The relationship between stone-free and patient position in retrograde intrarenal surgery: a randomized prospective study.

PURPOSE: Residual fragments not removed with urinary stone surgery may become symptomatic. In this context, this study was carried out to investigate the effect of performing retrograde intrarenal surgery, which is conventionally performed in the lithotomy position, in the modified lithotomy position (Trend-side) on stone-free rates following the surgery. METHODS: This prospective study consisted of 100 patients with a single kidney stone smaller than 2 cm between 2021 and 2023. These patients were randomized into two groups of 50 patients each to be operated on in the conventional lithotomy and Trend-side positions. Variables were compared using independent t test for continuous variables and chi-square test for categorical variables. RESULTS: There was no significant difference between the lithotomy and Trend-side position groups in terms of preoperative size, density, location of the stone, and hydronephrosis degree. Stone-free rate was 72% (n = 36) in the lithotomy group and 92% (n = 46) in the Trend-side group. Hence, there was a significant difference between the groups in the stone-free rate in favor of the Trend-side group (p = 0.009). Fragmentation time was statistically significantly shorter in the Trend-side group than in the lithotomy group (34 ± 17 min vs. 43 ± 14 min; p = 0.006). There was no significant difference between the groups in postoperative complication rates. CONCLUSION: Performing retrograde intrarenal surgery in the Trend-side position shortened the duration of fragmentation compared to the lithotomy position and was associated with higher stone-free rates. In conclusion, the Trend-side position can be safely preferred in patients undergoing retrograde intrarenal surgery due to kidney stones.

Predicting Stone-free Status based on Quadruple-D and Triple-D Scores after Extracorporeal Shock-Wave Lithotripsy and Comparing With Broad-Spectrum Population.

PURPOSE: To compare the Triple-D and Quadruple-D scores in predicting the success of shock-wave lithotripsy (SWL). MATERIAL AND METHODS: We retrospectively reviewed a total of 328 patients who had undergone SWL for stones with an average size of 10-15 mm in the renal pelvis, lower, middle, and upper calyces at the Urology Clinic of Kartal Dr. Lütfi Kirdar City Hospital between 2021 and 2023. Patients were divided into two groups - stone-free and residual - based on pre-and post-SWL imaging. Age, gender, stone location, ellipsoid stone volume (ESV) and side (right/left), stone density (SD), stone-skin distance (SSD), body-mass index (BMI), Triple-D score (TrD-S), and Quadruple-D score (QrD-S) values were recorded and compared. For TrD-S, SV <150 mm3, SD <600 Hounsfield (HU), and SSD <12 cm were scored in the range of 0-3. For QrD-S, lower calyx localization was scored as "0", and pelvis, middle calyx, and upper calyx stones were scored as "1" in the range of 0-4. RESULTS: Of a total of 328 patients, 219 (66.8%) were stone-free, 109 (33.2%) had residual stones, 211 were male, and 117 were female. Of the stones, 149 were located in the lower calyx, 118 in the middle calyx, 55 in the renal pelvis, and 6 in the upper calyx. ESV was 95.5 and 120 µ/L in the two groups, (p:0.001). Cutoff values of TrD-S and QrD-S were 1.5 and 2.5, and area under the curve (AUC) values were 0.65 and 0.67, respectively, (p:0.001). CONCLUSIONS: The Quadruple-D score is at least as successful as the Triple-D score in predicting SWL success.

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

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

Traumatic masturbation and erectile dysfunction: A matched case-control study.

