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BACKGROUND: Robot-Assisted Radical Prostatectomy (RARP) is increasingly becoming the standard surgical treatment for prostate cancer. While some risk factors for postoperative complications of RARP have been identified, no scoring model that incorporates both preoperative physical status of the patient and intraoperative risk factors has been developed. The Estimation of Physiologic Ability and Surgical Stress (E-PASS) score was initially described to predict postoperative complications after gastrointestinal surgical procedures. This study aims to assess the effectiveness of the E-PASS score in predicting postoperative complications of RARP. METHODS: A retrospective evaluation was conducted on 204 patients who underwent RARP between 2019 and 2022. Demographic data, parameters indicating patients' preoperative physical condition, and intraoperative risk factors were analyzed. The E-PASS score and subscores were calculated for each patient. RESULTS: Of the patients, 164 (80.4%) were discharged without any postoperative complications (Group 1), and 40 (19.6%) experienced various degrees of complications (Group 2). Patients in Group 2 had higher rates of previous abdominal surgery, elevated Eastern Cooperative Oncology Group (ECOG) performance scores, longer surgical durations, and higher E-PASS scores. To assess the effectiveness of the Comprehensive Risk Score (CRS) as a predictive factor for postoperative complications, a receiver operating characteristic (ROC) curve was constructed with a 95% confidence interval (CI), and a cut-off value was established. The cut-off value for CRS was determined to be -0.0345 (area under the curve [AUC]=0.783, CI: 0.713-0.853; p<0.001). Patients with a CRS higher than the cut-off value had a 16.4 times higher rate of postoperative complications after RARP (95% CI: 5.58-48.5). CONCLUSION: The E-PASS scoring model successfully predicts postoperative complications in patients undergoing RARP by using preoperative data about the physical status of the patient and surgical risk factors. The E-PASS score and its subscores could be utilized as objective criteria to determine the risk of postoperative complications before and immediately after surgery.
Subject(s)
Postoperative Complications , Prostatectomy , Prostatic Neoplasms , Robotic Surgical Procedures , Humans , Prostatectomy/methods , Prostatectomy/adverse effects , Male , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Retrospective Studies , Middle Aged , Robotic Surgical Procedures/adverse effects , Aged , Prostatic Neoplasms/surgery , Risk Factors , Risk Assessment/methods , Predictive Value of Tests , ROC CurveABSTRACT
Aim: Differentiating granulomas from cancerous tissue poses a significant challenge in upper urinary tract surgery. We present the case of a 62-year-old male with a gelatin-based matrix (SurgifloTM) granuloma in the kidney following renal cyst decortication eight years earlier.Methods: Contrast-enhanced abdominal tomography revealed a Bosniak type-4 cyst at the previous operation site. The patient underwent laparoscopic partial nephrectomy with near-infrared imaging.Results: The lesion presented as hypofluorescent relative to normal kidney tissue. Histopathological examination revealed a foreign body granuloma due to unabsorbed Surgiflo.Conclusion: The fluorescence pattern could not distinguish a Surgiflo granuloma from a malignant lesion of the kidney.
