What Has Changed in the History of Fournier's Gangrene Treatment: The Single-Center Experience.

Objectives: Fournier's gangrene (FG) is a rapidly progressive infection that requires emergent intervention. Wound closure is an important treatment step after surgery, and vacuum-assisted closure (VAC) can be preferred as an alternative method for wound closure. FG severity index (FGSI) scales that can be developed to evaluate the prognosis in FG. This study aims to compare VAC therapy, which was used and developed in the historical development of FG therapy, with conventional wound dressing (CWD). Methods: Data on who 85 patients treated at our hospital with a diagnosis of FG from January 2010 to July 2021. In the VAC group, the vacuum device was applied in a sealed manner. In the CWD group, mesh dressing was prepared. The VAC device was adjusted to subatmospheric pressure. Broad-spectrum antibiotics were administered to all patients during their follow-up. During the follow-up, as necrotic tissues were detected, redebridements were performed by providing appropriate analgesia and anesthesia. Demographic data of the patients were collected on the records. The clinical and laboratory data were obtained from the records at the 1st h, 72 h, and 1st week FSGI values were calculated. In statistical analysis, continuous variables were expressed as mean±standard deviation, ordinal variables were expressed as median [IQR], and categorical variables were expressed as n (%). In intergroup analyses, student's t-test was used if the data were normally distributed. If it did not show normal distribution, the Mann-Whitney U-test was applied. Results: Fifty-five patients who were diagnosed with FG were included in our study. CWD was applied to 18 patients, and VAC was applied to 37 patients. The mean 1st h FGSI of the patients who used VAC was 7.05 (3.75-8), and the patients who had CWD were 5.5 (5-9) (p=0.067). Mean 72nd-h FGSI was found to be 5.35 (3.5-7) in the VAC group and 5.33 (4.75-6.25) in the CWD group (p=0.714). The mean 1st-week FGSI VAC group was 2.97 (1-5), and in the CWD group, it was 5 (4-6) (p=0.0001). Conclusion: VAC significantly reduces the length of hospital stay. In our analysis, both groups observed a significant difference between the 1st-week FGSIs. This is the first study to evaluate FGSI, which is an essential predictor of the effect of VAC therapy used in treating FG. In the history of FG treatment, CWD has been replaced by VAC.

Sexual intercourse before exercise has a detrimental effect on lower extremity muscle strength in men.

INTRODUCTION: The question of whether sexual intercourse can harm athletic performance is a long-debated topic since first sport competitions were invented. Therefore, due to the lack of solid evidence, we aimed to evaluate the effects of sexual intercourse on muscle training performance. MATERIALS AND METHODS: Physically and sexually active, 50 men (age=29.3±1.14 years) were enrolled in the study. Participants completed three weight training sessions and all sessions were at the same time of the day. The maximum weight was adjusted in the first session. In the second and third sessions, they performed five repetitions of the squat with their maximum weight for each set with a total of five sets after participating in and abstaining from sexual intercourse the night before, respectively. The duration of sexual intercourse was measured with a stopwatch. RESULTS: The mean duration of sex was measured to be 13.8±3.61 min. Furthermore, the mean lifted weight before sex was calculated to be 109.4±11.41 kg and the mean lifted weight after sex was calculated to be 107±11.05 kg. According to obtained data, sexual intercourse has a significant detrimental effect on maximum weight in squat training (p=0001). CONCLUSION: Results demonstrate that sexual intercourse within 24 hours before exercise have detrimental effect on lower extremity muscle force, which suggests that restricting sexual activity before a short-term activity may be necessary.

Failure of ureteral access sheath insertion in primary flexible ureteroscopy for renal stones: is there any relation with inflammation?

PURPOSE: To investigate the relationship between failure to insert a ureteral access sheath (UAS) with inflammation and other clinical parameters in patients treated with flexible ureteroscopy for renal stones. METHODS: This study included patients who underwent flexible ureteroscopy for the treatment of renal stones in our centre between 2015 and 2020. Patients who underwent any surgical procedure on the ipsilateral ureter and had a history of spontaneous stone passage were excluded. Patients were divided into two groups based on UAS insertion success (group 1) or failure (group 2). Both groups were compared with a view to clinical characteristics, preoperative neutrophil, lymphocyte, monocyte and platelet counts and ratios of these counts, all being considered inflammatory markers. A multivariate logistic regression analysis was performed to determine the independent variables affecting UAS insertion success. RESULTS: There were 113 (59.1%) patients in group 1, while group 2 consisted of 78 (40.9%) patients. The rates of male gender, coronary artery disease and preoperative ipsilateral hydronephrosis were significantly higher in group 2, while platelet counts and platelet-lymphocyte ratios were significantly lower. Our analysis revealed four independent predictors for UAS insertion failure: female gender (odds ratio [OR]=2.1) increased the rate of UAS insertion success, while hydronephrosis (OR=1.6), low platelet counts and PLR increased the rate of UAS insertion failure (OR=0.99, OR=0.98, respectively). CONCLUSION: Our results suggest that male gender and ipsilateral hydronephrosis are associated with increased UAS insertion failure. Although we found a relationship between relatively low platelet levels and UAS insertion failure, we think that further studies are needed to investigate this matter.

