: A total of 422 patients were included in the retrospective multicentre study. The patients were divided into two groups according to whether sURS was to be performed. Patients' demographics, stone parameters and operative outcomes were compared. Surgical success was defined as no or up to 3-mm residual stone fragments without the need for additional procedures. The independent predictors for surgical success were determined with a multivariable logistic regression model. RESULTS: Of the 422 patients, 133 (31.5%) were in the sURS group and 289 (68.5%) were in the non-sURS group. Stone characteristics and patients' demographics were similar between the groups. Operation time in the sURS group was significantly longer (compared with the non-sURS group, P < .0001). A ureteral access sheath (UAS) could not be placed in four (3.0%) patients in the sURS group, nor in 25 (8.7%) patients in the non-sURS group (P = .03). Compared with the non-sURS group, the intraoperative complication rate was lower in the sURS group (14 [4.8%] vs 1 [0.8%], P = .04). The surgical success rate was higher in the sURS group (P = .002). Nevertheless, sURS had no independent effect on surgical success. We found two independent predictors for surgical success rate: stone number (P < .0001, OR:2.28) and failed UAS placement (P = .035, OR:3.49). CONCLUSIONS: Optical dilatation with sURS before RIRS increases surgical success by raising the rate of UAS placement and reducing the rate of intraoperative complications. We suggest that this method can be routinely applied to patients who have not been passively dilated with a JJ stent.
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Cálculos Renais , Ureter , Dilatação , Humanos , Cálculos Renais/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Ureteroscopia/efeitos adversosRESUMO
We aimed to evaluate the effect of the abnormal ejaculation (AEj) on patients using silodosin in terms of drug cessation. We also analysed the possible factors that may affect the decisions of patients with AEj to proceed or change their medication. The patients (n = 118) treated with silodosin 8 mg daily were prospectively analysed. In order to evaluate the erectile function, ejaculatory function, depression and sexual satisfaction; IIEF, MSHQ-EjD, Beck's depression and Golombok-Rust questionnaires were given to patients respectively. Patients were re-evaluated at the 3rd month of their treatment. The rate of AEj was 52.5%. Nearly 42% of the patients with AEj desired to stop their medication whereas it was 7.1% at patients without AEj (p < .001). The pre-treatment International Prostate Symptom Score (IPSS) and the decrease in IPSS score were significantly lower in patients who demand to stop their treatment (p < .05). AEj was significantly higher in patients who wanted to stop their medication (p < .001). Even if they had an AEj, patients who were happy with the clinical efficacy of silodosin did not want to change their drug. In addition to this, pre-treatment ejaculatory status was an important indicator for patients to decide drug cessation due to AEj side effect of silodosin.
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Sintomas do Trato Urinário Inferior , Hiperplasia Prostática , Ejaculação , Humanos , Indóis/efeitos adversos , Sintomas do Trato Urinário Inferior/tratamento farmacológico , Masculino , Hiperplasia Prostática/tratamento farmacológico , Resultado do TratamentoRESUMO
The study's aim was to document the rates of declared and hidden erectile dysfunction (ED) at urology outpatient clinic while attempting to develop a method to encourage patients to talk about ED. A total of 506 patients, all of whom underwent the same procedure by the same clinician with a standard algorithm, were prospectively evaluated. The patients who declared ED as their primary or secondary symptom were grouped as 'very early treatment seekers' (VETS) and 'early treatment seekers' (ETS) respectively. The patients who hid their ED until directly questioned and the patients whose ED was diagnosed with an IIEF-5 questionnaire were grouped as 'late treatment seekers' (LTS) and 'very late treatment seekers' (VLTS) respectively. The total number of ED was 291 (57.5%), comprised of 54 (18.6%) patients in the VETS, 48 (16.5%) in the ETS, 143 (49.1%) in the LTS and 46 (15.8%) in the VLTS groups. The rate of severe ED was significantly higher in the VETS group, whereas the rate of mild ED was significantly higher in the VLTS group (p < .001). Most of the patients would not seek help for their ED until the clinician directly or indirectly questioned them. Simple manipulations uncovered the hidden ED patients.
