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OBJECTIVE: To review the literature on salvage treatments after focal therapy (FT) for prostate cancer (PCa). MATERIALS AND METHODS: A non-systematic literature review was conducted on PubMed, Scopus, and Web of Science up to March 15, 2024, for studies that assessed salvage treatment outcomes in patients with recurrent PCa after primary FT. Original prospective and retrospective studies with more than 10 patients were included. Reviews, editorial comments, conference abstracts, and studies focusing solely on whole-gland treatments were excluded. RESULTS: Twenty-one studies with a total of 1012 patients were included. The most reported salvage treatments were salvage radical prostatectomy followed by re-do ablation therapy. Only one study evaluated salvage radiation therapy. Except for one prospective study, all studies were retrospective. Oncological outcomes showed acceptable biochemical recurrence rates. Functional outcomes varied, with significant impacts observed on erectile function across modalities, though continence rates were less impacted. Complications were generally low across all treatment options. CONCLUSION: Salvage treatment post-primary FT is feasible, safe, and has reasonable oncologic outcomes. However, significant declines in sexual function are common, while continence is comparatively less affected. The literature primarily consists of retrospective studies; hence, future research should focus on large-scale prospective evaluations to better define treatment protocols and improve patient outcomes.
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Background/Objectives: LUTS and voiding dysfunctions are prevalent in urology clinics, with uroflowmetry and IPSS as the prevailing diagnostic methods. Nevertheless, objective assessment can be constrained by age, gender, and variability in the test conditions. Portable (home) uroflowmetry addresses these limitations, allowing for more natural urinary flow recordings beyond clinic confines. This study aims to characterize spontaneous voiding patterns in healthcare professionals, exploring gender differences, variability in repeated measurements, and correlations among voiding parameters, IPSS, age, and BMI. Methods: This cross-sectional study was conducted during the SIU 43rd Congress in Istanbul using smart uroflow devices such as the Oruba Oruflow Uroflow Recorder, which were installed in public toilets. A total of 431 healthcare professionals participated by providing demographic information and completing the IPSS questionnaire. The data analysis included uroflowmetric parameters such as maximum flow rate (Qmax), average flow rate (Qave), and voided volume (VV), in addition to IPSS and demographic data to assess the possible associations with IPSS, age, BMI, and gender differences. Results: Of the participants, 76% were male and 24% female, with a higher prevalence of LUTS in women. Despite no significant gender difference in voided volume, men with lower volumes demonstrated more severe LUTS. Notably, women exhibited higher Qmax and Qave rates irrespective of their IPSS scores, contrasting with men whose flow rates declined with age and LUTS severity. In men, the total IPSS score was inversely associated with uroflowmetric performance, particularly impacting voiding symptoms over storage symptoms. Repeated measurements revealed noteworthy variability in Qmax and VV, without any influence from gender, BMI, age, or symptom severity. Conclusions: Our findings highlight the importance of gender-specific considerations in evaluating voiding complaints through uroflowmetry and IPSS. The significant variability observed in repeated uroflowmetry studies underlines the need for multiple measurements. Overall, this research emphasizes the significance of portable (home) uroflowmetry and calls for a reassessment of normal voiding standards in (non) clinical settings.
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Background/Objectives: Urinary incontinence diminishes quality of life, and its severity can be worsened by mobility impairments. This study explored the link between urinary incontinence, osteoarthritis, and back musculoskeletal system disorders, considering pain, mobility issues, and daily activity difficulties. Methods: This cross-sectional study included respondents aged ≥ 15 years from the 2008 Turkish Health Studies Survey (n = 13,976). We assessed self-reported urinary incontinence, daily activity, mobility impairment, pain, osteoarthritis, and musculoskeletal disorders to explore their association with urinary incontinence. Gender-specific logistic regression models included chronic conditions related to urinary incontinence. Results: The prevalence of urinary incontinence was higher in the participants with osteoarthritis and back musculoskeletal system problems. Among the patients with osteoarthritis, the prevalence was 25.84% in the mobility-impaired group and 10.03% in the non-impaired group. Similarly, 33.02% of those with activities of daily living (ADL) difficulties and 12.93% of those without difficulties had incontinence. The frequency of urinary incontinence increased with pain severity. According to the multivariable logistic regression analyses, the adjusted odds ratio (95% confidence interval) of urinary incontinence for osteoarthritis was 1.58 (95% CI 1.23-2.02, p < 0.01) for females and 2.38 (95% CI 1.62-3.49, p < 0.01) for males. Conclusions: Urinary incontinence was more common in females, increased with age, and was found to be associated with osteoarthritis and back musculoskeletal system disorders. Among the patients with osteoarthritis and back musculoskeletal system disorders, those with mobility impairment and daily activity difficulties had a higher prevalence of urinary incontinence. The patients with more severe pain had a higher frequency of urinary incontinence.