The impact of the pelvicalyceal anatomy characteristics on the prediction of flexible ureteroscopy outcomes.

BACKGROUND: The anatomical architecture is a prominent factor in the outcomes of flexible ureteroscopy (FURS). AIMS AND OBJECTIVES: The aim to regard the success of procedures based on Pelvicalyceal body that called Sampaio classification system. MATERIALS AND METHODS: A total of 125 FURS procedures were reviewed between December 2012 and December 2016 in our department. Seven patients were excluded from the study due to the horseshoe kidney in two cases and recurrent cystine stone configuration in five patients. The patient's renal collecting system anatomy characteristics are regarded, and they are classified into four main groups based on the mid-renal-zone anatomy assessed according to Sampaio Classification. RESULTS: Total stone-free rate (SFR) during the postoperative 1st-month evaluation was noncontrast computerized tomography 75 (63.6%). The evaluation of the SFR in all subgroup of cases based on Sampaio classification noticed easily, SFR was significantly lower in subgroup A2 (30.4%) (P = 0.00), significantly higher in subgroup B2 (P = 0.008). The comparative analysis of the operative duration defined that it was the shortest (75.3 ± 18.1 min) in Type B1 subgroup cases, and the longest (84.7 ± 25.7 min) in the Type A2 subgroup cases. Even though this duration was found to be relatively higher in Type A2 subgroup cases than the others, this difference was not statistically significant (P = 0.271). Fluoroscopy time was noted to be the shortest (11.9 ± 13.4 s) in B1 subgroup and the longest in A2 subgroup with a statistically significant different (median: 21.3 ± 30.4) (P = 0.04). While 6 (5.1%) cases had Clavien 2 and 3 (2.5%) cases, demonstrated Clavien 3a complications. CONCLUSION: The calyceal structure of the kidney affects the SFR; therefore, a detailed classification of pelvicalyceal could improve the outcomes, decrease the rate of auxiliary procedures and prevent the complications.

The role of preoperative ultrasound in the diagnosis of penile fractures and the effect of tunica defect length on postoperative functional outcomes.

PURPOSE: This study aimed to investigate the rate of tunica defect detection by postoperative penile ultrasound (US) and the effect of tunica defect length (TDL) on functional outcomes. METHODS: Forty-six patients who underwent early penile fracture surgery in our hospital between July 2010 and December 2018 were included in the study. Each diagnosis was made via history, physical examination and US. Functional outcomes were assessed at 3, 6 and 12 months postoperatively. The International Index of Erectile Function-5 (IIEF-5) score was used to assess erectile function. US detection rates for tunica defects, as well as whether the rates changed according to TDL, were also analysed. The TDL cut-off value for US detection was determined to be 11 mm using the receiver operating characteristic curve. The impact of TDL on functional outcomes was also evaluated using this cut-off value. RESULTS: The main cause of fractures in 34 patients (74%) was sexual intercourse. One patient (2.2%) had penile curvature, and 16 (34.8%) had penile nodules in the follow-ups. US had a higher detection rate in the group with TDL >11mm (94% vs 25%). IIEF-5 scores at the postoperative third month were statistically lower in patients with TDL >11mm (n = 34) compared with those with ≤11 mm (n = 12). The rate of penile nodules was found to be statistically higher in the group with TDL >11mm at the end of the 1-year follow-up period (44.1% vs 8.3%). CONCLUSIONS: US is a valuable tool for the detection of tunica defects especially with >11mm length. In addition, TDL >11 mm in penile fractures is associated with lower IIEF-5 scores in the early postoperative period and higher rates of penile nodules.

Hydrocele accompanying testicular cavernous hemangioma: A infant case report.

Testicular hemangioma is a rare benign testicular tumor. In this case we presented who an infant applied to our clinic with left scrotal swelling. The tests performed were found to be compatible with testicular hemangioma and accompanying hydrocele. We performed inguinal exploration due to hydrocele accompanying testicular hemangioma. Pathology of tissue was found to be compatible with testicular cavernous hemangioma. In our investigations, it was seen that it was the first infant cavernous hemangioma in the literature.

Regression of the Sweet's syndrome after Bacillus Calmette-Guérin therapy: A bladder cancer case report.

The Sweet's syndrome is a rare dermatosis which can be related to underlying malignancies. In this case we presented a case, who applied to our clinic with severe dermatosis and hematuria. We diagnosed high grade non-muscle invasive bladder tumor, which was treated with transurethral resection of bladder-tumor and six cycle of Bacillus Calmette-Guérin therapy. After the treatment the dermatosis was regressed almost completely. However, recurrent bladder tumor was detected at the first control cystoscopy.

The correlation between atherogenic indexes and erectile dysfunction.

