A Critical Analysis of the Magnetic Resonance Imaging Lesion Diameter Threshold for Adverse Pathology Features.

To investigate the relationship between lesion size determined using multiparametric magnetic resonance imaging (mpMRI) and histopathological findings of specimens obtained after mpMRI fusion biopsy and radical prostatectomy (RP). We retrospectively analysed 290 patients with PCa who underwent an MRI fusion biopsy. We measured the diameter of suspicious tumour lesions on diffusion-weighted mpMRI and stratified the cohort into two groups. Group A included patients with a suspicious tumour lesion 10 mm and Group B included those with a suspicious tumour lesion > 10 mm. In Group B, the PI-RADS score determined in mpMRI was higher than Group A, and there was a statistically significant difference between the two groups in terms of clinical T-stage. The PCa detection rate and the number of positive cores were statistically significantly higher in Group B than in Group A. In addition, there was a statistically significant difference between the two groups in relation to the biopsy, the International Society of Urological Pathology (ISUP) grade values, and the presence of clinically significant PCa. In Group B, pathological T-stage and extraprostatic extension (EPE) and surgical margin (SM) positivity were found to be higher among the patients who underwent RP. In the multivariate analysis, the mpMRI lesion size being > 10 mm was found to be an independent predictive factor for SM and EPE positivity. The clinical results of this study support the modification of the lesion size threshold as 10 mm for use in the differentiation of PI-RADS scores 4 and 5.

Assistant port is unnecessary for robotic-assisted laparoscopic pyeloplasty in children: a comparative cohort study.

OBJECTIVE: To compare the postoperative outcomes including the cosmetic results of robotic-assisted laparoscopic pyeloplasty (RALP) performed with and without assistant port in pediatric population. METHODS: 47 patients with ureteropelvic junction obstruction consecutively underwent RALP were stratified as: three-port (Group 1, n = 26) and four-port (Group 2, n = 21). In Group 1, no assistant port was placed and double-J stent was introduced with the aid of an angiocatheter via the percutaneous route. In group 2, an assistant port was placed. The Patient and Observer Scar Assessment Scale (POSAS), the Vancouver Scar Scale(VSS), Satava, Clavien classification systems, and success rates were compared. RESULTS: We found similar success rates for both groups (group 1:96.2%, group 2:100%). Two groups were similar in terms of improvement in the postoperative anteroposterior diameter of the renal pelvis and parenchymal thickness. There was no difference in terms of perioperative and postoperative complication rates (group 1:19.2%, group 2:9.5%). The total PSAS was significantly lower in Group 1 (p < 0.008). No difference was observed for VSS and OSAS. CONCLUSIONS: Using an assistant port does not improve the success or complications of RALP, while the cosmetic outcomes are inferior to three-port RALP in children. We suggest avoiding the use of assistant port during RALP in children.

A novel nomogram and a simple scoring system for urinary leakage after percutaneous nephrolithotomy.

INTRODUCTION: The present study aimed to investigate the factors of prolonged urinary leakage (PUL) after percutaneous nephrolithotomy (PCNL) and develop a new and simple scoring system to predict it. PATIENTS AND METHODS: We retrospectively reviewed patients with renal stones who underwent PCNL at the University of Health Sciences Izmir Bozyaka Training and Research Hospital between April 2011 and January 2020. The patients were divided into two groups according to the presence of PUL, and their preoperative and perioperative data were compared. A multivariate regression analysis was applied to examine the relationship between perioperative descriptors and PUL, and a nomogram was developed using significant predictors. Then, the individual components of the nomogram were assigned points to form a scoring system. RESULTS: There were 92 and 840 patients in the groups with and without PUL, respectively. The results of the univariate logistic regression analysis showed that hydronephrosis grade, parenchymal thickness, duration of nephroscopy, and duration of nephrostomy catheter were significantly associated with PUL. Subsequently, a multivariate regression analysis was carried out with these four factors as possible independent risk factors of PUL after PCNL. Based on the results of this analysis, a nomogram prediction model was developed with an area under the curve value of 0.811, which was consequently used to develop a new simple score system consisting of three characteristics: parenchymal thickness (1-5 points), duration of nephroscopy (1-3 points), and hydronephrosis grade (1-3 points). CONCLUSION: A novel scoring system is a useful tool for predicting PUL in patients who have undergone percutaneous nephrolithotomy.