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In longitudinal and cross-sectional studies, depression and anxiety have been associated with urinary incontinence (UI) in women. However, this association has not been studied in men. Utilizing data from the 2008 Turkish Health Studies Survey conducted by the Turkish Statistical Institute, we analyzed 13,830 participants aged 15 years and above. We investigated the association of UI with psychological discomfort in both sexes using multivariable logistic regression. High psychological discomfort significantly correlated with UI in males (OR 2.30, 95% CI 1.43-3.71) and females (OR 2.78, 95% CI 1.80-4.29). Anxiety increased UI likelihood in females (OR 2.36, 95% CI 1.61-3.46) and males (OR 2.37, 95% CI 1.10-5.13). Depression related significantly to UI in females (OR 2.54, 95% CI 1.81-3.58) but not males (OR 1.63, 95% CI 0.71-3.76). Antidepressant and anxiolytic use was not significantly related to UI in either gender. Anxiety and psychological discomfort contribute to UI in both genders. While depression significantly correlates with UI in females, it does not show the same magnitude and significance in males. Antidepressant and anxiolytic use did not significantly influence the association. These findings underscore the psychological distress-UI link, advocating a holistic approach for managing UI in individuals with mental health conditions.
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BACKGROUND AND AIM: This study aims to establish unilateral intermittent and unintermittent partial nephrectomy-like renal ischemia-reperfusion (I-R) model in rats and to compare the results with biochemical findings. MATERIAL AND METHODS: The study was conducted on 24 adult 8-week-old male Wistar-Albino rats, each weighing s200-250 g. The rats were divided into three groups. In the Sham group (n = 8), the kidney was surgically exposed and closed. We designed experimental I-R models in the second group (n = 8, a total of 30-min ischemia model in the manner of 3 intermittent sets 8 minutes clamping and 2 min unclamping) and in the third group (n = 8, one session of 30-min unintermittent ischemia). In postoperative day 1, the rats were sacrificed, and the effects of I-R models on the renal tissue were comparatively assessed by evaluating serum Neutrophil Gelatinase-Associated Lipocalin (NGAL), serum kidney injury molecule-1 (KIM-1), urinary NGAL, urinary KIM-1, and serum creatinine levels. RESULTS: Urinary NGAL and KIM-1 levels were significantly higher in the continuous ischemia group when compared to those in the sham and intermittent ischemia groups (P < 0.05). In the intermittent ischemia group, urinary NGAL and urinary KIM-1 levels were significantly higher than those in the sham group (P < 0.05). Although the results of serum NGAL, serum KIM-1, and serum creatinine levels seemed to be in parallel to the results of urinary markers, no statistically significant difference was found. CONCLUSION: Renal injury was significantly less in the intermittent I-R model when compared to that in the unintermittent I-R model in our experimental rat study.
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AIM: The aims of this research were to analyse the urological literature published during the COVID-19 pandemic and to guide future research. MATERIAL AND METHODS: Between 2019 and 2021, the Web of Science (WoS) All Databases collection was searched for publications related to COVID-19 and Urology. The keywords used during this search were coronavirus-19, COVID-19, SARS-CoV-2, novel coronavirus, 2019-nCoV, pandemic and/or urology. The top 50 cited (T50) publications were also identified and summarized. Exported Microsoft Excel files, Visualization of Similarities viewer (VOSviewer) software and descriptive assessment were used for bibliometric and statistical analyses of the publications. RESULTS: In total, 582 publications related to COVID-19 and urology were identified. In these publications, the most active author, journal, country and organisation were Francesco Porpiglia, European Urology, the United States of America (USA) and La Paz University Hospital, respectively. The most commonly used keywords were telemedicine-telehealth, SARS-CoV-2, coronavirus, pandemic, residency, testicle, semen, kidney transplantation, endourology and surgery. The most worrying issues in the articles are the negative impact of COVID-19 on resident training and permanent damage to urological organs. CONCLUSIONS: We analysed all the articles related to COVID-19 and urology published to date in the WoS All Databases collection. The most commonly published articles were based on clinical and outpatient practice, telemedicine, residency training, transplantation, and testicles. The long-term adverse effects of the pandemic on urology practice and especially urological organs will need to be assessed further in future research.