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Disfunção Erétil , Urologia , Instituições de Assistência Ambulatorial , Disfunção Erétil/epidemiologia , Humanos , Masculino , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To investigate the awareness about testicular cancer and testicular self examination among medical students and the community. METHODS: The cross-sectional comparative study was conducted from January to April 2019 at Tekirdag, Turkey, and comprised young male medical students aged 18-26 years and an age-matched control group of male high school graduates. Data was collected using face-to-face survey through a 15-question survey form. Data was analysed and compared using SPSS 20. RESULTS: Of the 345 subjects, 174(50.4%) were medical students and 171(49.6%) were in the control group. The mean age of the medical students was 21.51±2.02 years and that of the control group was 22.04±1.45 years (p=0.435). The awereness about testicular self examination was among 91(52.3%) medical students and 32(23%) controls (p<0.01). There was no significant difference between the groups in terms of individuals performing testicular self examination (p=0.069). The level of awareness and the practice of performing testicular self examination increased from the first to the last year of medical studies (p<0.01). CONCLUSION: The rate of awareness and performing testicular self examination was low in the general population. However, the rates significantly increased in medical students from the first to the final year.
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Neoplasias Testiculares , Adulto , Conscientização , Estudos Transversais , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Autoexame , Inquéritos e Questionários , Neoplasias Testiculares/diagnóstico , Neoplasias Testiculares/epidemiologia , Turquia/epidemiologia , Adulto JovemRESUMO
AIM: Bladder pain syndrome (BPS) is a complex disease which causes cognitive, behavioral, sexual, and emotional problems. Vascular factors related to bladder blood supply may be one of the etiologic cause of BPS. This study aims to investigate the bladder blood flow and internal iliac artery resistive indices of patients with BPS. METHODS: A total of 30 female patients with the diagnosis of BPS and 30 female as control group were enrolled in the study. Bilateral internal iliac arterial blood flow distal to uterine arteries were examined as the primary source of vesical arterial blood supply. Peak systolic velocities, end diastolic velocities, resistive indices, and flow volumes of internal iliac arteries were measured by color Doppler ultrasonography in a single-blind fashion. RESULTS: The blood flows volume of the right and left internal iliac arteries during empty and full bladder were significantly lower at BPS group compared with control (P < 0.05). Although the difference was not significant, the mean resistive index of right and left internal iliac arteries were lower at the control group ( P > 0.05). Aging decreased the bladder blood volume and both BPS and control group internal iliac artery blood volume decreased by aging. The decrease was more significant at the control group, but the internal iliac artery blood volume was still lower at patients with BPS compared with the control group. CONCLUSION: Arterial blood flow of bladder was lower at patients with BPS compared with the control group. The decrease in the vascular supply of bladder might be one of the related factors for the BPS etiology.