Subject(s)
Kidney Neoplasms , Laparoscopy , Male , Humans , Middle Aged , Gelatin , Kidney/diagnostic imaging , Kidney/surgery , Kidney Neoplasms/diagnostic imaging , Kidney Neoplasms/surgery , Nephrectomy/methods , Laparoscopy/methods , Granuloma/pathology , Granuloma/surgeryABSTRACT
Objective: This study aimed to determine whether the Mayo adhesive probability (MAP) score could predict perioperative outcomes in transperitoneal laparoscopic total adrenalectomy (LTA) and laparoscopic partial adrenalectomy (LPA). Materials and Methods: The clinical data of 139 patients who underwent transperitoneal LTA (n = 116) or LPA (n = 23) between March 2013 and September 2022 were retrospectively analyzed. According to the images obtained from preoperative contrast-enhanced computed tomography or magnetic resonance imaging, the patients were divided into two groups: the low MAP score group (0-1 points) and the high MAP score group (2-5 points). General clinical features and perioperative outcomes were compared between the groups. Results: In patients with a high MAP score, the mean body mass index (BMI) (p: 0.005), tumor size (p: 0.005), operative time (p: 0.002), estimated blood loss (EBL) (p: 0.001), and complication rate (p: 0.013) were significantly higher compared with those with a low MAP score. The comparison of the patients between the LTA and LPA subgroups revealed that operative time and EBL were significantly higher in both subgroups among the patients with a high MAP score. Moreover, the complication rate in the LTA subgroup was significantly higher in the high MAP score group compared with the other group. The Multivariate analyses revealed that a high MAP score was a risk factor for prolonged operative time (Odds Ratio [OR]: 3.081, 95% Confidence Interval [CI]: 1.284-7.398, p: 0.012), increased EBL (OR: 2.495, 95% CI: 1.114-5.588, p: 0.026), and complications (OR: 6.085, 95% CI: 1.532-24.171, p: 0.01) Conclusions: Patients with a high MAP score had a prolonged operative time, increased EBL, and a higher complication rate compared with those with a low MAP score. In addition, we found that a high MAP score was an independent risk factor for perioperative parameters and complications in patients who underwent LTA and LPA.
Subject(s)
Adrenalectomy , Laparoscopy , Humans , Adrenalectomy/adverse effects , Retrospective Studies , Odds Ratio , Risk FactorsABSTRACT
OBJECTIVE: Urethral stricture is characterized by fibrosis that decreases urine flow. Metabolic syndrome is a complex disorder that causes fibrosis in many organs. This study aimed to evaluate the relationship between metabolic syndrome and appearance of urethral stricture and effects of metabolic syndrome on the recurrence of urethral stricture in patients with primary urethral stricture who underwent direct visual internal urethrotomy. MATERIALS AND METHODS: One hundred thirty-two male patients who underwent direct visual internal urethrotomy between 2014 and 2021 because of primary urethral stricture were included. Location, length, and type of urethral stricture, time from diagnosis to surgery, postoperative follow-up, time from surgery to recurrence, and postoperative follow-up duration with a urethral catheter were retrospectively analyzed and association with metabolic syndrome was evaluated. RESULTS: The mean age was 50.48 ± 17.94 years. Recurrence was found in 34.1% and metabolic syndrome in 27.3%. Postoperative follow-up duration was significantly longer in patients with recurrence than in those without (P=.033). There was no statistically significant difference in terms of metabolic syndrome and postoperative urethral catheterization between patients with and without recurrence (P=.126, P=.714, respectively). Postoperative clean intermittent self-catheterization use was found to be statistically higher in patients with recurrence than in patients without recurrence (P=.018). Postoperative urinary tract infection rate was found to be significantly higher in patients with metabolic syndrome compared to patients without metabolic syndrome (P=.001). CONCLUSION: Metabolic syndrome was not associated with recurrence. However, postoperative urinary tract infections were more common in patients with metabolic syndrome than in patients without. Clean intermittent self-catheterization used postoperatively may increase the risk of stricture.
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BACKGROUND: In this study, we aimed to determine the most appropriate antimicrobial agents for prophylactic antibiotic use during emergency and elective transurethral procedures. METHODS: The study was conducted in five hospitals located in five different geographical regions of Türkiye. The microorganism cultured in urine before emergency and elective transurethral procedures in these centers between March 2021 and March 2022 were reviewed retrospectively from the hospital records. Demographic data (age and gender) of the patients, comorbid disorders, previous urological procedures, anomalies of the urogenital tract, use of urethral catheters (permanent or clean intermittent catheterization), cultured microorganisms, and antibiotic susceptibilities were noted. The patients hospitalized or had antibiotics for any reason in the previous 1 month were excluded from the study. RESULTS: A total of 1450 patients, 742 men (51.2%) and 708 women (48.8%), were included in the study. The mean age of the patients was 55.3±19.36 (1-98) years. Diabetes mellitus was evident in 271 (18.7%) patients. The five most common microorgan-isms cultured in urine, in order of frequency, were: ESBL (-) Escherichia coli in 418 (28.8%), ESBL (+) E. coli in 309 (21.3%), Klebsiella pneumonia in 183 (12.6%), Enterococcus faecalis in 124 (8.6%), and Pseudomonas aeruginosa in 89 (6.1%). The susceptibility rates to antimicrobial agents recommended for prophylaxis by the American Urology Association and the European Association of Urology guidelines were found as follows: cefepime 87.1%, ampicillin+sulbactam 84%, TMP-SMX 71.6%, amoxicillin+clavulanate 63.5%, cefoxitin 59%, ceftazidime 58.6%, cefuroxime 43.5%, ceftriaxone 43%, and cefixime 38.4%. CONCLUSION: We found that currently recommended antimicrobials provide poor coverage for the most common pathogens isolated. Urologists should consider patient-based antibiotic prophylaxis in endoscopic urethral procedures, follow appropriate proto-cols, and consider local antibiotic resistance.
