Multicentric evaluation of high and low power lasers on RIRS success using propensity score analysis.

In this study, we aimed to evaluate the effect of HPL on different parameters by different centers and urologists. While doing this, we evaluated different parameters by comparing HPL(High Power laser) and LPL(Low-power laser). This is an observational, retrospective, comparative, multicentric study of prospectively organised database. A total of 217 patients who underwent RIRS for kidney stones smaller than 2 cm in three different centers were included in the study. The patients were divided into two groups; LPL used (Group1, n:121 patients) and HPL used (Group2, n:96). Propensity score matching was done in the data analysis part. After matching, a total of 192 patients, 96 patients in both groups, were evaluated. There was no difference between the groups regarding age, gender, stone side, and stone location. The stone-free rate on the first day was 80.3% in Group 1, it was 78.1% in Group 2 (p = 0.9). In the third month, it was 90.7% in Group 1 and 87.5% in Group 2 (p:0.7).Hospitalization duration was significantly higher in Group 1. (2.35 ± 2.27 days vs. 1.42 ± 1.10 days; p < 0.001).The operation duration was 88.70 ± 29.72 min in Group1 and 66.17 ± 41.02 min in Group2 (p < 0.001). The fluoroscopy time (FT) was 90.73 ± 4.79 s in Group 1 and 50.78 ± 5.64 s in Group 2 (p < 0.001). Complications according to Clavien Classification, were similar between the groups(p > 0.05). According to our study similar SFR and complication rates were found with HPL and LPL. In addition, patients who used HPL had lower operation time, hospital stay, and fluoroscopy time than the LPL group. Although high-power lasers are expensive in terms of cost, they affect many parameters and strengthen the hand of urologists thanks to the wide energy and frequency range they offer.

An overlooked complication of the clean intermittent catheters: prostate calculi.

OBJECTIVE: Although the clinical importance of prostate calculi has been understood over time, it is a urinary system disease that can cause different symptoms and can be ignored by urologists sometime. Clean intermittent catheter (CIC) is the gold standard method for bladder rehabilitation and urinary drainage in patients with neurogenic bladder. The aim of this study was to compare the incidence of prostate calculi and related pathologies between patients using CIC and not using CIC. MATERIAL-METHOD: A total of 314 neurogenic bladder patients who were followed up and treated in our urology clinic were included in this study. The patients were divided into two groups as patients non-using CIC (Group-1, n:154) and patients using CIC (Group-2, n:160).Presence of prostate calculi, the number of CIC used per/day, plasma uric acid levels, urine parameters, mean-stone-density (MSD) and calculi sizes were retrospectively scanned from patient records. RESULTS: In this study, no significant difference was observed between the parameters such as age, uric acid level, MSD, urine parameters, and other electrolyte levels (Table 1) While the incidence of prostate calculi in Group 1 was 23.4%; The incidence of prostate calculi in group 2 was 37.5(p = 0.007) (Fig. 2). CONCLUSiON: In this study, it was tried to show the relationship between the use of CIC and prostate calculi that cause LUTS and dysuria, which are generally ignored in clinical evaluation but do not pass in patients. As a result of this study, it was determined that the incidence of prostate calculi increased in patients using CIC.

Comparison of early period sexual function parameters between surgical repair and conservative treatment after penile fracture / Comparación de los parámetros de función sexual en el período temprano entre la reparación quirúrgica y el tratamiento conservador después de una fractura de pene