OBJECTIVE: To identify atypical masturbatory behaviors (AMB) and to reveal their effects on both sexual and masturbational erection hardness in men with erectile dysfunction (ED). METHODS: Patients with ED and healthy controls were questioned about their masturbation habits. Accordingly, "rubbing in a prone position," "pressure on penis," and "masturbation through clothes" were included in the traumatic masturbation syndrome (TMS) group. Erection hardness score (EHS) is used to measure the erectile functions during masturbation (mast), foreplay (presex), and sexual intercourse (sex), separately. RESULTS: The data of 448 participants, 266 (59%) from the patient group, and 182 (41%) from the control group were analyzed. The mean ages were 30 years in both groups (p = 0.734). The rate of "rubbing in a prone position" and "penile pressure" while masturbating was higher in patients than the controls (10.2% vs. 6%, p = 0.024 and 8.6% vs. 3.3%, p = 0.0002, respectively). Patients had 2.2-fold (odds ratio, 2.21; 95% confidence interval, 1.40-3.47; p = 0.001) increased risks of having at least one AMB, compared with controls. In the secondary analysis, the patient group was divided into 2 subgroups according to having TMS (ED + TMS) or not (ED). The percentage of patients with EHS≥3 during masturbation was higher than those during sex and presex in the "ED + TMS" group (60.2%, 38.8%, and 37.2%, respectively, p = 0.0001; n = 98). Comparing the percentage of patients with EHS≥3 during mast, presex, and, sex was found to be similar in the "ED" group (58.9%, 56.5%, and 56%, respectively, p = 0.753; n = 168). CONCLUSION: Atypical masturbatory behaviors are more common in young men presenting with erectile dysfunction. These patients have higher erection hardness scores during masturbation compared to partnered sex.

Is Triple D Score Effective to Predict the Stone-Free Rate After Shockwave Lithotripsy in Pediatric Population?

Introduction: Triple D score was developed using skin-to-stone distance (SSD), stone density (SD), and stone volume (SV) for prediction of extracorporeal shockwave lithotripsy (SWL) outcomes in adults. SWL is the first-line treatment method for kidney stones <2 cm in children, however, it was not validated in the pediatric population. This article aims to validate Triple D score in pediatric patients. Materials and Methods: Of the 269 children treated with SWL between 2007 and 2021, a total of 147 children who had adequate follow-up data and evaluated with noncontrast CT before SWL were included in the study. Parameters were calculated for each of the SV, SSD, and SD variables. Receiver operator characteristic analysis was used to set cutoff values. Triple D scores were calculated, and success rates were determined for each score. Stone-free status was determined as complete clearance after 3 months of final SWL. Results: The median age of the study group was 7 years (range 1-16). Ninety-three of the 147 (63%) children had stone-free status. Mean SV, SSD, and SD values were significantly higher in the SWL-failed group than in the stone-free group after detecting cutoff values of 155 mm3, 6.5 cm, and 550 HU, respectively. Stone-free rates were detected as 23.8%, 35.1%, 74.0%, and 92.0% with the Triple D scores of 0, 1, 2, and 3 points. Conclusions: Our study confirms that Triple D scores support the SWL outcomes in the pediatric population. We believe that our research on Triple D score validation in children is of great clinical importance although various factors may affect to predict the success of SWL. IRB Approval: 2021/514/194/14.

Is it possible to predict spontaneous passage of a ureteral stone? An up-to-date comment on the current problem with new concepts concerning the patient and the stone.

Introduction: The aim of this article was to determine a predictive factor by examining the patient's characteristics and the stone to predict the ureteral stone spontaneous passage. Material and methods: A total of 200 patients aged 18-55 who were referred with middle and distal ureter ureteral stones between 5-7 mm were analyzed retrospectively. Patients were randomized as 50 spontaneous stone passage positive (SSPP) and 50 negative patients. Body mass index (BMI), waist-to-hip ratio (WHR), stone size, ureter length, ureter diameter, stone Hounsfield unit value (SHU), ureteral wall thickness (UWT), kidney parenchymal thickness (KPT), kidney parenchymal density, neutrophil-lymphocyte ratio (NLR) and thrombocyte-lymphocyte ratio (TLR) values were recorded. Results: The average SHU of the SSPP group was 579 and 970 in the negative group (p: 0.000). While the mean was 1.7 mm in the UWT SSPP group, it was 2.4 mm in the negative group (p: 0.000). SHU and UWT were statistically significantly different in univariate and multivariate logistic regression analyses. WHR values were 39.6 and 29.3 for SSPP and the negative group, respectively (p: 0.032). The ureter diameter was 7.6 mm for the SSPP group and 8.9 mm in the negative group (p: 0.01). Conclusions: Low SHU value is related to the ureteral stone's positive spontaneous passage, and the increase of UWT is inversely related to the spontaneous passage. WHR is higher in people who can passage ureteral stones. A narrow ureter diameter is correlated with spontaneous stone passage. Ureter length, KPT, and kidney parenchymal density were not associated with spontaneous passage.