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COVID-19 , Urología , Bibliometría , Humanos , Pandemias , SARS-CoV-2 , Estados UnidosRESUMEN
INTRODUCTION: Prostate cancer has traditionally been diagnosed by an elevation in PSA or abnormal exam leading to a systematic transrectal ultrasound (TRUS)-guided biopsy. This diagnostic pathway underdiagnoses clinically significant disease while over diagnosing clinically insignificant disease. In this review, we aim to provide an overview of the recent literature regarding the role of multiparametric MRI (mpMRI) in the management of prostate cancer. MATERIALS AND METHODS: A thorough literature review was performed using PubMed to identify articles discussing use of mpMRI of the prostate in management of prostate cancer. CONCLUSION: The incorporation of mpMRI of the prostate addresses the shortcomings of the prostate biopsy while providing several other advantages. mpMRI allows some men to avoid an immediate biopsy and permits visualization of areas likely to harbor clinically significant cancer prior to biopsy to facilitate use of MR-targeted prostate biopsies. This allows for reduction in diagnosis of clinically insignificant disease as well as improved detection and better characterization of higher risk cancers, as well as the improved selection of patients for active surveillance. In addition, mpMRI can be used for selection and monitoring of patients for active surveillance and treatment planning during surgery and focal therapy.
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Imágenes de Resonancia Magnética Multiparamétrica , Neoplasias de la Próstata/diagnóstico por imagen , Humanos , Masculino , Neoplasias de la Próstata/terapiaRESUMEN
OBJECTIVE: The aim of this study is to compare the effects of COVID-19 on urology practice using pre- and post-pandemic data of a pandemic hospital. MATERIAL AND METHODS: March 11 is considered as the beginning of COVID-19 and, changes in the number of the outpatient clinic examinations, non-surgical procedures, and surgery in the 8-week period before and during the pandemic were evaluated by weeks. Age, gender, and comorbid diseases of the operated patients were compared statistically. The symptoms, complaints, mortality, and morbidity conditions of the patients were recorded by contacting them. Descriptive data and chi-square test were used. RESULTS: The number of COVID-19 cases has been reported as 8,916 for the hospital, 88,412 for the city and 150,593 for the country. The mean age of the operated patients before and after 11 March was 51 and 47, and comorbidities were 79 and 40, respectively, and there was no statistically significant difference(p<0.05). The number of patients examined was 2,309 and 868, the number of operated patients 173 and 94, the number of patients undergoing non-surgical procedures were 371 and 174, respectively. The names and numbers of surgical and non-surgical procedures are listed according to European Association of Urology (EAU) priority classification. In follow-up, no complication because of COVID-19 was observed in any patient. CONCLUSION: Our study showed that, although the numbers have decreased, similar operations can be performed in daily urology practice without any contamination and mortality during the pandemic compared to the prepandemic period, by taking precautions and following the algorithms.
