Robotic assited perineal prostatectomy (RAPP) as a new era for anesthesiology: It's effects on hemodynamic parameters and respiratory mechanics.

Robotic-assisted perineal prostatactomy(RAPP) is a new alternative surgical technique, in prostate cancer patients especially with a history of intra-abdominal surgery. The aim of this study is to examine the effects of the challenging patient position and CO2 insufflation in perineal space during RAPP on both hemodynamic parameters and respiratory mechanics. Hemodynamic and respiratory parameters of 30 patients who underwent RAPP and 31 patients who underwent Robotic-assisted laparoscopic prostatectomy (RALP) for prostate cancer between 2017 and 2019 were retrospectively evaluated. Comparison between RAPP and RALP patients showed that anesthesia, surgery and insufflation times were shorter in RAPP patients (p < 0.05). Blood pCO2 level was higher, and the pH decrease was more prominent in the RAPP patients 30 and 60 min after perineal CO2 insufflation (p < 0.05). The mean arterial pressures, driving pressure, Ppeak and Pplato values were statistically higher in the RALP patients and 60 min after insufflation while static and dynamic lung compliance values were found to be lower. Our results showed that blood pCO2 level may severely increase after perineal CO2 insufflation. The fact that respiratory mechanics are less affected despite the difficult patient position for lungs in RAPP patients, the presence of higher CO2 level supports that the perineal CO2 insufflation plays a more important role in increased CO2 level. Considering these changes, especially the sudden increase in the risk of CO2 level, close follow-up and timely intervention by anesthesiology can ensure all changes remain in a clinically safe range.

The effect of single or multiple arteries in the donor kidney on renal transplant surgical outcomes.

BACKGROUND: As the number of end-stage renal disease (ESRD) patients is increasing, but there are not enough living donors, it is necessary to broaden the criteria for candidates who can undergo donor nephrectomy. Thanks to surgeons' increasing experience with laparoscopic donor nephrectomy (LND), multiple renal artery grafts, previously considered a relative contraindication to donor nephrectomy, have become candidates for LDN. We aimed to compare the outcomes of donors and recipients with single artery and with multiple arteries in LDN. METHODS: A total of 214 patients were included in the study. Patients were divided into two groups according to the number of donor arteries: donors with one artery (group 1) and donors with multiple arteries (group 2). The number of donor arteries, operative time, warm ischemia time (WIT), cold ischemia time (CIT), arterial anastomosis time, venous anastomosis time, the extent of bleeding, and preoperative complications were recorded to evaluate the preoperative data. RESULTS: The mean operation time in group 1 was 90.3 ± 11.8 min, while in group 2, it was 102.1 ± 5.5 min (p = 0.000). WIT group 1 was 90.9 ± 4.3 s and group 2 100.6 ± 2.1 s (p = 0.000). Arterial anastomosis time was 12.25 ± 3.8 in group 1 and 22.5 ± 4.5 in group 2 (p = 0.000). No statistically significant difference was found between the two groups in other parameters. CONLUSION: Increasing the number of donor arteries in renal transplantation (RT) operations prolonged the operation time on both the donor and recipient sides. Still, it had no negative impact on complications or graft function in the postoperative period.

Comparison of Incision Types Used for Kidney Extraction in Laparoscopic Donor Nephrectomy: A Retrospective Study.

PURPOSE: Laparoscopic donor nephrectomy (LDN) is the most commonly used method for kidney removal in kidney transplantation and, various incisions are used for kidney extraction. In this study, we aimed to compare the results of LDN operations using iliac fossa incision and Pfannenstiel incision. MATERIAL AND METHOD: LDN cases performed in our institute between June 2016 and February 2020 were retrospectively analyzed. Patients with previous abdominal surgery, bleeding coagulation disorders, ectopic kidneys, and patients who were converted to perioperative open surgery were excluded. Demographic data of the patients, operation times, warm ischemia times, complications were recorded and the patients were divided into two groups according to incision types. RESULTS: After the inclusion and exclusion criteria, 203 patients were included in the study. Iliac fossa incision was used in 65% of the patients and the Pfannenstiel incision was used in 35% of the patients to remove the donor's kidney. There were no difference in age, body mass index, gender, and Charlson Comorbidity Index (CCI) scores between the two groups. Operation time and warm ischemia time were significantly longer in the Pfannenstiel group (p = 0.001 and p = 0.016 respectively). There was no significant difference between the two groups in terms of bleeding amount, length of hospital stay, need for narcotic analgesic, visual analog scale scores, and postoperative complications. CONCLUSION: Both types of incisions can be used successfully and safely for the extraction of the kidney in LDN. Although WIT and operation time has been observed to be longer when a Pfannenstiel incision is made, complications and analgesic use are not different between Pfannenstiel incisions and iliac fossa incisions.