Aside from the ordinary plasma lipid level measurements, the ratios based on individual plasma lipid levels such as atherogenic index of plasma (AIP), Castelli's risk index 1/2 (CRI-1/2), and atherogenic coefficient (AC) are the novel parameters to evaluate the patients with a high risk of CVD. In this study, we aim to evaluate the relationship between AIP, AC, and CRI-1/2 with increased risk of ED. Between April 2018 and February 2019, 253 patients, who were diagnosed as a vasculogenic ED in our clinic, were enrolled in the study. While the first group (n = 134) consisted of patients with moderate and mild ED (IIEF-EF: 17-30), the second group (n = 119) consisted of patients with severe ED. In addition to the mean values of lipid parameters; CRI-1 (total cholesterol/HDL), CRI-2 (LDL/HDL) AIP (log10(triglycerides/HDL), and AC (non-HDL/HDL) were calculated. The mean age was 44.02 ± 10.41 (24-70), and the mean BMI was 27.80 ± 4.12 (18.52 ± 41.97). However, CRI-1 and AIP values were found to be higher in the severe ED group compared to the mild ED group (CRI-1: 4.50 ± 1.47, 4.88 ± 1.30; p = .039; AIP: 0.489 ± 0.315, 0.617 ± 0.283; p = .007). Our results demonstrated that CR-1 and AIP have a positive correlation with the severity of ED. Moreover, we can suggest that patients with higher CR-1 and AIP values are likely to have more severe ED in the future.

Sarcoidosis is a rare cause of infertility: A case report.

In this paper, we presented a patient, who applied to our clinic because of infertility. After an intensive investigation, we diagnosed systemic sarcoidosis with testicular involvement. Urogenital sarcoidosis is a rare and insidious condition, however, it can lead to infertility. Therefore, following the diagnosis, we applied systemic steroid therapy to the patient. Within one year, the patient had a child without assisted reproductive techniques. According to our experience, in this case, we concluded that infertility without an etiology should be investigated elaborately. Furthermore, urogenital sarcoidosis should keep in mind as a rare etiology.

A purely penoscrotal approach: Reservoir placement of an inflatable penile prosthesis (IPP) in an orthotopic neobladder patient. Case report.

INTRODUCTION: The inflatable penile prosthesis (IPP) is the last step in drug-resistant erectile dysfunction treatment. IPP implantation can be challenging, especially following a cystoprostatectomy with an orthotopic neobladder. There is no consensus about surgical techniques for placement of an IPP reservoir in such patients. In this paper, we present a case of an IPP and reservoir placement with a single penoscrotal incision. CASE: A 55-year-old patient, who underwent radical cysto-prostatectomy with an orthotopic neobladder seven years ago, presented with severe erectile dysfunction. His oncologic status was stable, and he was in remission. He also had high blood pressure and took medication for it. He previously used different medical treatments, such as oral phosphodiesterase-5 inhibitors (PDE5i), intraurethral prostaglandin E2 (PGE2) installations, and Trimix injections. As far as we know, he had no benefit from these treatments. A three-piece IPP was recom- mended. After a discussion of surgical techniques, we chose the penoscrotal approach, and the ectopic reservoir was placed through the inguinal canal, guided by a forefinger. RESULTS: The total operative time was 60 minutes, and the estimated blood loss was minimal. There were no perioperative complications. The patient was discharged on postoperative day one. He could start to use the IPP in the first month. His sexual and urinary functions were normal, and there was no abdominal bulging from the ectopic reservoir at the three-month follow-up. CONCLUSIONS: In conclusion, ectopic placement of the reservoir through a single penoscrotal incision appears to be a safe and acceptable surgical technique for postoperative ED following a radical cystoprostatectomy with an orthotopic neobladder.

Plication without degloving - Safe and effective approach for correcting lateral and dorsal penile curvature: Case series.

Penile curvature deformities are often manageable with surgical reconstruction methods. We aimed to show the safety and efficacy of ventral and dorsal plication techniques without degloving in our two patients who have penile curvature. Two young adults, aged 20 and 23 years, presented to our clinic with lateral and dorsal penile curvatures. This problem has been sustaining since their teenage. Following the required preparations, two surgical techniques were used, namely Nesbit and Lue's "16-dot" technique. Patients completed a satisfaction survey at a mean of 6 months later the surgery. Although both patients reported a subjective decrease in penile length, their satisfaction rate was high. Penile plication without degloving is a safe and effective technique for correcting dorsal and lateral penile curvatures.

A rare malformation of urinary system: Right ectopic thoracic kidney.

An ectopic kidney is a common developmental anomaly of the urinary system. However, the thoracic kidney (TK) is the rarest state form of an aberrant kidney. The aim of this case report is defining the symptoms in TK diagnosis and constructing a treatment model will promote the best outcomes. These patients come to the physician with the various symptoms, and they could be diagnosed incidentally. In our case, we describe 40 years female patient with severe respiratory problems and upper back pain. In the pulmonary clinic, suspected mass was diagnosed with chest X-ray, and computerized tomography detected nontraumatic nonhernia associated, a truly ectopic TK. Moreover, the thoracic surgeon and urologist team decided to exploration and reconstructed the right ectopic kidney. The 1st month of the control of patient symptoms was disappeared. Overall, TK should be kept in mind in the differential diagnosis of thoracic tumors. Surgical exploration and reconstruction should be thought in patients who have severe respiratory symptoms.