Introduction and objectives: Comparison of early period sexual function parameters in patients who had surgical repair and conservative follow-up after penile fracture and the evaluation of surgical intervention time on these parameters were planned in this study. Materials and methods: Total of 26 patients who were treated for penile fracture were evaluated. 19 patients had surgical repair and 7 patients had conservative treatment.Sexual function and erectile dysfunction (ED) degree of the patients before penile fracture and in the 12th week after fracture were evaluated with 5-question International Index of Erectile Function (IIEF-5) questionnaire, Erection Hardness Score (EHS), Sexual Encounter Profile(SEP) 2 and SEP 3. Parameters showing sexual function before and after the fracture were compared. Results: In both groups, a significant change was detected in IIEF-5 score, EHS, SEP-2 and SEP-3 parameters of the patients measured after penile fracture compared to the values before the fracture (all parameters, p<0.05). No difference was detected in the parameters measured before and after the fracture among surgical repair and conservative treatment groups (all parameters p>0.05). Mean time passing until the surgery after fracture was measured as 9.6±6.85h in 19 patients who had surgery. Conclusion: A difference wasn’t detected in sexual parameters in conservative treatment and surgical repair groups in this study. As a significant decrease was observed in sexual function parameters even in conservative treatment cases without sudden detumescence and tunica albuginea rupturing, we think that quick surgical exploration would be useful in cases considered to have penile fracture. (AU)

Introducción y objetivos: En este estudio se planificó la comparación de los parámetros de función sexual en el período temprano en pacientes sometidos a reparación quirúrgica y seguimiento conservador después de una fractura de pene y la evaluación del tiempo de intervención quirúrgica sobre estos parámetros. Materiales y métodos: Se evaluaron un total de 26 pacientes que fueron tratados por fractura de pene: 19 fueron sometidos a reparación quirúrgica y 7 tuvieron un seguimiento conservador. La función sexual y el grado de disfunción eréctil de los pacientes antes de la fractura de pene y en la semana 12 después de la fractura se evaluaron con el cuestionario International Index of Erectile Function de 5 preguntas (IIEF-5), el Erection Hardness Score (EHS), y el Sexual Encounter Profile (SEP) 2 y SEP 3. Se compararon los parámetros que muestran la función sexual antes y después de la fractura. Resultados: En ambos grupos se detectó un cambio significativo en la puntuación IIEF-5 y los parámetros EHS, SEP 2 y SEP 3 de los pacientes medidos después de la fractura de pene en comparación con los valores antes de la fractura (todos los parámetros, p<0,05). No se detectaron diferencias en los parámetros medidos antes y después de la fractura entre los grupos de reparación quirúrgica y tratamiento conservador (todos los parámetros p>0,05). El tiempo medio transcurrido hasta la cirugía después de la fractura se midió como 9,6±6,85h en los 19 pacientes intervenidos. Conclusión: No se detectaron diferencias en los parámetros sexuales entre los grupos de observancia conservadora y reparación quirúrgica en este estudio. Como se observó una disminución significativa de los parámetros de función sexual incluso en casos de seguimiento conservador sin detumescencia súbita y desgarro de la túnica albugínea, pensamos que la exploración quirúrgica rápida sería útil en los casos en los que se considere que tienen fractura de pene. (AU)

Comparison of early period sexual function parameters between surgical repair and conservative treatment after penile fracture.

INTRODUCTION AND OBJECTIVES: Comparison of early period sexual function parameters in patients who had surgical repair and conservative follow-up after penile fracture and the evaluation of surgical intervention time on these parameters were planned in this study. MATERIALS AND METHODS: Total of 26 patients who were treated for penile fracture were evaluated. 19 patients had surgical repair and 7 patients had conservative treatment. Sexual function and erectile dysfunction (ED) degree of the patients before penile fracture and in the 12th week after fracture were evaluated with 5-question International Index of Erectile Function (IIEF-5) questionnaire, Erection Hardness Score (EHS), Sexual Encounter Profile(SEP) 2 and SEP 3. Parameters showing sexual function before and after the fracture were compared. RESULTS: In both groups, a significant change was detected in IIEF-5 score, EHS, SEP-2 and SEP-3 parameters of the patients measured after penile fracture compared to the values before the fracture (all parameters, p<0.05). No difference was detected in the parameters measured before and after the fracture among surgical repair and conservative treatment groups (all parameters p>0.05). Mean time passing until the surgery after fracture was measured as 9.6±6.85h in 19 patients who had surgery. CONCLUSION: A difference wasn't detected in sexual parameters in conservative treatment and surgical repair groups in this study. As a significant decrease was observed in sexual function parameters even in conservative treatment cases without sudden detumescence and tunica albuginea rupturing, we think that quick surgical exploration would be useful in cases considered to have penile fracture.