Comparison of Open and Robot-Assisted Kidney Transplantation in terms of Perioperative and Postoperative Outcomes.

Background: The gold standard treatment method for end-stage renal disease (ESRD) is renal transplantation (RT). RT can be done with open or minimally invasive surgical methods. We aimed to compare the outcomes between patients who underwent robot-assisted renal transplantation (RART) and open renal transplantation (ORT). Methods: Data of the patients who underwent ORT or RART in two institutions between June 2015 and February 2020 were retrospectively reviewed. Patients who underwent live donor RT were included, and all donor nephrectomy procedures were performed by the laparoscopic technique. Demographic data, ischemia times, anastomosis times, operation times, and postoperative complications were recorded. Results: 98 patients were included in the ORT group, while 91 patients were included in the RART group. There was a significant difference between the two groups regarding mean patient age. While total ischemia time was 86.9 ± 7 minutes in the RART group, it was calculated as 71.2 ± 3.3 minutes in the ORT group, with a significant difference. The anastomosis time was significantly shorter in the ORT group than in the RART group. The incision length and duration of hospital stay were significantly shorter, visual analogue scores were significantly lower, and estimated blood loss was less in the RART group than in the ORT group. Conclusion: Both ORT and RART are effective and safe methods for treating ESRD. According to our study, RART is associated with relatively longer ischemia times but lower complication rates and higher patient comfort.

Pre-Operative Parameters Predicting Hemoglobin Decline Related to Percutaneous Nephrolithotomy.

Objectives: Percutaneous nephrolithotomy (PNL) for upper urinary tract stones is a minimally invasive, effective treatment modality. Despite its high success rates, its potential complications pose a risk. In this study, we aimed to determine the risk factors associated with bleeding which is one of PNL's most important complications. Methods: The data of patients who underwent PNL between January 2017 and December 2018 were retrospectively analyzed. The median reduction in post-operative hemoglobin levels compared to preoperative levels was found to be 1.6 g/dl, which was accepted as the threshold value. The patients with hemoglobin decrease above the threshold were assigned as Group 1, and below the threshold as Group 2. Pre-operative, perioperative data, and stone characteristics of the patients were recorded. Results: 169 patients, 85 patients in Group 1 and 84 patients in Group 2 were included in the study. The mean age of Group 1 was significantly higher (47.4±7.9 and 32±9.4 years, respectively, p=0.001) Sixteen in Group 1 (18.8%) and six in Group 2 (7, 1%) had a diagnosis of hypertension (HT) and a significant difference was found (p=0.038). The average stone burden was 2733±1121.3 mm3 in Group 1, and 2326.5±975.6 mm3 in Group 2. It was observed that there was a significantly higher stone burden in Group 1 (p=0.001). There was a significant difference between the groups in terms of mean operation time (84.4±7 and 76.2±9.9 min, respectively, p<0.001). When the complication rates were analyzed, complications were observed in 25 (29.4%) patients in Group 1 and 12 (14.2%) patients in Group 2, and a significant difference was found between both groups (p=0.019). Age and HT were found to be significant independent risk factors associated with hemoglobin decline in multivariate analyzes (p<0.001 and p<0.027, respectively). Conclusion: In this study; advanced age, presence of HT, and high stone burden were found to be predictive of reductions in hemoglobin levels. Furthermore, a correlation of decreased hemoglobin levels was detected with operative times and occurrence of complications.

Factors affecting length of stay in Fournier's gangrene: a retrospective analysis of 10 years' data.