Testosterone status is not associated with bladder cancer parameters in adult male patients: results of a prospective controlled study.

PURPOSE: This controlled study assessed whether there was a correlation between serum total testosterone levels and bladder cancer (BCa) in terms of tumor grade and stage as objective measures in adult men. MATERIALS AND METHOD: Our prospectively-designed study included 257 patients who were diagnosed with primary BCa and its surgery between January 2017 and January 2020. Hundred and forty patients who had surgery in the same period with TUR for prostate or endoscopic ureteral stone treatment were included in the study as a control group. All patients in the study and control groups were male. The age range of the patients was between 34 and 90 years old. In order to examine groups, fasting blood glucose, lipid profile, albumin, total testosterone, and vitamin D levels of all patients included in the study. RESULTS: The relationship between tumor aggression and total testosterone level was investigated with a multinomial logistic regression model, where the control group was accepted as a reference, following adjustment for potential confounding variables, including age and serum albumin levels. Testosterone level was not found to be associated with any of the categories that determine tumor aggressiveness (p > 0.05). CONCLUSION: In the present study, there was no correlation between any categories that determine tumor aggressiveness of BCa and total testosterone levels in adult men. It is obvious that our findings should be supported and further investigations are needed.

Can lockdown and homeschooling change the outcome of urotherapy for lower urinary tract dysfunction in children?

OBJECTIVE: Lower urinary tract dysfunction (LUTD) are still important for both children and pediatric urologists. Urotherapy is recommended in LUTD treatment management. In our country, all citizens under the age of 20 were banned from going out of their homes due to Covid-19 and the homeschooling system has been adopted The aim of this study is to investigate the effect of lockdown and homeschooling on the effectiveness of urotherapy used for LUTD treatment. METHODS: 83 patients were included in the study group. Besides 306 patients were determined as the control group (pre-Covid). The patients in the study group and the control group were compared in terms of improvement in Dysfunctional voiding and incontinence scoring system (DVISS), quality of life scores, bladder diary, Bristol stool scale, and treatment responses at 3rd and 6th months. RESULTS: The study group and control group were compared in terms of DVISS, voiding frequency and incontinence in the voiding diary, quality of life score, and Bristol stool scale at admission visit and the group characteristics were similar. During the 6th month visit, the mean DVISS of the study group was found to be significantly lower (7.12 ± 3.48; 8.58 ± 4.06 respectively (p 0.002)). Daily voiding frequency was similar in the study group and the control group during the 2nd and 3rd visit. The study group's mean number of daily incontinence was significantly lower at visit 3 (0.57 ± 0.9; 0.94 ± 0.27, respectively (p 0.02).After six months of treatment, 13.3% of the study group patients had a complete response, 44.6% had a partial response, whereas 42.2% non-responders. In the control group, the response rates were as 5.9%, 39.2% and 54.9% respectively (p 0.02). CONCLUSIONS: LUTD is still very common in pediatric urology. Standard urotherapy is widely used in treatment management. According to our results, the success of standard urotherapy increases with lockdown and homeschooling. We have shown that the success of standard urotherapy can be improved by regulating environmental conditions. In terms of LUTD management, environmental conditions can be regulated to provide a better quality of life and a better cure in a more economical way.

Traumatic masturbation syndrome may be an important cause of erectile dysfunction in pre-mature ejaculation patients.

We aimed to investigate of whether atypical masturbation behaviour is a pre-disposing factor in ED aetiology in pre-mature ejaculation (PE) patients. In addition to demographic data, self-estimated intravaginal ejaculatory latency time (IELT) was prospectively questioned in 2,572 patients between the ages of 18 and 60 who applied with the complaint of pre-mature ejaculation between March 2018 and May 2020. The masturbation habits of the patients were questioned with open-ended questions. After the exclusion criteria, 1,819 patients were evaluated. One thousand one hundred-fifty (63.2%) of patients were classified as lifelong PE, 369 (20.3%) were acquired PE, while 300 (16.5%) were natural-variable PE. According to the IIEF score, 714 patients (39.3%) had ED associated with PE. Eighty-eight per cent of men declared that they had masturbated in the last 4 weeks. Atypical masturbatory behaviours such as 'through clothes' and 'rubbing in prone position' were significantly higher in patients with ED (13% vs. 9%, p = .04 and 11% vs. 7%, p = .02 respectively). Atypical masturbatory behaviours are also seen in a significant part of the pre-mature ejaculation population and increase the rate of erectile dysfunction accompanying PE. This situation draws attention to the necessity of questioning masturbation habits, especially in the combination of PE and ED.