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PURPOSE: It is reported that surgical procedures performed during the COVID-19 pandemic are accompanied by high complications and risks. In this study, the urological interventions applied with appropriate infrastructure and protocols during the pandemic in the pandemic hospital that is carrying out the COVID-19 struggle are analyzed. METHODS: Urological interventions were reviewed in the 5-week period between March 11 and April 16. The distribution of outpatient and interventional procedures was determined by weeks concurrently along with the COVID-19 patient workload, and data in the country, subgroups were further analyzed. Patients intervened were divided into four groups as Emergency, High, Intermediate, and Low Priority cases according to the EAU recommendations. The COVID-19-related findings were recorded; staff and patient effects were reported. RESULTS: Of the 160 interventions, 65 were minimally invasive or open surgical intervention, 95 were non-surgical outpatient intervention, and the outpatient admission was 777. According to the priority level, 33 cases had emergency and high priority, 32 intermediate and low priority. COVID-19 quarantine and follow-up were performed at least 1 week in 22 (33.8%) operated patients at the last week, 43 (66.2%) patients who were operated in the previous 4 weeks followed up at least 2 weeks. No postoperative complications were encountered in any patient due to COVID-19 during the postoperative period. CONCLUSION: In the COVID-19 pandemic, precautions, isolation, and algorithms are required to avoid disruption in the intervention and follow-up of urology patients; priority urological interventions should not be disrupted in the presence of necessary experience and infrastructure.
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Atención Ambulatoria , Procedimientos Quirúrgicos Ambulatorios , Infecciones por Coronavirus , Control de Infecciones , Pandemias , Neumonía Viral , Enfermedades Urológicas , Procedimientos Quirúrgicos Urológicos , Atención Ambulatoria/métodos , Atención Ambulatoria/estadística & datos numéricos , Procedimientos Quirúrgicos Ambulatorios/métodos , Betacoronavirus , COVID-19 , Gestión del Cambio , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Tratamiento de Urgencia/métodos , Tratamiento de Urgencia/estadística & datos numéricos , Femenino , Humanos , Control de Infecciones/métodos , Control de Infecciones/organización & administración , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/estadística & datos numéricos , Evaluación de Procesos y Resultados en Atención de Salud , Pandemias/prevención & control , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , SARS-CoV-2 , Turquía/epidemiología , Enfermedades Urológicas/epidemiología , Enfermedades Urológicas/cirugía , Procedimientos Quirúrgicos Urológicos/métodos , Procedimientos Quirúrgicos Urológicos/estadística & datos numéricosRESUMEN
ABSTRACT Objectives: To investigate the characteristics of cases of NIH category I acute prostatitis developed after transrectal prostate biopsy and clarifiy the risk factors and preventive factors. Materials and Methods: We retrospectively reviewed the medical records of 3.479 cases of transrectal ultrasound-guided needle biopsies performed with different prophylactic antibiotherapy regimens at two different institutions between January 2011 and February 2016. The patients of Group I have received ciprofl oxacin (n=1.523, 500mg twice daily) and the patients of Group II have received ciprofl oxacin plus ornidazole (n=1.956, 500mg twice daily) and cleansing enema combination as prophylactic antibiotherapy. The incidence, clinical features and other related microbiological and clinical data, were evaluated. Results: Mean age was 62.38±7.30 (47-75), and the mean prostate volume was 43.17±15.20 (21-100) mL. Of the 3.479 patients, 39 (1.1%) developed acute prostatitis after the prostate biopsy procedure. Of the 39 cases of acute prostatitis, 28/3.042 occurred after the first biopsy and 11/437 occurred after repeat biopsy (p=0.038). In Group I, 22 of 1.523 (1.4%) patients developed acute prostatitis. In Group II, 17 of 1.959 (0.8%) patients developed acute prostatitis. There was no statistical difference between the two groups according to acute prostatitis rates (X2=2.56, P=0.11). Further, hypertension or DM were not related to the development of acute prostatitis (P=0.76, X2=0.096 and P=0.83, X2=0.046, respectively). Conclusions: Repeat biopsy seems to increase the risk of acute prostatitis, while the use of antibiotics effective for anaerobic pathogens seems not to be essential yet.