BACKGROUND: We aimed to investigate the parameters that have an effect on the length of stay and mortality rates of patients with Fournier's gangrene. MATERIAL AND METHODS: A retrospective review was performed on 80 patients who presented to the emergency department and underwent emergency debridement with the diagnosis of Fournier's gangrene between 2008 and 2017. The demographic and clinical characteristics, length of stay, Fournier's Gangrene Severity Index score, cystostomy and colostomy requirement, additional treatment for wound healing and the mortality rates of the patients were evaluated. RESULTS: Of the 80 patients included in the study, 65 (81.2 %) were male and 15 (18.7 %) female. The most common comorbidity was diabetes mellitus. The mean time between onset of complaints and admission to hospital was 4.6 ±â€Š2.5 days. As a result of the statistical analyses, it was found that Fournier's Gangrene Severity Index score, hyperbaric oxygen therapy, negative pressure wound therapy and the presence of sepsis and colostomy were significantly positively correlated with length of stay. Also it was found that the Fournier's Gangrene Severity Index score, administration of negative pressure wound therapy and the presence of sepsis were correlated with mortality. CONCLUSION: Fournier's gangrene is a mortal disease and an emergency condition. With the improvements in Fournier's gangrene disease management, mortality rates are decreasing, but long-term hospital stay has become a new problem. Knowing the values predicting length of stay and mortality rates can allow for patient-based treatment and may be useful in treatment choice.

Evaluation of the efficacies of methylphenidate and biofeedback treatments in giggle incontinence: One-year follow-up study.

INTRODUCTION: Giggle incontinence is a type of urinary incontinence (GI) that occurs with laughing due to the urinary bladder's involuntary contraction leading to complete emptying. There are studies in the literature that biofeedback therapy or methylphenidate can be effective in the treatment of this condition. OBJECTIVE: This study aimed to compare the efficacies of biofeedback therapy and methylphenidate treatment in patients with GI. STUDY DESIGN: In this non-randomized observational study, children aged 5-18 years who were diagnosed with GI between January 2014 and December 2019 were included in the study. Patients who were treated by biofeedback were assigned to Group 1, while patients who were given methylphenidate treatment were placed in Group 2. Patients in Group 1 were treated with biofeedback, which was planned once a week for four weeks and once a month for the following two months. They continued their pelvic floor strengthening exercises at home for the following nine months. Patients in Group 2 were prescribed 5 mg oral methylphenidate qid for three months. Patients in both groups were followed up with 3-month intervals within a year. The results were classified as complete response, partial response or no response as per The International Children's Continence Society (ICCS) recommendations. RESULTS: The study population consisted of 38 patients with GI. Mean age of the patients was 7.7 (5-11). Among these patients, 31 (81.5%) were female, while 7 (18.4%) were male. Two groups were similar regarding mean patient age and gender distribution. There was no difference between the two groups regarding treatment responses evaluated during the 1st, 3rd, and 6th-month outpatient clinic encounters (p > 0.05). However, treatment responses assessed during the 12th-month outpatient clinic encounter revealed 15 (94.1%) patients with complete response in Group 1, while there were 10 (55.6%) patients who showed complete response in Group 2, with a significant difference (p = 0.03). DISCUSSION: Our study showed that treatment responses were reduced after discontinuation of methylphenidate. We achieved high complete response rates in the first, third, sixth, and twelfth-month assessments by biofeedback treatment. CONCLUSIONS: Significantly more favorable treatment outcomes were achieved with biofeedback therapy than methylphenidate treatment after completion of 1-year. Multi-center, randomized studies are needed to evaluate efficacy and safety.

Is neutrophile to lymphocyte ratio a predictor of Gleason score upgrading according to risk classifications in patients with prostate cancer.

OBJECTIVES: We aimed to determine the parameters that predict Gleason Score (GS) upgrading in patients undergoing robot-assisted laparoscopic radical prostatectomy (RARP) and especially the ability of neutrophile to lymphocyte ratio (NLR) in predicting the upgrading. METHODS: Patients who underwent RARP for prostate cancer in our clinic between January 2013 and January 2018 were retrospectively analyzed. Patients' demographic data, preoperative and postoperative parameters were all recorded in the database. NLR was calculated by dividing the absolute neutrophil count (NC) by the absolute lymphocyte count (LC). Patients were classified as low, moderate and high risk according to the National Comprehensive Cancer Network (NCNN) Guidelines. Any increase in GS between biopsy results and radical prostatectomy specimens were consideredas an GS upgrading. RESULTS: After applying the inclusion and exclusion criteria, a total of 571 patients, 205 patients without GS upgrading (Group 1) and 366 patients with GS upgrading (Group 2), were included. The mean preoperative PSA values and prostate volumes were 10.8 ± 8 ng/dL and 45 ± 18.8 ml, respectively. Group 2 had a significantly high NC and NLR, significantly low platelet count (PC) and LC, (p=0.0001, 0.0001, 0.001 and0.002, respectively). Group 2 was found to have significantly higher positive surgical margin (PSM), extraprostatic extension (EPE) and seminal vesical invasion (SVI) (p<0.001). There was no significant correlation between the parameters of NLR and PSM, EPE, SVI, and lymph node invasion (LNI). Binomial logistic regression showed patients with increased NLR had 1.68 times higher odds to exhibit an upgrade in GS in the post-surgical histopathological analysis. CONCLUSIONS: NLR calculated preoperatively is an easy diagnostic method that can predict GS upgrading in patients scheduled for radical prostatectomy for prostate cancer.