The efficiency of prostate-specific antigen density measurement using three different methods on the prediction of biochemical recurrence.

BACKGROUND: The aim of this study was to evaluate the efficiency of prostate-specific antigen (PSA) density (PSAD) calculated through prostate volume (PV) obtained via transrectal ultrasound (TRUS) and magnetic resonance imaging (MRI) and actual prostate weight (PW) methods obtained via pathological evaluation on the prediction of biochemical recurrence (BCR) in the follow-ups of patients who had undergone radical prostatectomy (RP). METHODS: A total of 335 clinically localized prostate cancer (PCa) patients who had received open RP between January 2015 and December 2018 were enrolled in the study. Pre and postoperative demographic data, clinical and pathological findings and BCR conditions were recorded. The PSAD was calculated using information obtained through preoperative TRUS examinations, MRI, and collected pathological specimens after RP by dividing the maximum preoperative PSA value and PV/PW. RESULTS: In a mean follow-up duration of 20.2 ± 8.5 months, recurrence was observed in 52 patients (24.4%) and progression was observed in 8 (3.8%) patients. The TRUS-PSAD, MRI-PSAD, and PW-PSAD values were statistically significantly higher in BCR patients compared to non-BCR patients. The International Society of Urologic Pathologists (ISUP) grade 5 and pT3b as a pathological stage were detected as independent variables in the prediction of BCR formation. Actual PW had a high prediction value compared to other PSAD measurements at <40 g prostate weights, but it had a low prediction value in prostates with an actual PW >60 g. CONCLUSIONS: In this study, it was stated that PSAD acquired through different imaging methods does not affect the usability of PSAD in BCR prediction in clinical practice. The ISUP grade 5 and pT3b stage PCa were detected as independent markers in BCR prediction after RP.

The comparison of perioperative outcomes between percutaneous nephrolithotomy and retrograde intrarenal surgery in elderly patients.

OBJECTIVES: In this study, we aimed to compare the outcomes and complication rates of percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) in elderly patients. MATERIALS AND METHODS: Between April 2011 and January 2020, patients who underwent PCNL and RIRS for renal stone in elderly patients were retrospectively evaluated. The two groups' perioperative values, stone-free rates and complication rates were compared. Post-operative complications were noted according to the Clavien scoring system. RESULTS: There were 89 and 72 patients in the PCNL and RIRS group respectively. The median age was 67 years in both the groups (P = .192). The stone size were 22.2 ± 3.5 mm and 19.9 ± 7.1 mm in the PCNL and RIRS group, respectively (P = .082). Stone-free rates were significantly higher in PCNL group (P = .021, P = .034). Also we found that overall complication and major complication rates were significantly higher in PCNL group (P = .016, P = .029). CONCLUSION: Despite there was higher stone clearance in PCNL, the complication rates were higher compared with RIRS. So RIRS might be a safe alternative treatment method to PCNL in older patients.

External validation of the T.O.HO. score and derivation of the modified T.O.HO. score for predicting stone-free status after flexible ureteroscopy in ureteral and renal stones.