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Humanos , Masculino , Anciano , Ornidazol/administración & dosificación , Prostatitis/etiología , Biopsia con Aguja/efectos adversos , Ciprofloxacina/administración & dosificación , Profilaxis Antibiótica/métodos , Enema/métodos , Antibacterianos/administración & dosificación , Próstata/patología , Prostatitis/prevención & control , Factores de Tiempo , Biopsia con Aguja/métodos , Reproducibilidad de los Resultados , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento , Ultrasonografía Intervencional , Combinación de Medicamentos , Persona de Mediana EdadRESUMEN
OBJECTIVES: To investigate the characteristics of cases of NIH category I acute prostatitis developed after transrectal prostate biopsy and clarifiy the risk factors and preventive factors. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 3.479 cases of transrectal ultrasound-guided needle biopsies performed with different prophylactic antibiotherapy regimens at two different institutions between January 2011 and February 2016. The patients of Group I have received ciprofloxacin (n=1.523, 500mg twice daily) and the patients of Group II have received ciprofloxacin plus ornidazole (n=1.956, 500mg twice daily) and cleansing enema combination as prophylactic antibiotherapy. The incidence, clinical features and other related microbiological and clinical data, were evaluated. RESULTS: Mean age was 62.38 ± 7.30 (47-75), and the mean prostate volume was 43.17 ± 15.20 (21-100) mL. Of the 3.479 patients, 39 (1.1%) developed acute prostatitis after the prostate biopsy procedure. Of the 39 cases of acute prostatitis, 28/3.042 occurred after the fi rst biopsy and 11/437 occurred after repeat biopsy (p=0.038). In Group I, 22 of 1.523 (1.4%) patients developed acute prostatitis. In Group II, 17 of 1.959 (0.8%) patients developed acute prostatitis. There was no statistical difference between the two groups according to acute prostatitis rates (X2=2.56, P=0.11). Further, hypertension or DM were not related to the development of acute prostatitis (P=0.76, X2=0.096 and P=0.83, X2=0.046, respectively). CONCLUSIONS: Repeat biopsy seems to increase the risk of acute prostatitis, while the use of antibiotics effective for anaerobic pathogens seems not to be essential yet.
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Antibacterianos/administración & dosificación , Profilaxis Antibiótica/métodos , Biopsia con Aguja/efectos adversos , Ciprofloxacina/administración & dosificación , Enema/métodos , Ornidazol/administración & dosificación , Prostatitis/etiología , Anciano , Biopsia con Aguja/métodos , Combinación de Medicamentos , Humanos , Masculino , Persona de Mediana Edad , Próstata/patología , Prostatitis/prevención & control , Reproducibilidad de los Resultados , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Ultrasonografía IntervencionalRESUMEN
OBJECTIVES: Vasectomy is a popular and effective male surgical contraceptive method. Different techniques have been proposed to reduce failure rates and complications. In this study, we sought to compare vas deferens occlusion rates using both standard occlusion techniques and LigaSure (LSVS) for vasectomy. MATERIAL AND METHODS: A total of nine patients underwent open radical retropubic prostatectomy at our institution. During the procedure, a total of 125 fresh vas deferens samples were obtained and divided into four groups as follows: Group 1: ligation (n = 22), Group 2; ligation and electrocauterization (n = 18), Group 3; 5 mm LSVS (n = 44), Group 4; 10 mm LSVS (n = 41). All specimens were harvested during surgery and subsequent histopathological assessments were performed to assess the luminal status of the vas deferens. RESULTS: Histopathological evaluation revealed that the majority of vas lumens with LSVS (79.5% of Group 3 and 89.4% of Group 4) were totally occluded. With standard techniques, however, the majority of vas lumens (86.4 and 77.8% of Groups 1 and 2, respectively) maintained a tiny patency. CONCLUSIONS: On histopathological review, the application of LSVS resulted in better occlusion rates, compared to standard ligation methods. These findings suggest a higher occlusive role for LSVS for vasectomy. Further clinical studies are needed to confirm the clinical efficacy and safety of this technique.
