The Impact of Vaginoplasty on Female and Male Sexual Function and Satisfaction.

BACKROUND: An important factor which underlines the clinical significance of vaginal laxity presence is the association of the latter with the female sexual function. Male sexuality can also be affected by vaginal laxity. OBJECTIVES: We aimed to investigate the effect of vaginoplasty on a cohort of women, who underwent the respective procedure under the indication of vaginal laxity/impaired sexual function. At the same time, it is very important to evaluate the sexual satisfaction of partners after vaginal tightening. METHODS: Fifty women who underwent vaginoplasty and their male partners (n=50) were included in the study. State-Trait Anxiety Inventory (STAI) and Female Sexual Function Index (FSFI) were performed to female patients three months before and after the treatment. Also, male partners were asked for their sexual functions by International Index of Erectile Function-5 (IIEF-5) three months before and after the treatment. A 5-question questionnaire inquiring about pleasure status was administered to the male partners using a four-point Likert scale. RESULTS: Post-treatment STAI THE STATE and STAI THE TRAIT scores of the female patients were statistically significantly lower than their pre-treatment scores (52.5 vs 32, p<0.001; 56 vs 44, p<0.001, respectively). The post-treatment FSFI score of the female patients was significantly higher than their pre-treatment score (19.2 vs 29.7, p<0.001). CONCLUSIONS: Our results demonstrated significant improvement in the sexual function of males and females and additionally, a significant decrease in the indices of the temporary anxiety levels and the inherent predisposition for anxiety disorders after vaginoplasty.

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

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

Male Urethral Stricture in Patients with Metabolic Syndrome.

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.

Impact of Urinary pH on the Efficacy of a Postoperative Single Instillation of Mitomycin-C.

OBJECTIVE: To assess the effect of the urinary pH value on the efficacy of a postoperative single instillation of mitomycin-C. STUDY DESIGN: A descriptive study. PLACE AND DURATION OF STUDY: Department of Urology, Ankara Numune Training and Research Hospital, Ankara, Turkey from 2011 to 2016. METHODOLOGY: Patients newly diagnosed with low-risk non-muscle invasive bladder cancer and given a postoperative single instillation of mitomycin-C were retrospectively reviewed. The demographic data and pre-instillation urinary pH values of the patients were recorded. All patients included in the study (n=117) were followed up for five years. The primary outcome was the time to the first recurrence. The patients were divided into two groups: Group 1 consisted of 87 patients with no recurrence and Group 2 comprised 30 patients that had recurrence during the follow-up. RESULTS: The mean pre-instillation urinary pH value was significantly lower in Group 2 than in Group 1 (5.89 vs. 5.37, p <0.001). The receiver operating characteristic analysis revealed that the cut-off value of urinary pH in predicting recurrence was 5.25. The patients with a urinary pH value of 5.25 or greater had significantly higher recurrence-free survival rates. CONCLUSIONS: The patients with higher urinary pH before a single instillation of mitomycin-C had better recurrence-free survival. KEY WORDS: Bladder cancer, Mitomycin-C, Single instillation, Urinary pH.

The Impact of Ureteral Access Sheath Size on Perioperative Parameters and Postoperative Ureteral Stricture in Retrograde Intrarenal Surgery.

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.

What is the role of inflammatory markers in predicting spontaneous ureteral stone passage?

PURPOSE: To investigate the role of inflammatory markers in predicting the spontaneous passage of ureteral stones. METHODS: We retrospectively reviewed 279 patients with ureteral stones sized 4-10 mm that were managed conservatively. The patients were divided into two groups: Group 1 consisted of 137 patients who passed the stone spontaneously; Group 2 comprised 142 patients without spontaneous stone passage. The groups were compared using the Mann-Whitney U and chi-square tests. In addition, univariate and multivariate analyses were performed to identify the significance of the parameters. RESULTS: The mean age of the patients was 41.2 years. The patients in Group 1 had a significantly lower mean stone size, white blood cell count and neutrophil count. In addition, stone location, presence of hydronephrosis and history of urolithiasis were significantly different between the groups. Neutrophil percentage, neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio were insignificantly lower in Group 1. In a multivariate analysis, stone size, distal location and hydronephrosis status significantly predicted the spontaneous stone passage. However, inflammatory markers including white blood cell count, neutrophil count and neutrophil-to-lymphocyte ratio could not determine the likelihood of spontaneous stone passage. CONCLUSION: Our results suggest that inflammatory markers are no meaningful parameters for the prediction of spontaneous stone passage.

An analysis of three different prostate cancer risk calculators applied prior to prostate biopsy: A Turkish cohort validation study.

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.

What Is the Interaction between Urine C-Reactive Protein, Prostatic Inflammation, and Doxazosin Treatment in Patients with Benign Prostatic Hyperplasia? A Pilot Study.

INTRODUCTION: It was aimed to show the relationship between benign prostatic hyperplasia and inflammation by measuring urinary C-reactive protein values before and after alpha-blocker treatment. METHODS: A total of 71 patients with a total prostate-specific antigen <3.5 ng/mL, International Prostate Symptom Score >7, and maximum urinary flow rate <15 mL/s were included in the study. Doxazosin 4 mg p.o. once daily was started orally as an alpha-blocker treatment. Serum and urine C-reactive protein values, International Prostate Symptom Score, maximum urinary flow rate, and the post-void residual volume of patients were recorded at the first admission and in the first month of alpha-blocker treatment. RESULTS: The mean age of the patients was 59.2 ± 7.5 years. The mean serum C-reactive protein values of the patients at the first admission and follow-up were 2.62 ± 1.8 (range, 0-5) mg/L and 2.83 ± 1.6 (0-6) mg/L, respectively. The mean urine C-reactive protein values of the patients at the first admission and follow-up were 0.45 ± 0.11 (range, 0.28-0.99) mg/L and 0.14 ± 0.04 (range, 0.79-0.328) mg/L, respectively, which was statistically significantly different. In the subgroup analysis, the urine C-reactive protein level change was more prominent in severely symptomatic patients than in moderately symptomatic patients. CONCLUSION: Our results showed that C-reactive protein was detectable in urine, alpha-blocker treatment significantly reduced urine C-reactive protein levels, and the decrease was more prominent in severely symptomatic patients.