OBJECTIVE: The T.O.HO. scoring system was developed to predict stone-free status after flexible ureterenoscopy (fURS) lithotripsy applied for ureter and renal stones. This study aimed to perform the external validation of the T.O.HO. score in the Turkish population and propose a modification for this system. MATERIAL METHODS: Patients who underwent fURS for kidney and ureteral stones between January 2017 and January 2020 were retrospectively analysed. The patient and stone characteristics and perioperative findings were noted. The T.O.HO. score was externally validated and compared with the STONE score. Stone-free parameters were evaluated with the multivariate analysis. Based on the results of this analysis, the T.O.HO. score was modified and internally validated. RESULTS: A total of 621 patients were included in the study. The stone-free rate was determined as 79.8% (496/621) after fURS. The regression analysis showed that stone area had better predictive power than stone diameter (P = .025). Lower pole (reference), middle pole [odds ratio (OR) = 0.492 P = .016] and middle ureteral (OR = 0.227, P = .024) localisations, stone density (OR = 1.001, P < .001), and stone volume (OR = 1.008, P < .001) were determined as independent predictive markers for stone-free status. Based on the effect size of the stone surface area in the nomogram, stone volume was divided into five categories, at 1-point intervals. The AUC values of the T.O.HO., STONE, and modified T.O.HO. score in predicting stone-free status were calculated as 0.758, 0.634, and 0.821, respectively. The modified T.O.HO. created by adding stone volume was statistically significantly superior to the original version (ROC curve comparison, P < .001). CONCLUSION: The T.O.HO. score effectively predicted stone-free status after fURS. However, modified T.O.HO. SS showed the best predictive performance compared with original T.O.HO. SS.

A nationwide survey on the impact of COVID-19 pandemic on minimal invasive surgery in urology practice.

OBJECTIVE: The beta-coronavirus (COVID-19) pandemic has changed the clinical approach of 93% of urologists worldwide, and this situation has affected the use of laparoscopic and robot-assisted laparoscopic methods, which are known as minimally invasive surgery (MIS). This study aimed to determine the effects of the COVID-19 pandemic on MIS in urology practice at national level. DESIGN, SETTING AND PARTICIPANTS: A total of 234 urologists in Turkey participated in an online survey between August 22 and September 23, 2020. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Descriptive statistical analyses were conducted to determine the participants' demographic characteristics and responses to multiple-choice questions. RESULTS: While 54% of urologists stated that they were concerned about the possibility that the patients planned to undergo MIS were carrying COVID-19 or false-negative for the virus, 51% considered that open surgery was safer than MIS in this regard. The pandemic led to a difference in the preferences of 40% of the urologists in relation to open or MIS methods, and during the pandemic, 39% of the urologists always directed their patients to open surgery. It was determined that during the pandemic, there was a statistical decrease in the intensity and weekly application of MIS methods among all surgical procedures compared to the pre-pandemic (P < .001 and P < .001, respectively). MIS was preferred for oncological operations by 97.3% of the urologists during the pandemic, with the most performed operation being radical nephrectomy (90.7%). Among oncological operations, radical prostatectomy was most frequently postponed. To prevent virus transmission during MIS, 44% of the urologists reported that they always used an additional evacuation system and 52% took additional precautions. There were a total of 27 healthcare workers who took part in MIS and tested positive for COVID-19 after the operation. CONCLUSIONS: Although the number of operations has decreased during the ongoing pandemic, MIS is a method that can be preferred due to its limited contamination and mortality in urology practice provided that safety measures are taken and guideline recommendations are followed.

Nation-wide analysis of the impact of Covid-19 pandemic on daily urology practice in Turkey.

OBJECTIVE: To present a nation-wide analysis of the workload of urology departments in Turkey week-by-week during Covid-19 pandemic. METHODOLOGY: The centres participating in the study were divided into three groups as tertiary referral centres, state hospitals and private practice hospitals. The number of outpatients, inpatients, daily interventions and urological surgeries were recorded prospectively between 9-March-2020 and 31-May-2020. All these variables were recorded for the same time interval of 2019 as well. The weekly change of the workload of urology during pandemic period was evaluated, also the workload of urology and the distributions of certain urological surgeries were compared between the pandemic period and the same time interval of the year 2019. RESULTS: A total of 51 centres participated in the study. The number of outpatients, inpatients, urological surgeries and daily interventions were found to be dramatically decreased by the 3rd week of pandemics in state hospitals and tertiary referral centres; however, the daily urological practice were similar in private practice hospitals throughout the pandemic period. When the workload of urology in pandemic period and the same time interval of the year 2019 were compared, a huge decrease was observed in all variables during pandemic period. However, temporary measures like ureteral stenting, nephrostomy placement and percutaneous cystostomy have been found to increase during Covid-19 pandemic compared with normal life. CONCLUSIONS: Covid-19 pandemic significantly affected the routine daily urological practice likewise other subspecialties and priority was given to emergent and non-deferrable surgeries by urologists in concordance with published clinical guidelines.