OBJETIVOS: Determinamos los parámetros que predicen el grado de sobregradación de Gleason en pacientes que recibieron prostatectomía radical robótica asistida por laparoscopia (PRRL) y especialmente la habilidad de la tasa de neutrófilos/linfocitos (NLR) a la hora de predecir la sobregradación.MÉTODOS: Los pacientes que recibieron PRRL por cáncer de próstata en nuestra clínica entre enero 2013 y enero de 2018 se analizaron retrospectivamente. Los datos demográficos, parámetros preoperatorios y postoperatorios fueron reportados en la base de datos. NLR se calculo dividiendo el numero absoluto de neutrófilos (NC) por el numero absoluto de linfocitos (LC). Los pacientes se clasificaron como bajo, moderado y alto riesgo en la relación a las guías de National Comprehensive Cancer Network (NCNN). Cualquier aumento en el grado de Gleason entre los resultados de la biopsia y la prostatectomía radical fueron considerados como una sobregradación de grado deGleason. RESULTADOS: Después de aplicar los criterios de inclusión y exclusión, un total de 571 pacientes, 205 sin sobregradación de Gleason (Grupo 1) y 366 pacientes con sobregradación de Gleason (Grupo 2). La media de PSA preoperatorio y volúmenes prostáticos fueron de 10,8 ± 8 ng/dL y 45 ± 18,8 ml, respectivamente. El grupo 2 presentó un NC y NLR más alto, significativamente, bajos niveles de plaquetas y LC (p=0,0001, 0,0001, 0,001 y 0,002, respectivamente). El grupo 2 demostró tener niveles significativamente más altos de márgenes quirúrgicos (PSM), extensión extraprostatica (EPE) e invasión de vesículas seminales (SVI) (p<0,001). No se econtró una correlación significativa entre los parámetros de NLR y PSM, EPE, SVI, invasión ganglios linfáticos. El modelo de regresión binomial logística demostró que los pacientes con un incremento de NLR tuvieron 1,68 más veces de tener una sobregradación de Gleason en el análisis histopatológico postquirúrgico. CONCLUSIONES: El cálculo de NLR preoperatorio es un método fácil de diagnóstico que puede predecir la sobregradación de Gleason en pacientes que van a recibir una prostatectomía radical por cáncer de próstata.

Evaluation of Retinal and Choroidal Microcirculation Alterations After a Single Dose of Oral 5-mg Tadalafil: A Prospective Pilot Optical Coherence Tomography Angiography Study.

Purpose: To evaluate the effects of a single dose of oral 5-mg tadalafil on macular microcirculation as measured using optical coherence tomography (OCT) and angiography (OCTA) in healthy volunteers. Methods: Twenty-two healthy, middle-aged, sexually active, and male health care worker volunteers were included in this prospective study. All volunteers have a history of occasionally using off-label 5 mg tadalafil to enhance sexual performance. Superficial and deep capillary plexus vascular densities, foveal avascular zone parameters, outer retina, and choriocapillaris flow areas were performed using the OCTA, and subfoveal-choroidal thickness (CT) was performed by using the OCT. Measurements were performed preintake, 30 min, 1, 4, 24 h, 2, 3, 4, and 7 days after the intake of tadalafil off-label. Results: Twenty-two eyes of 22 male volunteers were included in the study. The mean age was 37.16 ± 4.52 years. At 30 min, 1 h, and 4 h after intake, a statistically significant increase was observed in the choriocapillaris flow area and CT compared with preintake (Friedman test, P = 0.034 and P < 0.001, respectively). Conclusion: This study showed that a single dose of oral 5-mg tadalafil causes an increase in choriocapillaris flow and CT. To evaluate the effects of tadalafil on the retina and choroid, an OCTA assessment may be helpful.