Comparison of retrograde intrarenal stone surgery with and without a ureteral access sheath using kidney injury molecule-1 (KIM-1) levels: a prospective randomized study.

The objective is to compare patients who underwent retrograde intrarenal surgery with and without a ureteral access sheath (UAS) using kidney injury molecule-1 (KIM-1) levels. We also examined the difference in kidney damage between standard and dual lumen UAS. Sixty patients diagnosed with kidney stones and scheduled for RIRS were randomized into three groups: RIRS without UAS (Group 1), 11Fr/13Fr Boston scientific Navigator™ UAS (Group 2), and 11Fr/13Fr dual lumen ClearPetra™ UAS (Group 3). Data were prospectively collected in consecutive patients. Urine KIM-1/Cr levels were measured preoperatively, at postoperative 4 h, and on a postoperative day 14. Stone size, location, number, pre- and postoperative stent use, operation time, stone-free rate (SFR), post-ureteroscopic lesion scale (PULS) grade, hospitalization duration, and complications were recorded. There was no significant difference in demographical parameters and preoperative KIM-1/Cr levels among the groups. Postoperative 4th-hour urine KIM-1/Cr levels were higher in patients without UAS than patients with UAS (1.86, 0.67, 0.63 Groups 1, 2, 3, respectively). In comparing group 1 with groups 2 and 3 separately, Group 1 had a statistically significantly higher value than both groups (p = 0.002, p = 0.001, respectively). According to UAS type, there was no significant difference between groups 2 and 3. The use of UAS during RIRS has been shown to reduce kidney injury in the evaluation with KIM-1. Different UAS types on kidney injury and which one can protect the kidneys more during the procedure; will be elucidated by prospective randomized studies involving larger patient groups and UAS types.

The Benign Renal Masses that Were Exposed after Nephron-Sparing Surgery: "Postsurgical Fatty Tumor." Is It Related to the Surgical Technique?

After nephron-sparing surgery (NSS), postsurgical fatty tumor could be mistakenly reported as angiomyolipoma during radiologic imaging of some patients. In the present paper, we studied the postsurgical fatty tumor detected after NSS but not covered before in the literature. In addition, we also evaluated whether the postsurgical fatty tumor was related to the surgical technique employed. Patients admitted to the urology department of our university hospital from 2014 to 2019 and operated with open NSS were evaluated retrospectively. We detected those 156 patients were operated with NSS. Nine patients with angiomyolipoma as primary pathology and four patients with surgical border positivity were excluded from the study. The patients were divided into two groups based on the repair of tumor extraction region. In Group 1, fatty tissue was used for repair, and Group 2 is the primary repair group. In all, 143 patients (Group 1 = 79, and Group 2 = 64) were included in the study. No demographic and radiologic differences, such as number of patients, age, gender, positioning of tumor, mass localization, tumor diameter, and RENAL nephrometry scoring system, were detected between the two groups. Postsurgical fatty tumors were detected in 28 patients in Group 1 and in two patients in Group 2 (P < 0.001). In patients with negative surgical margins after partial nephrectomy, lesions that were radiologically detected mimicking as angiomyolipoma were defined as "postsurgical fatty tumor." This mass containing adipose tissue only neither depicted vascularization and enhancement nor increase in size for at least 1 year. We assumed that these lesions must be followed as benign lesions not requiring additional treatment.

The effect of intratesticular dexpanthenol on experimentally-induced testicular ischaemia/reperfusion injury.