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Conducto Deferente/cirugía , Vasectomía/métodos , Humanos , Masculino , Complicaciones Posoperatorias/etiología , Prostatectomía , Vasectomía/efectos adversos , Vasectomía/instrumentaciónRESUMEN
OBJECTIVE: In the present study, we aimed to invastigate the ciprofloxacin resistance in rectal flora of the patients undergoing prostate biopsy in our department. Additionally, the possible effects of the presence of ciprofloxacin resistant bacteria in faecal flora on the risk of infective complications after the procedure as well as the effect of antibiotic prophylaxis on such infectious complications have been evaluated. MATERIAL AND METHODS: A total of 142 patients undergoing transrectal ultrasound-guided prostate biopsy were included into the study program. Rectal swab samples were taken from all patients prior to biopsy. The presence of complications have been evaluated after a week following the biopsy procedure. Patients with fever were also evaluated. The possible correlation between the presence of ciprofloxacin-resistant bacteria in faecal flora and the risk of urinary tract infection development and the other complications were evaluated. RESULTS: E. coli bacteria were present in all cultures of rectal swab samples obtained from 142 patients prior to prostate biopsy. Of all these patients, while ciprofloxacin-resistant E. coli (CR E. coli) grew in 76 (53.5%) patients; ciprofloxacin susceptible E. coli (CS E. coli) was obtained in 66 (46.5%) patients. In 16 patients (11.3%), infectious complications were observed. While the infective complications were present in the 14.5% of patients with CR E. coli; they were present in the 7.6% of patients with CS E. coli (p=0.295). High fever was observed in nine patients (6.3%). Of these nine patients, although six had CR E. coli growth as detected during culture sensitivity tests; three had CS E. coli growth in their rectal swab culture tests. Sepsis was observed in three (2.1%) of these patients with high fever. Ciprofloxacin-resistant E. coli grew in all of the rectal swab cultures obtained from these patients with sepsis. CONCLUSION: In the light of our findings we may say that, it will be appropriate to reconsider the ciprofloxacin prophylaxis and prefer to use other prophylactic agents for a certain period of time in populations with higher rates of resistance to this medical agent. Furthermore, it will be appropriate again to obtain rectal swab specimens for culture tests before biopsy procedure in order to perform targeted prophylaxis according to the culture antibiogram test results. This approach will enable us to evaluate the cost-effectiveness of the procedure in detail.
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OBJECTIVE: To explore the feasibility of laparoscopic trans-rectal Natural Orifice Transluminal Endoscopic Surgery (NOTES) radical prostatectomy in a cadaveric model and to define anatomical landmarks of this surgical route. MATERIALS AND METHODS: After the ethical clearance, the study was conducted in Turkish Council of Forensic Medicine. With the cadaver in an exaggerated lithotomy position, a full thickness incision was made on the anterior wall of the rectum. The anteriorly visible Denonvilliers' fascia was incised sharply, exposing the posterior surface of the prostate. A single-port device (GelPOINT(®)Path) was inserted transanally passing the incision on the anterior wall of the rectum, into the bluntly created space between rectum and prostate. Three, 10 mm ports were placed through the GelPOINT(®)Path, at 3, 6, and 9 o'clock positions. A 5 mm, 0° degree lens was introduced at 6 o'clock position; followed by laparoscopic scissors and laparoscopic grasper. Prostatic and periprostatic anatomy was defined as encountered during each step of the procedure. RESULTS: Exposure of the posterior surface of the prostate and seminal vesicles was easily achieved. No additional openings of the rectal wall were made. Surgical specimen was extracted keeping its integrity. CONCLUSION: Transrectal radical prostatectomy is technically feasible in the cadaver model, being facilitated by previous experience with perineal surgery. Anatomical observations during the present experimental study suggest that the transrectal NOTES route provides good exposure of the operative field and easy access to the posterior surface of prostate, Future experimental endeavors should focus on reproducibility of this approach and feasibility of lymph node dissection using trans-rectal route.
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OBJECTIVE: To compare the mid-term outcomes of photoselective vaporization of prostate (PVP) with GreenLight HPS 120 W laser and transurethral resection of the prostate (TURP) for obstructive lower urinary tract symptoms (LUTS) in men with prostate cancer (CaP). PATIENTS AND METHODS: Seventy four patients with locally advanced (T3/T4) CaP with severe LUTS or acute urinary retention (AUR) were allocated to TURP (n = 36) or PVP (n = 38). International Prostate Symptom Scores (IPSS), maximum flow rates (Qmax) and post-void residual volumes (Vres), PSA levels, prostate volumes, complications, catheter removal and hospitalization periods were recorded. Patients were reassessed at 3, 6, and 12 months. RESULTS: The catheter removal time was significantly longer in the TURP group (3.8 ± 1.1 vs. 1.2 ± 0.7 days, p = 0.02), whereas failure of initial voiding trial was higher in PVP (2.7 vs. 13.1%, p = 0.01). No significant difference in IPSS, Qmax and Vres values was observed within the follow-up period between two groups. A significant difference in urethral stricture rate (8.3 vs. 0%), catheter removal time (3.8 ± 11 vs. 1.2 ± 0.7 days) and hospital stay (2.9 ± 0.6 vs. 1.1 ± 0.5 days) was observed in favor of PVP. CONCLUSIONS: Palliative PVP is very safe and effective by means of symptomatic relief in patients with locally advanced CaP.