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Cistite Intersticial/etiologia , Bexiga Urinária/irrigação sanguínea , Adulto , Velocidade do Fluxo Sanguíneo/fisiologia , Cistite Intersticial/diagnóstico por imagem , Feminino , Humanos , Artéria Ilíaca/diagnóstico por imagem , Pessoa de Meia-Idade , Método Simples-Cego , Ultrassonografia Doppler em Cores , Bexiga Urinária/diagnóstico por imagemRESUMO
INTRODUCTION: Turkish Continence Society aimed to analyze how overactive bladder (OAB) is being managed in routine practice by the urologists in Turkey. MATERIAL AND METHODS: Fourteen urology departments were randomly selected to represent the whole population in this multicenter study. An online data entry and storage software was created for patient recruitment and data assessment. A survey including demographic data, daily habits, lower urinary tract symptoms, and Turkish-validated OAB-V8 and ICIQ-SF questionnaires were completed by all patients. Second part of the survey, including the questions about clinical evaluation and management of the patient, was completed by the treating physician. RESULTS: A total of 507 patients (394 female and 113 male) were included. Behavioral therapy was recommended to 73.2% of female and 81.4% of male patients although bladder diary was requested for 59.5% and 52.7% of the female and male patients, respectively. In the first visit, 86.1% of the female and 89.3% of the male patients were given antimuscarinics (P = .431). Antimuscarinic-related side effects occurred in 94.9% and 88.9% of the female and male patients, respectively (P = .937). However, the rate of medical treatment change due to antimuscarinic-related side effects was only 1.7% in female and 4.8% in male patients at the end of 4 months. CONCLUSIONS: Behavioral therapy and antimuscarinics were the preferred initial treatment modalities of OAB in concordance with the guidelines. Despite guideline recommendations, bladder diaries were not utilized in half of the patients. Insufficient efficacy appeared to be the main reason for treatment modification.
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Dietoterapia , Antagonistas Muscarínicos/uso terapêutico , Diafragma da Pelve , Modalidades de Fisioterapia , Bexiga Urinária Hiperativa/terapia , Redução de Peso , Exercícios Respiratórios , Constipação Intestinal/terapia , Feminino , Humanos , Sintomas do Trato Urinário Inferior/fisiopatologia , Sintomas do Trato Urinário Inferior/terapia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Inquéritos e Questionários , Turquia , Bexiga Urinária Hiperativa/fisiopatologiaRESUMO
Urethral stricture is a common disease with high recurrence rate. Several manipulations were defined to prevent the recurrence but the results were disappointing. This study aimed to evaluate the efficacy of triamcinolone and mitomycin-C on urethral stricture formation and their effect on inhibition of urethral fibrosis. A total of 24 New Zealand rabbits were divided into 3 groups. Urethras of rabbits were traumatized with pediatric resectoscope. Resection area was irrigated with 10mL saline, swapped with a cotton wool soaked with 0.5mg/mL MMC and injected by 40mg triamcinolone in groups 1, 2 and 3 respectively. Retrograde urethrogram was performed at 28th day of procedure and the urethra was removed for histopathologic evaluation. There were significant differences in urethral diameters and in lumen reduction rate between the control and study groups (p<0.001). Compared to control group, all treatment groups showed mild fibrosis, less collagen bundle irregularity, and lower numbers of fibroblasts (p=0.003). The Tunnel assay showed that the number of apoptotic cells in the submucosal connective tissue was quantitatively higher in control groups (p=0.034). In the view of efficacy and safety, MMC and triamcinolone have the potential to replace the use of stents, clean intermittent catheterization, or long term catheters following internal urethrotomy. There were no statistically significant differences between two agents in terms of preventing urethral stricture formation in the present study. Mitomycin C and triamcinolone decreased the recurrence rates of urethral stricture.
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Mitomicina/uso terapêutico , Triancinolona/uso terapêutico , Estreitamento Uretral/prevenção & controle , Animais , Modelos Animais de Doenças , Masculino , CoelhosRESUMO
BACKGROUND: Testicular torsion is an emergency condition in which spermatogenesis may be irreversibly damaged. There have been controversial results about the effect of testicular torsion on steroidogenesis. We aimed at investigating the effect of testicular torsion on steroidogenesis. MATERIAL AND METHODS: A total of 40 adult male rats were divided into 4 groups. Left testicles were removed in all groups. Right testicles were torsioned and remained in the torsion position for 1, 3 and 5 h in study groups, whereas no torsion was performed in control. Serum luteinizing hormone (LH) and total testosterone (TT) levels were measured on the 3rd and 30th days of surgery and orchiectomy was performed on the 30th day of testicular torsion for histopathological evaluation. RESULTS: TT levels of study groups were significantly lower than that of the control group on the 3rd day of torsion. LH of study groups was higher than that of the control group, but the difference was significant only in the 5 h-torsion group. The total number of Leydig cells increased in 1- and 3-h groups, whereas it decreased in the 5-hour group. CONCLUSION: Testosterone production and Leydig cell functions significantly decreased after 5 h torsion in the rat model. The duration of torsion less than 5 h yielded partial dysfunction on steroidogenesis.