What is the optimal frequency in shock wave lithotripsy for pediatric renal stones? A prospective randomized study.

The aim of the study is to compare the effects of varying frequency rates (60, 90, and 120 SWs/min) on the stone free rate and complication rates of pediatric SWL. 75 children with renal stones were divided into 3 groups depending on the SW frequency applied. Group 1. low (60 SWs/min), Group 2. intermediate (90 SWs/min) and Group 3. high (120 SWs/min) frequency. Patient demographics (age, gender, BMI), stone (location, size, laterality), and SWL (total number of sessions, shock waves, anesthesia time) related parameters were documented. Postoperative success, complication rates, and the need for additional interventions were comparatively evaluated. There was no significant difference regarding the patient demographics, stone characteristics, SWL parameters, postoperative complication rates, need for additional interventions as well as efficacy quotient between all (p > 0.05). The stone free rates were significantly lower in cases with high frequency, whereas there was no statistically significant difference between the intermediate and low frequency groups (p > 0.05). Although not statistically significant; low frequency application may be more advantageous than intermediate as lower number of high energy shock waves required which may cause less tissue damage. On the other hand, despite lack of a statistically significant difference, relatively longer anesthesia time may constitute a disadvantage for lower frequency. We believe that considering the growing nature of the child kidney application of low frequency (60 SWs/min) will be advantageous. However, we believe that further studies with larger series of cases are needed to make a clear-cut differentiation between low and intermediate SW applications.

Comparison of Mini Percutaneous Nephrolithotomy (Mini PCNL) and Retrograde Intrarenal Surgery (RIRS) for the Minimal Invasive Management of Lower Caliceal Stones.

PURPOSE:   To evaluate the stone-free rates, quality of life, complications, use of fluoroscopy, analgesic requirements, a hospital stay following the management of lower calyceal with two different techniques (Mini Percutaneous Nephrolithotomy and Retrograde Intrarenal Surgery) in a prospective manner. MATERIAL AND METHODS: 50 patients with a diagnosis lower pole 1-2 cm stone were included into the study and were randomized into two groups.(Mini PCNL n: 25) ( RIRS n: 25). Safety and efficacy of both methods along with some other certain related factors were comparatively evaluated in both groups. RESULTS:  There was no significant difference between preoperative stone size, stone to skin distance, hemogram and creatinine values, need for analgesic drug, patients' replies to visual analog scale (VAS). The duration of both the hospital stay and the exposure to fluoroscopy, hematocrit decrease due to hemorrhage, complication rates were significantly higher in cases undergoing mini PCNL when compared to RIRS. Additionally, any significant difference was not observed with respect to the stone-free rates. Despite an increase in quality of life following the both type operations was noted; there was no significant difference in the quality of life between the patients in both groups. CONCLUSION:  Our findings demonstrated that both surgical techniques are the feasible alternatives in the minimal invasive treatment of lower pole stones. Although there was no meaningful difference in stone-free rates between two groups; complications, use of fluoroscopy, bleeding and duration of hospital stay were noted to be significantly higher in cases treated with mini PCNL.