Subject(s)
Anti-Infective Agents , Escherichia coli , Male , Humans , Female , Adult , Middle Aged , Aged , Retrospective Studies , Anti-Bacterial Agents/therapeutic use , Trimethoprim, Sulfamethoxazole Drug CombinationABSTRACT
PURPOSE: Fournier's Gangrene (FG) is a fatal condition, therefore prognosis prediction is a crucial step before treatment planning. We aimed to investigate the predictive value of Hemoglobin, Albumin, Lymphocyte and Platelet (HALP) score which is frequently employed in vascular disorders and malignancies, on disease severity and survival in FG patients and to compare HALP score with well-known scoring systems on this aspect. MATERIALS AND METHODS: Eighty-seven men who had surgical debridement for FG between December 2006 and January 2022 were included in this study. Their symptoms, physical examination findings, laboratory tests, medical histories, vital signs, extent and timing of the surgical debridement and antimicrobial therapies were noted. The HALP score, Age-adjusted Charlson Comorbidity Index (ACCI) and Fournier's Gangrene Severity Index (FGSI) were evaluated for their predictive values for survival. RESULTS: FG patients were grouped as survivors (Group 1, n = 71) and non-survivors (Group 2, n = 16) and the results were compared. The mean ages of survivors (59 ± 12.55 years) and non-survivors (64.5 ± 14.6 years) were similar (p = 0.114). The median size of necrotized body surface area was 3% in Group 1 and 4.8% in Group 2 (p = 0.013). On admission, hemoglobin, albumin and serum urea levels and white blood cell counts were significantly different in two study groups. Two study groups were similar for HALP scores. However, ACCI and FGSI scores were greater significantly in non-survivors. CONCLUSIONS: Our results indicated that HALP score does not predict a survival successfully in FG. However, FGSI and ACCI are successful outcome predictors in FG.
Subject(s)
Fournier Gangrene , Male , Humans , Middle Aged , Aged , Fournier Gangrene/therapy , Fournier Gangrene/surgery , Prognosis , Severity of Illness Index , Hemoglobins , Albumins , Lymphocytes , Retrospective StudiesABSTRACT
Objective: To investigate the effect of the diameter of ureteral access sheath (UAS) used during retrograde intrarenal surgery (RIRS) on operative parameters, perioperative ureteral injury, and ureteral stricture development. Materials and Methods: The study was designed as a prospective randomized controlled trial and included 320 patients who underwent RIRS. The patients were divided into two groups according to the diameter of UAS (9.5F/11.5F [Group 1] and 12F/14F [Group 2]) placed during the operation. At the end of the operation, ureteral injury was checked visually using semirigid ureterorenoscopy and classified according to the ureter injury scale. In the postoperative first year, the control CT urography images were used to observe newly developing ureteral dilatation. Results: There was no statistical difference between the two groups in terms of patient and stone characteristics, operative time, postoperative stone-free rate, and postoperative infection development parameters. In Group 1, 30 (18.8%) of the patients had low-grade and 8 (5%) of the patients had high-grade ureteral injury, while in Group 2, 44 (27.5%) had low-grade and 19 (11.9%) had high-grade ureteral injury (p = 0.013). In the postoperative period, ureteral stricture was found in 5 (1.6%) patients, of whom 4 (2.5%) were in Group 2 and 1 (0.6%) (p = 0.371). Conclusion: The results of our study showed that the use of a 12F/14F UAS in patients who are not previously stented increases the risk of high-grade ureteral injuries; however, despite this increase there is no difference in ureteral stricture formation.