Can robot-assisted kidney transplantation provide higher quality of life than open kidney transplantation during the early postoperative period?

PURPOSE: Purpose of this study is to investigate the quality of life (QoL) in patients with end-stage renal disease who underwent open or robot-assisted kidney transplantation (OKT and RAKT). MATERIALS AND METHODS: Patients who underwent OKT and RAKT at Bakirkoy Sadi Konuk Training and Research Hospital between June 2016 and December 2018 constituted the target population of this study. The patient group was divided into two groups as per the surgical technique (ie, open vs. robot-assisted). Demographic data, preoperative and postoperative data of all patients were collected prospectively. The QoL of the patients was assessed preoperatively and on the postoperative 30th day. RESULTS: Sixty-seven patients who underwent OKT and 60 patients who underwent RAKT were included. The mean patient age and BMI were calculated as 40.9 ± 11.6 years and 24.4 ± 2.9 kg/m2 , respectively. Patients in the RAKT group were significantly younger than the patients in the OKT group (P = .002). There were no significant differences between the two groups in terms of gender, BMI, ASA and the ratio of premptive patients. The mean preoperative hemoglobin level was significantly higher in the OKT group than the RAKT group (P = .003). While mean total ischemia time was shorter in the "open" group, intraoperative blood loss and incision length were shorter in the RAKT group. Duration of surgical drainage and hospital stay was shorter in the "robot-assisted" group. There was no significant difference between the groups in terms of SF-36 subparameters preoperatively. The physical component scores of the QoL questionnaire revealed that postoperative impairment of quality of life in the early postoperative period was more significant in the OKT than the RAKT. CONCLUSION: Patients who underwent RAKT have a higher QoL than the patients who were treated with OKT as per their self-reported QoL scores in the early postoperative period.

Does the duration between urine culture and percutaneous nephrolithotomy affect the rate of systemic inflammatory response syndrome postoperatively?

This study aimed to evaluate the preoperative and intraoperative factors that may cause systemic inflammatory response syndrome (SIRS) after percutaneous nephrolithotomy (PCNL) and to investigate the effect of the duration between urine culture (UC) and operation on postoperative SIRS. Three hundred and fifty-six patients who had PCNL between January 2015 and June 2019 were retrospectively included in the study. UC was obtained from all patients before the operation and during the puncture at the beginning of the operation. Postoperatively, patients were closely monitored for fever and other signs of SIRS. The post-PCNL SIRS incidence was 7%. In univariable and multivariable analyses, the rate of ipsilateral PCNL history, recurrent urinary tract infection (UTI) history, operation time and the length of hospital stay were significant predictive factors for SIRS. The duration between UC and PCNL was not a statistically significant variable in both univariable and multivariable analysis. Our study concluded that the duration between UC and PCNL is not an influential factor for post-PCNL SIRS. Clarifying this issue may be possible with prospective studies in which the effects of factors such as ipsilateral PCNL history and recurrent urinary tract infection history which has been proven to be risk factors for post-PCNL SIRS are restricted.

Incidence of ureteral stricture after ureterorenoscopic pneumatic lithotripsy for distal ureteral calculi.