Reliability and validity of the National Institutes of Health Chronic Prostatitis Symptom Index questionnaire in the Turkish Population

Background/aim: To develop the first Turkish version of the National Institutes of Health Chronic Prostatitis Symptom Index (NIH- CPSI) questionnaire and to investigate its validity and reliability in men with chronic prostatitis/chronic pelvic pain syndrome (CP/ CPPS) and healthy controls. Material and methods: A total of 204 patients, 116 CP/CPPS and a control group which consisted of 88 healthy individuals were included in this prospective study. The NIH-CPSI form was first translated into Turkish and later on back into English. Using the Turkish version of the NIH CPSI, 40 patients completed the same questionnaires twice at 2-week intervals for test-retest concordance. To evaluate internal consistency and test-retest reliability, Cronbach's alpha value, and the Spearman correlation test were utilized respectively. Results: Our findings demonstrated statistically significant differences in NIH-CPSI scores between the patients and control groups (P <0.001). Cronbach's alpha coefficient value of NIH-CPSI was 0.864. Reliability of test-retest was 0.909 (P <0.001). Additionally, the Spearman correlation test showed that the results obtained using the Turkish NIH-CPSI were significantly correlated. Conclusion: The first Turkish version of the NIH-CPSI was found to be a reliable and valid instrument for Turkish patients with chronic prostatitis in both clinical and research settings.

Effect of continuous antibiotic prophylaxis in children with postoperative JJ stents: A prospective randomized study.

OBJECTIVE: We aimed to investigate the effectiveness of continuous antibiotic prophylaxis (CAP) in patients with JJ stent and tried to identify the group that could specifically benefit from CAP by a prospective randomized study. METHODS: A prospective, randomized, controlled, non-blind, non-placebo study was performed in a single center.A total of 105 patients who underwent surgery with JJ stent (PNL, URS, pyeloplasty, UNC) were randomized into two groups. 53 patients in Group A received CAP and 52 patients in Group B were controlled without CAP, during the presence of a JJ stent. Patients with external stents, nephrostomy tubes, indwelling long-term urethral catheters were excluded. History of preoperative use of CAP and lower urinary tract symptoms were noted. Trimethoprim/sulfamethoxazole (TMP/SMX) was used as the initial choice of antibiotic however if there was a history of antibiotic resistance in previous urinary cultures, Nitrofurantoin was administrated. Urinary cultures were obtained before surgery and before stent extraction. JJ stents were sent to culture. Symptomatic febrile urinary tract infections with positive urine cultures (105 CFU on a clean catch or 103with urethral catheterization) were compared between groups. DISCUSSION: Our study has some limitations; the study is the single-center, we did not follow-up of patients in terms of scar, there were low number of uncircumcised patients, multiple types of surgical procedures were performed. JJ stent is a frequently used instrument in children. Unfortunately, any randomized prospective on antibiotics administration while using a JJ stent is not available in the current literature. We hope our research will contribute to the existing literature and cause a significant change in clinical practice. RESULTS: The mean age among all patients was 4.8 ± 3.9 years. The mean length of time jj stents stayed inside was 16.34 ± 6.45 days in group A and 15.29 ± 7.71 days in group B. The incidence of febrile urinary tract infections with CAP was significantly reduced (3.8% vs. 19% (p 0.015)). Multivariate regression analysis revealed that a positive history for preop febrile urinary tract infections and/or LUTS has a significantly higher association with the incidence of febrile urinary tract infecitons. CONCLUSIONS: CAP in the presence of JJ stents reduced the incidence of febrile urinary tract infections in a short period, especially in children with the previous history of febrile urinary tract infections and lower urinary tract symptoms.

Prostate volume effect on Gleason score upgrading in active surveillance appropriate patients.

INTRODUCTION: Gleason Score (GS) upgrading rates in the literature are reported to be around 33-45%. The relationship between prostate volume and GS upgrading should be defined, aiming to reduce upgrading rates in patients with low risk groups who are eligible for active surveillance (AS) or minimally invasive treatment, by varying biopsy cores, or lengths of cores according to prostate volumes. In this regard, the aim of our study was to establish the relationship between prostate volume and GS upgrading. MATERIALS AND METHODS: We retrospectively analyzed the medical records of 78 patients, who were appropriate for AS between 2011-2016 at our hospital. Inclusion criteria were patient age under 65 years, PSA level under 10 ng/ml, GS (3 + 3) or (3 + 4), and 3 or less positive cores, clinical stages ≤ T2. GS increase in radical prostatectomy specimen was considered as 'upgrading' and in addition, score reported by biopsy as 3 + 4 but in surgical specimen as 4 + 3 were also considered as 'upgrading'. The effect of prostate volume on Gleason grade upgrading was examined by calculating upgrading rates separately for patients with prostate volume 30 ml or less, those with 30 to 60 ml, and those over 60 ml. RESULTS: As a result of the analysis of the data, upgrading was seen in 35 (44.8%) of 78 patients included in the study. In the cohort mean prostate volume was 49.8 (± 26.3) ml. Twenty-two patients (28.2%) had prostate volume 30 ml or less, 34 (43.6%) 30 to 60 ml, and 22 (28.2%) 60 ml or more. The patients were divided into two groups as those with and without GS upgrading. Between the groups prostate volume and prostate volume range (0-30/31-60/> 60) were not significantly different (p value > 0.05). CONCLUSIONS: Gleason grade upgrading causes patients to be classified in a lower risk group than they actually are, and may lead to inappropriate treatment. This condition has a direct effect on the decision of active surveillance. Therefore, it is important to define the factors that can predict GS upgrading in active surveillance appropriate patients. In this study, we found that prostate volume has no significant effect on upgrading in active surveillance appropriate patients.