Randomized, controlled trial of fesoterodine fumarate for overactive bladder in Parkinson's disease.

AIMS: To evaluate short-term efficacy and safety of fesoterodine fumarate in Parkinson's disease (PD) patients with overactive bladder (OAB) symptoms. METHODS: This is a randomized, double-blind, placebo-controlled study. It also has an open-label extension phase. From May 2016 to May 2018, 63 patients were randomized to receive fesoterodine 4 mg or placebo for 4 weeks. At the end of 4 weeks of randomization phase, patients were received fesoterodine fumarate 4 mg daily for another 4 weeks at the open-label extension phase. The change in the mean number of micturition episodes per 24 h period was the primary outcome measure of the study. RESULTS: The number of micturition episodes per 24 h period significantly improved with the use of fesoterodine fumarate in the double-blind phase (p < 0.001). Also the mean number of nocturia and urgency episodes decreased in the fesoterodine group. In the open-label phase, the mean number of micturition, urgency and urgency urinary incontinence episodes were improved significantly. The number of nocturia episodes did not change in the open-label phase. Cognitive functions were stable after 4 weeks of fesoterodine 4 mg treatment. CONCLUSIONS: OAB symptoms were significantly improved in older adults with PD under fesoterodine fumarate treatment, and this advantage continued in the open-label portion in the short term. In this randomized controlled study, the cognitive functions of the participants were not affected by fesoterodine 4 mg treatment compared with placebo.

Is prostate volume better than PSA density and free/total PSA ratio in predicting prostate cancer in patients with PSA 2.5-10 ng/mL and 10.1-30 ng/mL?

Objective: Benign prostatic hyperplasia (BPH) and prostate cancer (PCa) are the most common benign and malignant diseases of the prostate gland. The clinical distinction between BPH and PCa should be determined to guide patients to appropriate treatment. We aimed to evaluate the value of PSA, prostate volume (PV) and associated parameters for the detection of PCa in patients with PSA levels of 2.5-30.0 ng/mL.Materials and methods: A total of 211 men with a biopsy (≥10 cores) and a PSA of 2.5-30.0 ng/ml were included in the study. To evaluate the performance of PV in diagnosing PCa, subjects were divided into PSA 2.5-10.0 ng/ml and PSA 10.1-30.0 ng/ml groups. Age, BMI, PSA, PV, f/t PSA, PSAD, and biopsy Gleason score were included in the analysis.Results: PCa was diagnosed in 74 (35.1%) of the 211 patients. The differences in f/t PSA, PV, and PSAD for patients with and without PCa were statistically significant. (p < .001). PV was a significantly better indicator of PCa than PSAD and f/t PSA ratio in both groups.Conclusions: PV plays an active role in predicting PCa in patients with PSA in gray-zone as well as in patients with PSA 10.1-30 ng/mL.

Effects of the transobturator tape procedure on overactive bladder symptoms and quality of life: a prospective study.

INTRODUCTION: This study aimed to evaluate the effects of transobturator tape (TOT) on overactive bladder (OAB) symptoms and quality of life. MATERIALS AND METHODS: Patients with stress-predominant mixed urinary incontinence (MUI) who had undergone TOT procedures were considered candidates for this research. Preoperative assessment included anamnesis, pelvic examination, cough stress test (CST), and validated symptom severity and quality of life (QoL) questionnaires. The primary outcome, improvement and cure rates of OAB symptoms were determined based on the patient's baseline scores in symptom-related questions in OAB-V8. Secondary outcomes included the success rates of SUI, changes in the QoL score and patient satisfaction rates. RESULTS: A total of 104 patients were included in the study. Sixty-two patients underwent TOT placement alone, and 42 patients underwent TOT placement along with prolapse surgery. The mean follow-up period of the patients was 30.47 months range: 13-52 months. At the fi rst-year follow-up, 52 patients (50.0%) and 59 patients (56.7%) reported cure in preoperative urgency and urgency incontinence, respectively. The objective and subjective cure rates were 96.2% and 56.7%, respectively. A total of 80.7% of the cases had a 15-point improvement in QoL scores. CONCLUSIONS: MUS is not only a gold standard treatment in SUI but also presents as a promising treatment modality in stress-dominant MUI. Although the improvement rates of OAB symptoms signifi cantly decrease over time, QoL and patient satisfaction rates remain higher than any other treatment in this patient group at the third-year follow-up.