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Terapia por Láser/métodos , Rayos Láser , Neoplasias de la Próstata/cirugía , Neoplasias de la Próstata/terapia , Resección Transuretral de la Próstata/efectos adversos , Obstrucción del Cuello de la Vejiga Urinaria/etiología , Anciano , Anciano de 80 o más Años , Cateterismo , Hospitalización , Humanos , Síntomas del Sistema Urinario Inferior/etiología , Síntomas del Sistema Urinario Inferior/cirugía , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Próstata/cirugía , Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/complicaciones , Resultado del TratamientoRESUMEN
PURPOSE: To evaluate contemporary management approaches to medium-sized (10-20 mm) renal stones. PATIENTS AND METHODS: A total of 935 patients treated for medium-sized renal stones (10-20 mm) between July 2012 and March 2014 were included in the study program. Contemporary minimally invasive approaches applied in the management of such stones were evaluated and compared. RESULTS: The cohort consisted of 561 male (60%) and 374 female (40%) patients. Of the 935 patients with medium-sized renal calculi, 535 (57.2%) were treated with shockwave lithotripsy (SWL), 201 (21.4%) with retrograde intrarenal surgery (RIRS), 110 (11.7%) with minimally invasive percutaneous nephrolithotomy (miniperc), and the remaining 89 (11.7%) patients with micropercutaneous nephrolithotomy (microperc). In the SWL group, stones were located mostly in the pelvis (51%), while in the miniperc and microperc groups, they were located mainly in the lower pole (46%, 53%, respectively). Stone-free rates after a single session were 77.2%, 86.1%, 88.8%, and 83.6% in the SWL, RIRS, microperc, and miniperc groups, respectively. Although no serious complications (above Clavien level III) were noted in any of the groups evaluated, Clavien I to II complications were common in the miniperc group. CONCLUSION: Although SWL is the preferred treatment option for patients with medium-sized (10-20 mm) renal stones, endourologic methods also have been found to have a significant role. Relatively lower complication rates along with higher stone-free status observed with the RIRS technique compared with percutaneous approaches have made this method a valuable option in the management of such stones in recent years.
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Cálculos Renales/cirugía , Nefrostomía Percutánea/métodos , Adulto , Anciano , Femenino , Humanos , Litotricia/métodos , Litotricia/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/estadística & datos numéricos , Nefrostomía Percutánea/estadística & datos numéricos , Evaluación de Resultado en la Atención de Salud , Complicaciones Posoperatorias , Estudios RetrospectivosRESUMEN
OBJECTIVE: To evaluate the possible effects of residual fragments on the health-related quality of life in patients undergoing extracorporeal shockwave lithotripsy for renal stones. PATIENTS AND METHODS: Seventy-one patients with residual fragments were divided into 2 further groups; group 1 (n = 42; fragment size, ≤ 4 mm) and group 2 (n = 29; fragment size, >4 mm). During 3-month follow-up, spontaneous passage rates; number of emergency department visits, amount of the analgesic required, additional procedures, and the changes in the quality of life were evaluated. Quality of life was evaluated using the Short Form 36 survey. Statistical analyses included independent sample t tests. RESULTS: Of the 42 cases with fragments ≤ 4 mm, although 92.8% patients passed the fragments spontaneously, fragments resided until 3 months in 4.8% patients. Again, after 2 sessions of extracorporeal shockwave lithotripsy, of the 29 cases with fragments >4 mm, 55% were stone free, whereas 14% still had residual fragments. Mean number of emergency department visit was found to be 0.07 and 0.5 in both groups, respectively. Mean analgesic need was 138.75 mg in group 1 and 375 mg in group 2. Although significantly lower scores were noted only for one parameter during 1-month evaluation in cases with larger fragments, they were present in all 8 parameters during 3-month evaluation. CONCLUSION: Larger residual fragments could significantly affect the quality of life. Emergency department visits and colic attacks are the causes of discomfort. Effective stone disintegration by an experienced urologist should be aimed to limit the negative effects of residual fragments on the quality of life.