The role of anticholinergic therapy based on the upoint system in the treatment of chronic prostatitis.

OBJECTIVE: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common problem and severely impairs the quality of life (QoL). We aimed to investigate the effects of different treatment options on voiding symptoms and QoL in patients with urinary phenotype according to the UPOINT system. Matherial and methods: Ninety-six patients with NIH category II,III CP/CPPS were included in the study prospectively. After the diagnosis, the questionnaires including NIH Chronic prostatitis Symptom Index (NIH-CPSI), International Prostate Symptom Score (IPSS), Overactive Bladder Screening Questionnaire (OAB-V8), and Beck depression inventory were filled by the patients. The patients with urinary phenotype were treated by alpha-blocker, antimuscarinic or both therapy modalities (combined) considering the specific therapy recommendations by UPOINT. The questionnaires applied on the first visit were reapplied after one month and treatment success was evaluated. RESULTS: Seventy-three patients were included in 'Urinary phenotype' group (76%) and 23 were included in 'other phenotypes' (24%) group of the patients according to the UPOINT classification. Significant improvements of symptoms were observed with the all treatment modalities when the NIH-CPSI, IPSS and OAB-V8 scores were compared before and after treatment in the 'Urinary phenotype' group. Significant differences in the percentage of change in values were obtained in the anticholinergic group for pain subdomain of NIH-CPSI and IPSS scores. CONCLUSION: U-POINT clasification is useful for deciding on the treatment modality in CP/CPSS patients. We showed anticholinergic therapy might be effective option. Addition to the symptomatic recovery, there is need more further studies about effectivity cholinergic system in the prostate tissue.

Efficacy of magnetic resonance imaging for diagnosis of penile fracture: A controlled study.

PURPOSE: To evaluate the diagnostic value of magnetic resonance imaging (MRI) in patients with suspected penile fracture. MATERIALS AND METHODS: A total of 122 patients admitted to our inpatient clinic with a suspicion of penile fracture following a recent history of penile trauma and who underwent surgical exploration were included this study. A thorough physical examination, a detailed medical history, description of the trauma, and preoperative International Index of Erectile Function (IIEF) scores were obtained for each patient prior to surgery. Thirty-eight of these patients were evaluated with MRI before the surgical exploration. Intraoperative findings were also recorded. Physical findings and IIEF scores were also recorded at postoperative 6 months. RESULTS: The mean age of our patient group was 36.5±12.3 years. Penile fracture was detected in 105 of 122 patients in whom surgical exploration was performed owing to a suspected diagnosis. The mean time interval from penile trauma to hospital admittance was 9.9±15.1 hours. No cavernosal defect was detected in 9 of 84 patients (10.7%) who were not evaluated with MRI prior to surgery. Compared with surgical exploration, MRI findings showed 100% (30 of 30) sensitivity and 87.5% (7 of 8) specificity in the diagnosis of penile fracture. MRI had a high negative predictive value of 100% (7 of 7) and a positive predictive value of 96.7% (30 of 31) with just 1 misdiagnosed patient. CONCLUSIONS: MRI is a reliable diagnostic tool in the diagnosis of penile fractures. Compared to history and physical findings taken all together, the high sensitivity and specificity of this imaging technique can decrease the number of unnecessary surgical explorations.