Surgical management of female paraurethral cyst with concomitant stress urinary incontinence.

Paraurethral cysts are usually asymptomatic and frequently detected incidentally during routine pelvic examination however, patients can present with complaints of a palpable cyst or with lower urinary tract symptoms (LUTS) and also dyspareunia. In most cases, diagnosis can be made on physical examination but for more detailed evaluation and to differentiate from malign lesions ultrasonography (US), voiding cystourethrogram (VCUG), computerized tomography (CT), or magnetic resonance imaging (MRI) can also be used. Management of symptomatic paraurethral cyst is surgical excision. In this video our objective is to show the surgical management of female paraurethral cyst with concomitant stress urinary incontinence (SUI). A 37 year-old woman presented with an 8-year history of progressive urinary symptoms, consisting of dysuria, urinary frequency, urgency urinary incontinence, SUI and dyspareunia. Physical examination in the lithotomy position revealed a cystic lesion located in the left anterolateral vaginal wall. Also cough stress test for SUI was positive. Her preoperative ICI-Q, UDI-6, IIQ-7 and SEAPI scores were 16, 8, 9 and 18 respectively. Vaginal US revealed a solitary 2 cm paraurethral cyst, localized in the distal urethra. Pelvic MRI also revealed a benign cystic lesion in the distal urethra. The patient underwent surgical excision of the cyst and anterior colporrhaphy for SUI. At third month visit the patient was very satisfied. The ICI-Q, UDI-6, IIQ-7 and SEAPI scores were 0. Sometimes the LUTS concurring with the parauretral cyst can be dominant. Herein we want to show that extra surgical procedures can be necessary with paraurethral cyst excision for full patient satisfaction.

The Predictive Factors of Renal Loss After Iatrogenic Ureteral Avulsion in the Medicolegal Perspective.

Objectives: As an effective and minimally invasive technique, ureteroscopy has some potential intraoperative complications. Ureteral avulsion is among these complications, although rare. This study aimed to determine factors predicting nephrectomy by considering ureteral avulsion from a medicolegal perspective for the 1st time in the literature. Methods: A total of 33 patients with ureteral avulsion during ureteroscopic surgery, who presented to various hospitals in Turkey between September 2004 and April 2019 and whose cases were being reviewed at the Institution of Forensic Medicine with regard to malpractice, were evaluated retrospectively. The patients who underwent nephrectomy after ureteral avulsion were evaluated as Group 1, and those who underwent reconstructive surgery as Group 2. Results: The mean age of the patients was 39.5±12.1 years. Seventeen (51.5%) patients had partial and 16 (48.4%) had complete ureteral avulsion. Nephrectomy was performed in 14 (42.4%) patients, and ureteral reconstruction in 19 (57.5%) patients. It was determined that the patients in Group 1 had more proximal stones and a higher degree of hydronephrosis compared to Group 2. Complete avulsion developed in 71.4% of the patients in Group 1 and in 31.6% of those in Group 2. After avulsion, 78.6% of the patients in Group 1 were treated in a state hospital, and 63.2% of those in Group 2 were treated in a tertiary referral hospital. The increase in the degree of hydronephrosis, presence of complete avulsion, and intervention at a state hospital were determined as independent predictive factors for nephrectomy. Conclusion: This is the first study with the largest cohort in the literature to medicolegally evaluate ureteral avulsion and determine predictive factors for nephrectomy. Although each patient should be treated with different methods in the presence of ureteral avulsion, our study aimed to provide a common approach to this catastrophic complication.