INTRODUCTION: Testis torsion is a urological emergency and a serious situation that may cause testis atrophy, testicular dysfunction and infertility due to ischaemia/reperfusion(I/R) injury even with early intervention. OBJECTIVE: To assess the protective effect of dexpanthenol administered intratesticular after detorsion against testis I/R injury. STUDY DESIGN: Twenty-seven rats were randomly divided into 3 groups containing 9 rats each. The 1st group comprised the sham group with no procedure performed. The 2nd group had only torsion applied, while the 3rd group had torsion + dexpanthenol applied. Rats had 720° clockwise rotation applied to the left testis. After 2 h of ischaemia, testes were de-torsioned and the dexpanthenol group had 500 mg/kg dexpanthenol administered intratesticular after detorsion. After 4 h of reperfusion, rats had blood samples taken and orchiectomy was performed for histologic assessment. RESULTS: A significant difference was detected in all parameters [necrosis(p:<0.001), Cosentino grade (p < 0.001), congestion (p:0.005), fibrosis (p:<0.001), interstitial oedema (p:0.017), JTBS score (p:<0.001), apoptosis (p < 0.001) and testosterone levels (p:0.006)] when the sham, torsion, and torsion + dexpanthenol groups were compared. Significant differences were observed for fibrosis (p:0.010), Cosentino score (p < 0.001), JTBS score (p:<0.001), apoptosis (p:0.001) and total testosterone levels (p:0.013) when torsion and torsion + dexpanthenol groups were compared. The torsion + dexpanthenol group was identified to have more preservation of testis function observed histologically and hormonally compared to the torsion group. DISCUSSION: Dexpanthenol is used in many areas due to both epithelizing and antioxidant effects and lack of clear side effects. In spite of use of many chemical and biological agents to protect against testis I/R injury, none have entered routine use. This study showed that dexpanthenol, which can be easily injected intratesticular during detorsion surgery, has protective effect against histological and functional injury that may develop linked to testis I/R injury. The main limitations of the study are short duration of follow-up due to being a rat experiment and lack of comparison of lipid peroxidation products. CONCLUSION: This study identified that dexpanthenol with clinically easy use by intratesticular injection after detorsion during surgery had a protective effect against histological and functional injury that will develop linked to I/R injury in the testis.

A randomised-controlled, prospective study on the effect of dorsal penile nerve block after TURP on catheter-related bladder discomfort and pain.

PURPOSE: In the present study, the impact of penile nerve block (PNB) on postoperative pain and Catheter-Related Bladder Discomfort (CRBD) in the transurethral resection of prostate(TURP) patients were evaluated. METHODS: Participants of the present study were selected from patients who performed TURP under spinal anaesthesia for benign prostatic hyperplasia (BPH) between January 2018 and July 2020. The present study was planned as a single-centre, randomised-controlled prospective study in which the patients were divided into two groups. Group 1 was administered Control (n:40), and Group 2 ultrasonography(USG) guided PNB (n:40). The patients were included in the Groups, respectively. Visual analogue scale (VAS) scores were questioned and recorded in order to evaluate the postoperative pain complaints of the patients after the operation. In addition, in order to evaluate the CRBD, VAS scores were questioned and recorded as 0th, 0-1th hour, 1st-2nd hour, 2nd-4th hour, 4th-8th hour, 8th-12th hour, and 12th-24th hour. In addition, postoperative pain and need for analgesic drug were recorded. Tramadol was given to patients with moderate to severe CRBD. The findings were compared between the Groups. RESULTS: There was no statistical difference demographic and per-operative data between Group 1 and Group 2. The CRBD and pain-related VAS scores were significantly higher in Group 1 between the 0 and 8th hours. There was no difference between VAS scores in the postoperative 8-24th hours. In total 24 hours, Group 2's need for tramadol was significantly less than Group 1. On examining the factors affecting CRBD in the multivariate analysis, age, body mass index(BMI), prostate volume, operation time do not affect CRBD statistically, and only PNB reduces CRBD (P: .029). While less drug-related complications were observed in Group 2, no serious complications related to PNB were observed. CONCLUSION: Penile nerve block is an effective method for the decrease pain and CRBD after urological surgery. It will also reduce the need for analgesics, and provide painless patients in the postoperative period.