Transient cessation of antiplatelet medication before percutaneous stone surgery: does it have any safety concern on bleeding related problems?

To evaluate the short term effects of transient AP medication cessation on the safety of percutaneous nephrolithotomy (PCNL) and evaluate them with normal cases in a comparative manner. 71 cases undergoing PCNL for renal pelvic stones were divided into two groups: Group 1 (n: 35) Cases under AP medication (100 mg/day acetyl salicylic acid) in whom the medication was stopped for 7 days before PCNL procedure. Group 2 (n: 36) Cases without any AP medication prior to PCNL. Coagulation test parameters were normal in all cases prior to stone removal. Treatment related parameters with an emphasis on post-operative course were evaluated between two groups. While prolonged macroscopic hematuria (mean 3.5 days) was present in a 25.7 % of the cases in Group 1; it was 5.7 % in Group 2 (mean 2 days). Mean duration of nephrostomy tube was longer in Group 1 (3.49 vs 2.64 days respectively). Additionally, hospitalization period was longer in cases under antiplatelet therapy when compared with the others. No statistically significant difference was noted between two groups regarding post-operative Hb drop rates, transfusion, fever, embolization rates. Lastly, of all the risk factors evaluated; use of AP medication was found to increase the risk of macroscopic hematuria 5.8-fold on logistic regression analysis. Our findings demonstrated that despite the cessation of the antiplatelet agents with an appropriate regimen; these cases should be followed for the risk of prolonged hematuria and tube drainage after PCNL in a very close manner.

Factors affecting the course of body and kidney growth in infants with urolithiasis: A critical long-term evaluation.

OBJECTIVE: To investigate the possible effects of dietary, patient and stone related factors on the clinical course of the stone disease as well as the body and renal growth status of the infants. PATIENTS AND METHODS: A total of 50 children with an history of stone disease during infancy period were studied. Patient (anatomical abnormalities, urinary tract infection - UTI, associated morbidities), stone (obstruction, UTI and required interventions) and lastly dietary (duration of sole breast feeding, formula feeding) related factors which may affect the clinical course of the disease were all evaluated for their effects on the body and renal growth during long-term follow-up. RESULTS: Mean age of the children was 2.40 ± 2.65 years. Our findings demonstrated that infants receiving longer period of breast feeding without formula addition seemed to have a higher rate of normal growth percentile values when compared with the other children. Again, higher frequency of UTI and stone attacks affected the growth status of the infants in a remarkable manner than the other cases. Our findings also demonstrated that thorough a close follow-up and appropriately taken measures; the possible growth retardation as well as renal growth problems could be avoided in children beginning to suffer from stone disease during infancy period. CONCLUSIONS: Duration of breast feeding, frequency of UTI, number of stone attacks and stone removal procedures are crucial factors for the clinical course of stone disease in infants that may affect the body as well as kidney growth during long-term follow-up.

The importance of Internet usage for urologic patients.

OBJECTIVES: To evaluate Internet usage frequency, rate of searched diseases and impact of Internet derived data on future patient physician relationship in patients applying to an Urology Department. METHODS: A well prepared questionnaire has been given to 1000 referring cases, out of which 589 accepted to participate on a volunteer basis to a face to face interview. Patients were divided into subgroups with respect to age, gender and as well as their educational and economical status. Regarding Internet, questions inquired the use of Internet, the point of view about it, opinions about healthcare system and most commonly urological diseases searched in Internet. RESULTS: Of 589 patients participating, 38.2% reported access to the Internet; in relation to subgroup analysis of data, there was a statistically significant relationship between the use of Internet and age (p < 0.001), gender (p = 0.048), educational status (p < 0.001) and economical status of (p = 0.002) the cases evaluated. Disease specific information was most frequently sought: 18.2% searched for urolithiasis, 14.2% for non-cancer related kidney diseases, and 14.2% for urologic cancers. CONCLUSIONS: Younger patients with higher educational status tended to use Internet and the majority of these cases share all these information with their physicians during their visit. These findings indicate that all physicians should consider this fact seriously and make their future plans in the light of internet based activities which provides numerous advantages.