Should Peritoneal Re-Approximation Be Performed After Transperitoneal Robot-Assisted Radical Prostatectomy?

Background: The aim of the study is to examine the effect of peritoneal re-approximation or non-approximation on the postoperative course of patients at the end of transperitoneal robot-assisted radical prostatectomy (tRARP). It is also aimed to examine the relationship between peritoneal re-approximation or non-approximation and drain removal time, need for analgesics, passage of flatus, and length of hospital stay. Methods: A total of 247 patients who underwent tRARP by 2 different experienced surgeons were included in the study. At the end of the tRARP procedure, 1 surgeon performed peritoneal re-approximation (Group 1, n = 108), whereas the other performed peritoneal non-approximation (Group 2, n = 139). The effect of the procedures on drain removal time, passage of flatus, need for analgesics, and length of hospital stay were compared between the groups. Results: There was no significant difference between the groups in terms of preoperative parameters including age, body mass index, and preoperative prostate-specific antigen levels (P > .05) (P = .622, P = .126 and P = .591, respectively). No statistically significant difference was found between the two groups in terms of comorbidity, Gleason score, clinical stage, and lymph node dissection (P = .086, P = .344, P = .318, P = .587, respectively). There was no statistically significant difference between the groups in terms of drain removal time, need for analgesics, passage of flatus, and length of hospital stay (P = .095, P = .142, P = 95, P = .389, respectively). Conclusion: This study did not demonstrate any additional postoperative benefit of peritoneal re-approximation. It has been shown that peritoneal re-approximation has no effect on the length of hospital stay, the need for pain relievers, and passage of flatus, drain duration, day. Therefore, we do not recommend re-approximation of the peritoneum.

Safety and Efficacy of Flexible Ureterorenoscopy Surgery in Different Age Groups.

OBJECTIVE: To comparatively investigate the efficacy, safety and complications of flexible ureterorenoscopy (f-URS) in the treatment of patients of different age groups (<60, 60-74 and ≥75 years) with proximal ureteral and kidney stones. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of Urology, HSU Izmir Bozyaka Training and Research Hospital, HSU Ankara Diskapi Training, Research Hospital, and Mustafa Kemal University Faculty of Medicine, between March 2014 and June 2020. METHODOLOGY: Nine hundred and fifty-six patients, who underwent f-URS due to proximal ureteral and kidney stones, were divided into three age groups as <60 years (Group 1), 60-74 years (Group 2) and ≥75 year (Group 3). The patients' American Society of Anesthesiologists (ASA) score, Charlson Comorbidity Index (CCI), anticoagulant use, stone-free rates and surgical and medical complication rates were examined for each group. RESULTS: There were 688 patients in Group 1, 230 in Group 2, and 38 in Group 3. A significant difference was observed between the age groups in terms of CCI and anticoagulant use (p<0.001 for both). The highest rate of medical complications was observed in Group 3 at 42.1%, followed by Group 2 at 17.8%, while the lowest rate was observed in Group 1 at 2.3% (p<0.001). As a result of the multivariate analysis, receiving anticoagulant treatment (p=0.002) and having a high CCI (p=0.005) were independent predictors of medical complication development. CONCLUSION: It was clearly demonstrated that f-URS could be used as a safe and effective alternative for the treatment of moderate-size kidney stones in all age groups. Key Words: Elderly, Geriatric patients, RIRS, Holmium laser lithotripsy, Urolithiasis, Safety, Efficacy.

Does Access Location Influence Outcome of Percutaneous Nephrolithotomy in Staghorn Stones?