Ultra-mini Percutaneous Hepatolithotomy in Patients With Large and Multiple Hepatolithiasis.

BACKGROUND: In this study, we applied the ultra-mini percutaneous hepatolithotomy (UM-PHL) technique on hepatolithiasis patients with multiple and large stones on which other minimally invasive methods failed, and our aim was to report its results, sharing in series for the first time. MATERIALS AND METHODS: Preoperative and postoperative data, laboratory parameters, radiologic findings, and preoperative and postoperative details were recorded for a total of 14 patients for whom the UM-PHL technique was applied between April 2017 and December 2019. As all patients had multiple stones and extreme stone load and had bile duct surgery, they did not have a normal anatomy. All patients were radiologically confirmed to have had preprocedural magnetic retrograde cholangiopancreatography. RESULTS: Operation duration of the patients was 137.6±44.9 minutes, while intraoperative blood loss was 69.2±24.9 mL, drainage catheter removal time was 2.85±0.86 days, and the hospitalization time was 4.28±2.55 days. Intraoperative balloon dilation was applied to enlarge the stricture area in 5 patients (35.7%). On the basis of the Clavien-Dindo classification, grade 2 complication was observed in 2 patients (14.2%) due to postoperative cholangitis. Patients were followed up for an average of 15 months, and nonsymptomatic radiologic stone recurrence was detected in the 12th month control of 1 patient (7.1%). CONCLUSION: The UM-PHL technique is a successful method that facilitates stone clearance by providing minimal dilatation through percutaneous intervention and by using instruments with small diameter, and it can safely be applied with its low complication level, low recurrence ratio, and short hospitalization time.

Comparison of Oral Sodium Bicarbonate and Solifenacin Treatment in Female Overactive Bladder Patients With Acidic Urine pH.

OBJECTIVE: In this study, we planned to compare the effects of oral sodium bicarbonate (NaHCO3) and anticholinergic (solifenacin) treatments in women with overactive bladder (OAB) and acidic urine pH values (<6). METHODS: According to the referral order of OAB patients, 8 g/d oral NaHCO3 (group 1) or 5 mg/d solifenacin succinate (group 2) was given to the patients. Both treatment regimens were applied one at a time for 12 weeks in total. Laboratory values, bladder diary, Patient Perception of Bladder Condition score, Patient Perception of Intensity of Urgency Scale, Overactive Bladder-Validated 8-Question Awareness Tool, and the King's Health Questionnaire (KHQ) scores before and after treatment were compared. RESULTS: A total of 59 patients were evaluated. Thirty-one patients were included in group 1, and 28 patients were included in group 2. No difference was detected in pretreatment and posttreatment laboratory values other than urine pH values in both groups. Whereas there was no difference in pretreatment urine pH values among the 2 groups, posttreatment urine pH values were significantly higher in group 1 compared with group 2 (P = 0.08, P < 0.001, respectively). There was a significant amelioration in the bladder diary parameters, symptom scores, and KHQ values measured after treatment in both groups. However, degree of amelioration in posttreatment outcomes was similar among the groups. CONCLUSIONS: It was demonstrated that urinary alkalization made with oral NaHCO3 in female OAB patients with acidic urine pH had a significantly positive effect on symptoms and symptom scores, and these results are similar to the results of solifenacin treatment.

Dynamic thiol/disulfide homeostasis as a novel indicator of oxidative stress in patients with urolithiasis.