Subject(s)
Kidney Calculi , Ureter , Ureteral Obstruction , Constriction, Pathologic/etiology , Humans , Kidney Calculi/surgery , Postoperative Complications/etiology , Postoperative Period , Prospective Studies , Treatment Outcome , Ureter/injuries , Ureter/surgery , Ureteral Obstruction/etiology , Ureteral Obstruction/surgery , Ureteroscopy/adverse effects , Ureteroscopy/methodsABSTRACT
The study aimed to investigate the best-performing of three risk calculators (RCs) for the Turkish population in predicting cancer-free status and high-risk prostate cancer (PCa) in patients undergoing transrectal ultrasound-guided prostate biopsy. The electronic medical records of 527 patients who underwent prostate biopsy for the first time due to PSA of 0.3-50 ng/dl and/or cancer suspicion at digital rectal examination (DRE) between January 2017 and December 2020 were retrieved retrospectively. The predictive power of the RCs in the biopsy and the surgical cohort was calculated by two urologists using European Randomised Study of Screening for Prostate Cancer (ERSPC) RC, the North American Prostate Cancer Prevention Trial-RC (PCPT-RC), and the Prostate Biopsy Collaborative Group (PBCG)-RC. All three RCs were successful in predicting PCa and high-risk disease at ROC analysis (p < 0.0001). Of these three nomograms, PBCG-RC outperformed PCPT-RC 2.0 and ERSPC-RH in predicting benign pathology outcomes at biopsy. A better performance of PBCG-RC was also observed in terms of prediction of high-risk disease at biopsy. Using any of the available RCs prior to biopsy is of greater assistance to prostate-specific antigen and DRE than examination alone. The study results show that PBCG-RC performed before biopsy has a higher predictive power than the other two RCs.
Subject(s)
Prostatic Neoplasms , Risk Assessment , Biopsy , Cohort Studies , Humans , Male , Prostate-Specific Antigen , Prostatic Neoplasms/diagnosis , Randomized Controlled Trials as Topic , Reproducibility of Results , Retrospective Studies , Risk Assessment/methodsABSTRACT
BACKGROUND: A novel infection, COVID-19, emerged in China and soon became a global pandemic. Pandemic conditions have resulted in stress in the workplace and led to anxiety among healthcare workers (HCWs), having negative impacts on different aspects of their lives, including their sexual function. AIM: To evaluate the changes in the anxiety status of HCWs during the COVID-19 pandemic and the impact of anxiety on their sexual functions. METHODS: This is a longitudinal study based on an online survey conducted from April 2020 to February 2021 in hospitals designated as pandemic healthcare centers. An online survey link was sent to HCWs that provided consent for participation in the study. The anxiety status of the participants was assessed using the State Anxiety Inventory, and sexual function was evaluated using the International Index of Erectile Function-15 for men and Female Sexual Function Index for women. OUTCOMES: Scores obtained at the beginning of the pandemic were compared with those obtained at 6 months into the pandemic to determine the changes in the anxiety levels and sexual functions of the HCWs. RESULTS: A total of 399 HCWs participated in the survey, and the median age was 32 (20-60) years. Compared to the beginning of the pandemic, there was a significant increase in the State Anxiety Inventory score of the female and male HCWs at the sixth month of the pandemic. Among the women, the mean total Female Sexual Function Index score was 23.55 ± 8.69 at the beginning of the pandemic and 21.42 ± 8.91 at the sixth month, and there was a significant decrease in all parameters except pain. Among the men, the International Index of Erectile Function-15 total score was 62.75 ± 12.51 at the beginning of the pandemic and 55.1 ± 12.87 at the sixth month, indicating a significant decrease in all parameters. CLINICAL IMPLICATIONS: Considering that the pandemic will continue for a long time, more psychological support should be provided, and interventions should be made to protect the mental health of HCWs. STRENGTHS & LIMITATIONS: The strength of the study is that it had a fairly high number of participants across several institutions. However, being conducted in one country and the sample not being randomly selected and being based on voluntariness can be considered as limitations. CONCLUSION: Our results show that the COVID-19 pandemic has led to an increase in the anxiety levels of both female and male HCWs, and this situation has negatively affected their sexual functions. Eroglu U, Balci M, Coser S, et al, Impact of the COVID-19 Pandemic on the Psychosexual Functions of Healthcare Workers. J Sex Med 2022;19:182-187.