OBJECTIVE: To assess the effect of lower and middle calyceal accesses on the outcomes of percutaneous nephrolithotomy (PCNL) in staghorn stones. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Department of Urology, University of Health Sciences, Izmir Bozyaka Training and Research Hospital, Turkey, from April 2012 to January 2019. METHODOLOGY: Patients who underwent PCNL for staghorn stones were retrospectively analysed. The patients were grouped as Group-1 (middle calyceal access) and Group-2 (lower calyceal access). Demographic and stone characteristics (size, density), perioperative and postoperative data, and stone-free rates were compared between these two groups. Postoperative detection of > 4 mm stones was defined as residual stones. RESULTS: There were 249 patients in the study; 108 in middle calyceal access group and 141 in lower calyceal access group. The mean stone burden was 765 (524-1322) and 777 (490-1445) mm2 in group-1 and group-2, respectively (p=0.876). The number of stone-free patients was 50 (46.3%) in middle calyceal access group and 93 (66.0%) in lower calyceal access group. The rate of stone-free status was significantly higher in lower calyceal access group (p=0.002). The overall complication rate was similar between the groups (p=0.132). The binary analysis showed that stone burden, and calyx of entry were predictive factors for success. CONCLUSION: Although the choice of the calyx to be entered does not affect the complication rate in staghorn stones, the stone-free rate is significantly higher in lower calyceal access. Key Words: Percutaneous nephrolithotomy, Staghorn stones, Clavien scoring system, Calyx, Access.

Development of a Novel Nomogram and a Simple Scoring System Using Ureteral Jet Flow to Predict Impacted Ureteral Stone.

Purpose: To examine the efficacy of ureteral jet flow measured by Doppler ultrasonography (USG) together with radiological parameters obtained by noncontrast enhanced CT in predicting whether a ureteral stone is impacted. Materials and Methods: A total of 178 patients that met the criteria were included in the study. Stone size, location, grade of hydronephrosis, HU values of the stone and the proximal and distal parts of the stone, and ureteral wall thickness (UWT) were obtained from noncontrast enhanced abdominal CT images. Ureteral jet flows (Vmax) were measured and recorded by Doppler USG. Thirty-eight cases in whom the guidewire or opaque contrast material could not pass beyond the stone were included in the impacted ureteral stone (IUS) group, whereas the remaining 140 patients constituted the non-IUS (non-IUS) group. Results: Significant independent predictors of IUS were determined as stone size (odds ratio [OR]: 2.23, p = 0.020), ureteral HU value under the stone (OR: 1.11, p = 0.014), UWT (OR: 5.66, p = 0.009), anteroposterior diameter (OR: 1.23, p = 0.033), and the Vmax value of the stone side (OR: 0.76, p = 0.011). The proposed scoring system predicted IUS with 89% sensitivity and 91% specificity at a cutoff value of 11.5. Conclusion: Determining whether a ureteral stone is impacted is important in deciding on the optimal treatment modality. The nomogram and scoring system that we created based on the data that were obtained with noninvasive methods can predict IUS with high sensitivity and specificity.

Comparison of Guy's, S.T.O.N.E. and CROES Scoring Systems for Predicting Percutaneous Nephrolithotomy Outcomes in Eldery Patients.

OBJECTIVE: To evaluate the efficacy and reliability of Guy's (GSS), S.T.O.N.E., and CROES scoring systems developed to predict percutaneous nephrolithotomy (PCNL) outcomes in aged patients. Study Design: Descriptive study. PLACE AND DURATION OF STUDY: Department of Urology, Ministry of Health University Izmir Bozyaka Training and Research Hospital and Department of Urology, Faculty of Medicine, Amasya University, Turkey, from April 2011 to January 2020. METHODOLOGY: Patients aged 65 years and over, who underwent PCNL for kidney stones, were retrospectively analysed. The patients' clinical and perioperative characteristics and the radiological features of the stones were obtained from the prospectively recorded data. GSS, S.T.O.N.E. and CROES nephrolithometry scores were calculated for each patient and their relation with stone-free status, complications, and perioperative findings were analysed. RESULTS: A total of 147 patients were included in the study. Stone-free status was achieved in 76.0% of the patients, and complications developed in 27.2%. All three scoring systems were associated with stone-free status and complication development. GSS (OR=0.213,p=0.005) and S.T.O.N.E. (OR=0.601, p=0.042) scores were detected as independent markers for stone-free status, while the CROES score was not an independent marker. Only diabetes mellitus was determined to be an independent marker for the development of complications (OR=2.375, p=0.045). CONCLUSION: PCNL is an effective and safe treatment method with high stone-free rates in the treatment of large renal stones, but care should be taken in terms of cardiac risks. The results of this study showed that GSS and S.T.O.N.E. scoring systems were effective and reliable in predicting stone-free status. Key Words: Aged, Nephrolithotomy, Percutaneous, Comorbidity, Stone-free status, Treatment outcome, Complications, Scoring systems.