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Cálculos Renales/psicología , Cálculos Renales/terapia , Litotricia/métodos , Litotricia/psicología , Adulto , Anciano , Analgésicos/administración & dosificación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Prospectivos , Calidad de Vida , Prevención Secundaria , Encuestas y Cuestionarios , Resultado del Tratamiento , Urología/métodosRESUMEN
PURPOSE: To evaluate the relationship between levels of total testosterone and total prostate-specific antigen (PSA) in healthy men with PSA<4 ng/mL. MATERIALS AND METHODS: The study comprised 179 men with a mean age of 59.19±12 years who visited Osmaniye State Hospital, Osmaniye, Turkey, between January 2006 and January 2007 for a routine checkup. The patients were divided into two subgroups: patients with PSA<2.5 mg/ml (group I, n=160 patients) and patients with PSA of 2.5 to 4 ng/mL (group II, n=19 patients). The relationship between PSA and testosterone levels was investigated in both groups and in patients aged <60 years. The mean testosterone level was calculated for patients aged <50 years and was compared with the mean value of patients aged ≥50 years. RESULTS: In all patients, the mean values for serum PSA and total testosterone were 1.27±0.88 ng/mL and 404.04±158.86 ng/mL, respectively. No correlation was detected between serum PSA and testosterone levels in either subgroup (group I, r=0.072, p=0.363; group II, r=0.031, p=0.900) or in patients aged <60 years (r=0.032, p=0.72). The mean values of testosterone in patients aged ≥50 years and in patients aged <50 years were 417.01±163.35 and 344.16±120.21 ng/dL, respectively (p=0.02). CONCLUSIONS: No impact of testosterone was found on the PSA level in healthy men with PSA <4 ng/mL. Therefore, a high serum testosterone level may not mandate adjustment of PSA values. This serum sex hormone showed a significant increment after the age of 50 years. Further studies including a larger number of patients should be carried out to confirm these findings.
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Calicreínas/sangre , Antígeno Prostático Específico/sangre , Testosterona/sangre , Anciano , Envejecimiento/sangre , Biomarcadores de Tumor/sangre , Humanos , Masculino , Persona de Mediana Edad , Valores de ReferenciaRESUMEN
Metastatic malignant melanoma of the prostate is extremely rare in clinical practice, and only one case has been reported in the English literature in the past 30 years. We report a case of malignant melanoma that metastasized to the prostate and review the current literature. A 50-year-old man with a history of malignant melanoma metastasis to the left axilla, which was excised 3 years ago, presented with lower urinary tract symptoms and gross hematuria. He underwent cystoscopy and transurethral resection of the prostate. The pathological examination showed metastatic malignant melanoma of the prostate gland. The patient died 6 months after the transurethral resection.
RESUMEN
PURPOSE: Ischemic priapism, a compartment syndrome, requires urgent treatment in order to nourish the corpora cavernosa. As the first step, aspiration of blood and irrigation of the cavernosal bodies is performed to prevent fibrotic activity and secure erectile capability. During aspiration, there are risks of cardiovascular side effects of adrenergic agonists. We aimed to evaluate a transient distal penile corporoglanular shunt technique in place of aspiration and irrigation techniques for treatment of early ischemic priapism. MATERIALS AND METHODS: A transient distal penile shunt was applied to 15 patients with early ischemic priapism between January 2011 and May 2012. Priapism duration, history, causes, pain, and any prior management of priapism were assessed in all patients. A complete blood count and penile Doppler ultrasonography were performed, which showed attenuated blood flow in the cavernosal artery. A sterile closed system blood collection set, which has two needles and tubing, was used for the transient distal penile shunt. RESULTS: Ten of 15 patients with early ischemic priapism were successfully treated with this transient shunt technique. No additional procedures were needed after the resolution of rigidity in the 10 successfully treated patients. CONCLUSIONS: The transient nature of this technique is an advantage over aspiration and irrigation in the treatment of early ischemic priapism. Our results indicate that the technique can be offered for patients with an ischemic priapism episode of no more than 7 hours.