Subject(s)
COVID-19 , Pandemics , Adult , Anxiety/epidemiology , Female , Health Personnel , Humans , Longitudinal Studies , Male , SARS-CoV-2ABSTRACT
INTRODUCTION: In the present study, we prospectively investigated the impact of endoscopic transnasal trans-sphenoidal surgery (ETTS) on sexual function in male and female patients with pituitary adenoma. METHODS: The study included a total of 40 consecutive patients (male, n = 28 and female, n = 12) aged 22-65 years, who underwent ETTS for pituitary adenoma in our center between March 2019 and August 2019. Twenty-seven (67.5%) and 13 (32.5%) patients had functioning and nonfunctioning pituitary adenomas, respectively. Routine preoperative hormone levels were obtained in every patient. The tests were repeated at the postoperative third month. Preoperatively and at the postoperative third month, the 5-item version of the International Index of Erectile Function and the Female Sexual Function Index (FSFI) was used in male and female patients, respectively. RESULTS: Before surgery, 24 (85.7%) men had erectile dysfunction (ED), and 10 (83%) women had female sexual dysfunction. After surgery, all the patients' abnormal hormone parameters improved. All the male patients' ED degrees were positively affected by surgery. In women, the FSFI was significantly better than in the preoperative period. DISCUSSION/CONCLUSION: Our results showed that both males and females with pituitary adenomas benefitted from minimally invasive pituitary surgery in terms of a high-remission rate and improvement in sexual dysfunction.
Subject(s)
Adenoma/surgery , Endoscopy , Neurosurgical Procedures , Pituitary Neoplasms/surgery , Sexual Behavior , Sexual Dysfunction, Physiological/etiology , Sexual Dysfunctions, Psychological/etiology , Adenoma/complications , Adenoma/diagnosis , Adult , Female , Humans , Male , Middle Aged , Pituitary Neoplasms/complications , Pituitary Neoplasms/diagnosis , Prospective Studies , Recovery of Function , Sexual Dysfunction, Physiological/diagnosis , Sexual Dysfunction, Physiological/physiopathology , Sexual Dysfunctions, Psychological/diagnosis , Sexual Dysfunctions, Psychological/psychology , Time Factors , Treatment Outcome , Young AdultABSTRACT
AIM: In this study, we aimed to evaluate the anxiety and depression status of prostate cancer (PCa) patients whose planned operations in the urology clinic of our hospital, which is serving as a pandemic hospital in Turkey have been postponed because of the coronavirus disease 2019 pandemic. METHODS: This survey study was conducted at urology clinic of Ankara City Hospital between March 1 and June 1, 2020, and included 24 male patients who agreed to answer the questionnaires (State-Trait Anxiety Inventory [STAI] I and II and Beck Depression Inventory [BDI]). Demographical and clinical data (age, time since diagnosis, total serum prostate-specific antigen (PSA) levels, risk groups according to the D'Amico classification system, smoking, alcohol habitus, major surgical history and comorbidities) of the patients were collected from hospital software. RESULTS: The mean STAI-I score of the patients (46.7 ± 1.4 [44-49]) was significantly higher than their STAI-II score (41.7 ± 2.4 [39-47]) (P < .001). The negative correlation between the decrease in age and STAI-I score was found to be statistically significant (r = 0.439, P < .05). The mean BDI score of the patients was 4.3 ± 3.2 (0-13), which was compatible with mild depression. There was no statistically significant difference among the time elapsed from diagnosis, PSA levels, smoking and alcohol habitus, major surgical history and comorbidity status and STAI-I, STAI-II and BDI scores (P > .05). CONCLUSION: Prostate cancer patients with postponed operations should be guided properly in order to manage their anxiety status especially young patients.