Retrospective Analysis of the Factors Affecting Intraoperative and Immediate Postoperative Complications of Retrograde Intrarenal Surgery Classified by the Clavien and Satava Grading Systems.

Background: To classify intraoperative and postoperative complications using the modified Clavien classification system (MCCS) and modified Satava classification system (SCS) and to evaluate the parameters associated with complications in patients undergoing retrograde intrarenal surgery (RIRS) for renal and proximal ureteral stones. Materials and Methods: We performed a retrospective analysis of 949 patients who underwent RIRS for renal stones and proximal ureteral stones at two institutions between March 2015 and June 2020. Intraoperative complications were assessed using the SCS, and postoperative complications were graded according to the MCCS. Univariate and multivariate analyses were undertaken to determine predictive factors affecting complication rates. Results: The median stone size was determined as 13 mm (range 10-20 mm). The stone-free rate was 83.6% after the first intervention. Reprocedure was applied to 89 of the patients with residual stones and the final stone-free rate was 94.4% after reprocedure. According to SCS, the number of intraoperative events and complication incidences was 153 (16.1%). MCCS revealed postoperative complications in 121 (12.8%) patients. Major complications were observed in 18 (1.9%) patients. The rate of complications was higher in patients with renal anomalies (9.9% vs 3.4%, p = 0.001). Stone location, stone size, stone burden, stone number, stone density, and residual fragments were determined to be associated with the development of complications (p < 0.001, p < 0.001, p < 0.001, p < 0.001, p = 0.002, and p < 0.001, respectively). In addition, the multivariate analysis revealed that only the presence of residual fragments was a significant predictor of complication development for the patients with Grade ≥3 complications according to MCCS (p = 0.032). However, significant predictors were stone burden (p < 0.001), stone density (p = 0.002), and fluoroscopy time (p < 0.001) for those with Grade ≥2b complications according to SCS. Conclusion: This study showed that abnormal kidney anatomy, operation time, stone burden, and residual fragments were reliable predictors of complication development during and after RIRS. Appropriate preoperative management should be planned according to these predictors to prevent intraoperative and postoperative complications.

The presence of chronic inflammation in positive prostate biopsy is associated with upgrading in radical prostatectomy.

OBJECTIVE: This study aimed to determine the predictive effect of the presence of chronic prostatitis associated with prostate cancer (PCa) in prostate biopsy on Gleason score upgrade (GSU) in radical prostatectomy (RP) specimens. MATERIALS AND METHODS: The data of 295 patients who underwent open or robotic RP with a diagnosis of localized PCa following biopsy were retrospectively analyzed. Patients were divided into two groups with and without GSU following RP. Predictive factors affecting GSU on biopsy were determined. The impact of chronic prostatitis associated with prostate cancer on GSU was examined via logistic regression analysis. RESULTS: Out of 224 patients with Gleason 3+3 scores on biopsy, 145 (64.7%) had Gleason upgrade, and 79 (35.2%) had no upgrade. Whilst comparing the two groups with and without Gleason upgrade in terms of patient age, prostate-specific antigen (PSA) value, PSA density (PSAD), prostate volume (PV), neutrophil/lymphocyte (N/L) ratio, number of positive cores, percentage of positive cores, and Prostate Imaging Reporting and Data System version 2 score, no statistically significant difference was detected. The presence of chronic prostatitis associated with PCa was higher in the patient cohort with GSU in contrast to the other group (p < 0.001). According to the univariate logistic regression analysis, the presence of chronic prostatitis was identified to be an independent marker for GSU. CONCLUSIONS: Pathologists and urologists should be careful regarding the possibility of a more aggressive tumor in the presence of chronic inflammation associated with PCa because inflammation within PCa was revealed to be linked with GSU after RP.