BACKGROUND AND PURPOSE: We investigated the incidence of ureteral stricture in patients treated with ureterorenoscopic pneumatic lithotripsy for distal ureteral calculi. PATIENT AND METHODS: Between April 2006 and January 2009, 154 patients requiring ureterorenoscopic pneumatic lithotripsy for distal ureteral calculi were enrolled into the study. We evaluated the stone size, impaction of a stone, the need for ureteral orifice dilatation and the need for application of double-J stent. RESULTS: A total of 154 patients underwent URS-PL for ureteral calculi. Mean calculi diameter was 12.17 +/- 2.54 (range: 5-20 mm). Stone free rates after the first URS-PL operation were 97.4% of patients. In 2 patients (1.29%), ureteral perforation occurred as an early complication. We observed deep mucosal injury in 9 patients (5.84%). Partial stricture (partial obstruction) was observed in 9 patients (5.84%). Of 9 patients who had an ureteral stricture postoperatively, 7 patients had ureteral calculi > or = 10 mm, 2 patients had calculi < 10 mm. We observed ureteral stricture in 2 (8.69%) out of 23 patients who had calculi < 10 mm, and in 7 (5.34%) out of 131 patients who had calculi > or = 10 mm (p > 0.05). Ureteral stricture was observed in 2 (13.33%) out of 15 patients who had impacted calculi, and in 7 (5.03%) out of 139 patients who did not have impacted calculi (p < 0.05). We observed ureteral stricture in 3 (6.25%) out of 48 patients who required ureteral dilatation, and in 6 (5.66%) out of 106 patients who did not require ureteral dilatation (p > 0.05). Ureteral stricture was observed in 6 (15%) out of 40 patients who required ureteral double-J catheter placement, and in 3 (2.63%) out of 114 patients who did not require ureteral double-J catheter placement (p < 0.05). CONCLUSION: The results of our study have demonstrated that the success rate was not related to the stone dimension, but the time of operation was found to be increased with larger stones. Main risk factors for formation of ureteral stricture were impacted ureteral calculi and reasons which merits double-J catheter placement like mucosal damage, perforation, impacted calculi and high stone burden.

Effectiveness of acupuncture in patients with category IIIB chronic pelvic pain syndrome: a report of 97 patients.

OBJECTIVE: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is of significant interest in urology and unfortunately, the therapy modalities recommended are not fully effective. Therefore, we undertook a pilot study to determine whether acupuncture improves the pain, voiding symptoms, and quality of life in men with category IIIB CP/CPPS. DESIGN: Prospective, one-group trial, cohort study. SETTING: Outpatient urology clinic. PATIENTS AND INTERVENTIONS: Ninety-seven CP/CPPS patients received six sessions of acupuncture to the BL-33 acupoints once a week. The National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI) was completed by each patient before and after the treatment and on 12th and 24th weeks following the treatment. OUTCOME MEASURES: Mean values of total CPSI score, pain subscore, urinary subscore, and quality of life subscore after the treatment and on follow-up after the treatment were compared with the baseline values. RESULTS: There was a statistically significant decrease in all of the subscores evaluated at all periods compared with the baseline. Eighty-six patients out of 93 (92.47%) were NIH-CPSI responders (more than 50% decrease in total NIH-CPSI score from baseline) at the end of the treatment. CONCLUSIONS: The results of this study suggest that acupuncture appears to be a safe and potentially effective treatment in improving the symptoms and quality of life of men clinically diagnosed with CP/CPPS.

Quantification of PSA mRNA levels in peripheral blood of patients with localized prostate adenocarcinoma before, during, and after radical prostatectomy by quantitative real-time PCR (qRT-PCR).

OBJECTIVE: To evaluate the clinical value of detected prostate-specific antigen (PSA) mRNA expression levels in circulating cells in patients with prostate cancer by quantitative real-time polymerase chain reaction (qRT-PCR) and to determine the effect of surgical manipulation on hematogenous dissemination. METHODS: Blood samples before, during, and after (24 h) surgery were obtained from 34 patients with prostate cancer who underwent radical prostatectomy for detecting PSA mRNA expression levels. PSA mRNA expression levels, PSA levels, and Gleason scores were then compared. RESULTS: PSA mRNA expression levels were detected in 14 of 34 (41%) patients, and biochemical recurrence of blood PSA was observed in 6 of 34 (17%) patients. Differences of PSA mRNA expression levels in pre-, per-, and postoperative periods were statistically significant (P < 0.001) and differences of PSA mRNA expression levels in pre- and peroperative samples (P < 0.008), pre- and postoperative samples (P < 0.031), and per- and postoperative samples (P < 0.001) were also statistically meaningful. There was significant relationship between the detectable PSA mRNA expression levels in preoperative samples and biochemical recurrence of blood PSA levels. We demonstrated that surgical manipulation had no effect on biochemical recurrence of blood PSA. We also showed that there was significant correlation between high Gleason score and the detectable PSA mRNA expression levels (P < 0.027). CONCLUSIONS: Our results suggest that highly detectable PSA mRNA expression levels in preoperative samples seem to be a significant predictable factor for prostate cancer recurrence.