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Hormônio Luteinizante/biossíntese , Torção do Cordão Espermático/metabolismo , Testículo/metabolismo , Testosterona/biossíntese , Animais , Hormônio Luteinizante/sangue , Masculino , Ratos , Ratos Sprague-Dawley , Torção do Cordão Espermático/sangue , Testosterona/sangue , Fatores de TempoRESUMO
INTRODUCTION AND HYPOTHESIS: Nocturia and nocturnal enuresis (NE) share similar aetiopathological factors, and may represent two different situations involving the same underlying issue. In this study, we tried to evaluate the relation between NE of childhood and nocturia of young adulthood. METHODS: A total of 577 female university students aged 17-24 years were included in the survey. A face-to-face questionnaire was administered concerning present nocturia and past NE history. A non-validated questionnaire, created by the authors, was used to evaluate the presence and the frequency of childhood NE and present nocturia. All participant data were checked by telephone contact with their parents. RESULTS: The overall prevalence rates of nocturia and history of nocturnal enuresis in the study population were 8.6 % and 15 % respectively. Sixteen per cent of nocturics and 15 % of non-nocturics had a history of childhood NE (p = 0.837). The childhood NE was graded as severe or infrequent. The presence of nocturia was compared between participants with severe NE and infrequent NE, and no significant difference was observed (11.1 % vs 7.8 %, p = 0.713). Nocturia frequency was compared with the history of childhood NE and we found that as the nocturia frequency increased, the rate of childhood NE also increased. CONCLUSIONS: There was no relation between young adulthood nocturia and childhood NE in our study population, but as the severity of nocturia increased, the relation between nocturia and NE became more relevant.
Assuntos
Noctúria/epidemiologia , Noctúria/etiologia , Enurese Noturna/complicações , Enurese Noturna/epidemiologia , Adolescente , Fatores Etários , Feminino , Inquéritos Epidemiológicos , Humanos , Incidência , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Inquéritos e Questionários , Adulto JovemRESUMO
Objective: To evaluate and compare the quality and comprehensibility of answers produced by five distinct artificial intelligence (AI) chatbots-GPT-4, Claude, Mistral, Google PaLM, and Grok-in response to the most frequently searched questions about kidney stones (KS). Materials and Methods: Google Trends facilitated the identification of pertinent terms related to KS. Each AI chatbot was provided with a unique sequence of 25 commonly searched phrases as input. The responses were assessed using DISCERN, the Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P), the Flesch-Kincaid Grade Level (FKGL), and the Flesch-Kincaid Reading Ease (FKRE) criteria. Results: The three most frequently searched terms were "stone in kidney," "kidney stone pain," and "kidney pain." Nepal, India, and Trinidad and Tobago were the countries that performed the most searches in KS. None of the AI chatbots attained the requisite level of comprehensibility. Grok demonstrated the highest FKRE (55.6 ± 7.1) and lowest FKGL (10.0 ± 1.1) ratings (p = 0.001), whereas Claude outperformed the other chatbots in its DISCERN scores (47.6 ± 1.2) (p = 0.001). PEMAT-P understandability was the lowest in GPT-4 (53.2 ± 2.0), and actionability was the highest in Claude (61.8 ± 3.5) (p = 0.001). Conclusion: GPT-4 had the most complex language structure of the five chatbots, making it the most difficult to read and comprehend, whereas Grok was the simplest. Claude had the best KS text quality. Chatbot technology can improve healthcare material and make it easier to grasp.