The Role of Pentraxin-3, Fetuin-A and Sirtuin-7 in the Diagnosis of Prostate Cancer.

PURPOSE: Prostate canceris the most commonly diagnosed type of cancer and one of the leading causes of cancer-related death in men.Numerous efforts have been made to improve existing diagnostic methods and develop a new biomarker to identify patients with prostate cancer. In line with current literature, we preferred new serum-based biochemical markers as Pentraxin-3, Fetuin-A and Sirtuin-7 in the present study. MATERIALS AND METHODS: A total of 174 patients aged 42-76 years were included in the study. Patients with prostate cancer (n=38) were enrolled as Group 1 and patients with benign prostatic hyperplasia (n=136) as Group 2. The serum levels of Pentraxin-3, Fetuin-A and Sirtuin-7 levels were compared between the groups. RESULTS: The mean age of the patients was 61.9±7.6 years (p= .001). The mean serum Prostate Specific Antigen levels 32.0±59.6 (2.6-336) ng/mL and 10.0±11.3 (2.5-77.4) ng/mL in Group 1 and 2, respectively (p= .029). The mean serum levels of Pentraxin-3 and Fetuin-Ain Group 1 were statistically significantlydifferent from Group 2(3.3±4.4 ng/mL vs 1.8±2.4 ng/mL, p= .002 and 466.8±11.0 µg/mL vs 513.3±11.0 µg/mL,p= .041,respectively). There was no significant difference between Group 1 and 2 according to serum levels of Sirtuin-7 (12.7±8.2 ng/mL vs 12.7±12.4 ng/mL respectively, p= .145). CONCLUSION: Pentraxin-3, Fetuin-A and Sirtuin-7 may be effective in the diagnosis of prostate cancerin light of the current literature.In this study, it was found that Pentraxin-3 and Fetuin-A were significantly different in the diagnosis of prostate cancer.Larger-scale prospective studies are needed to determine the importance of Pentraxin-3 and Fetuin-A in the diagnosis of prostate cancer.

Does previous open or percutaneous renal stone surgery affect retrograde intrarenal surgery outcomes?

Background/aim: Open or percutaneous renal stone surgery can have an adverse effect on the collecting system of the kidney. We evaluated retrograde intrarenal surgery outcomes in patients with ≤30 mm renal stones who had open or percutaneous renal stone surgery history. Materials and methods: A total of 707 patients who underwent retrograde intrarenal surgery treatment were included in this study. Fifty-six patients had open or percutaneous renal stone surgery history (Group 1) and the remaining did not (Group 2, n = 651). The groups were compared in terms of age, stone size, stone-free rates, and complications. Results: The mean age of the patients was 51.16 ± 14.8 and 45.95 ± 14.6 years in Groups 1 and 2, respectively (p = 0.008). The mean stone size was 14.97 ± 6.1 mm and 16.47 ± 6.9 mm in Groups 1 and 2, respectively (p = 0.107). The stone-free rates were 71.4% and 84.1% in Group 1 and 2 respectively and it was significantly higher in Group 2 (p = 0.013). The overall rate of postoperative complications was higher in Group 1 (p = 0.019), but there was no difference between the two groups in terms of Clavien 1­2 and 3­4a complication rates. Conclusion: Our results showed that having a history of open or percutaneous renal stone surgery has a negative effect on the success and complication rates in retrograde intrarenal surgery. Therefore, patients should be well informed before this operation.

Safety and reliability of fluoroscopy-free technique in retrograde intrarenal surgery.

BACKGROUND: Traditional retrograde intrarenal surgery is performed under fluoroscopic guidance. In the present study, we assessed the efficacy and safety of retrograde intrarenal surgery without fluoroscopic guidance in selected patients with renal and proximal ureteral stone disease. METHODS: Between October 2013 and August 2016, a total of 350 patients who underwent retrograde intrarenal surgery for upper urinary tract stone disease were retrospectively analyzed. Ninety-five (Group 1) and 255 (Group 2) patients underwent retrograde intrarenal surgery with and without fluoroscopy guidance, respectively. We documented complications and success rates of the procedures retrospectively. RESULTS: The mean age of the patients was 45.3 years. The mean stone size was 14.5±5.5 (5-30) mm and 13.7±5.2 (4-30) mm in Group 1 and 2, respectively (P=0.197). The stone-free rates one month after surgery were 86.3% and 87% in Group 1 and 2, respectively (P=0.739). The overall incidence of intraoperative complication was 16.3%. In Group 1, incidence of intraoperative complication was 17.9% (N.=17) while in Group 2 incidence was 15.7% (N.=40) (P=0.620). The overall postoperative complication rate was 5.1%. Postoperative complications developed in seven patients (7.4%) in Group 1 and in 11 patients (4.3%) in Group 2 (P=0.250). CONCLUSIONS: Fluoroscopy-free retrograde intrarenal surgery seems to be technically feasible and safe for the treatment of renal and proximal ureteral stone disease in uncomplicated selected cases.