Purpose: A dynamic thiol/disulfide balance is pivotal in organizing anti-oxidant defense, detoxification, apoptosis, and enzyme activities, as well as transcription and cellular signal-transfer mechanisms. The connection between urolithiasis and oxidant/antioxidant status, which can be assessed through thiol-disulfide homeostasis (TDH), has not yet been examined. In this study, we evaluated the effects of TDH on the formation, size, and location of stones by examining the associations between TDH parameters and urolithiasis. Materials and Methods: Patients with urolithiasis and healthy controls were recruited. The patients were divided into subgroups in terms of stone size (>15 mm or ≤15 mm) and stone location (nephrolithiasis or ureterolithiasis). TDH parameters were measured using a novel automatic and spectrophotometric method and compared statistically. Results: TDH parameters were different between the urolithiasis and control groups. TDH tended towards the disulfide side in the urolithiasis group. Stone size increased an average 0.14 mm with a 1 µmol/L increase in disulfide level and decreased an average 0.058 mm with a 1 µmol/L increase in native thiol level. Disulfide and native thiol levels were found to be different across patients with stone size >15 mm, ≤15 mm, and controls (p<0.001 and p<0.001, respectively). However, the nephrolithiasis and ureterolithiasis groups were similar in respect of TDH parameters. Conclusions: In this study, it was found that patients with urolithiasis displayed oxidative stress characterized by a TDH tendency towards the disulfide side, and an inadequate antioxidant response identified by a lower level of native thiol as compared with healthy controls.

Evaluation of the readability of informed consent forms used in urology: Is there a difference between open, endoscopic, and laparoscopic surgery?

OBJECTIVE: The aim of this study is to evaluate the readability levels of informed consent forms used in Turkey before urological surgery and to compare the readability levels of open, endoscopic, and laparoscopic surgical informed consent forms. MATERIAL AND METHODS: A total of 529 informed consent forms used for urological open, endoscopic, and laparoscopic surgical procedures were collected from different hospitals in Turkey. Evaluating informed consent forms that have exactly the same text only once, a total of 69 consent forms were evaluated. The Gunning Fog Index and Flesch-Kincaid test measuring the general readability level were used to calculate the readability level of informed consent forms in addition to the Atesman and Bezirci-Yilmaz formulas defined to determine the readability level of Turkish texts. Informed consent forms were evaluated and divided into three groups as open, endoscopic, and laparoscopic surgery forms, depending on their content. RESULTS: Among 69 informed consent forms evaluated, 35 were open, 19 were endoscopic, and 15 were laparoscopic surgery consent forms. The readability level of all informed consent forms was detected as average according to the Atesman formula, very difficult according to the Flesch-Kincaid test, difficult according to the Gunning Fog Index, and at the high school education level according to the Bezirci-Yilmaz formula. A statistical evaluation of the three groups did not show a significant difference in the readability level. CONCLUSION: In this study, it was detected that the informed consent form readability levels used for urological surgical procedures in our country were rather low. We think that the cooperation of the concerned institutions is required for the revision of the consent information texts available and the improvement of the texts according to the strategies recommended.

Effects of urine alkalinization with sodium bicarbonate orally on lower urinary tract symptoms in female patients: a pilot study.

INTRODUCTION AND HYPOTHESIS: In this study, we planned to explore the effects of sodium bicarbonate orally (NaHCO3) treatment on female patients with lower urinary tract symptoms (LUTS) who have acidic urine pH values (<6). METHODS: NaHCO3 was given orally to 33 female patients for 4 weeks at a dose of 2 × 4 g/day. Laboratory values, bladder diary, the Patient Perception of Bladder Condition Score (PPBC), Patient Perception of Intensity of Urgency Scale (PPIUS), Overactive Bladder-Validated 8-question Awareness tool (OAB-V8), Pelvic Pain and Urgency & Frequency Patient Symptom Scale tests (PUFSS), and the King's Health Questionnaire (KHQ) scores before and after treatment were compared. RESULTS: A significant increase was detected in urine pH values measured after treatment (5.31 ± 0.52 to 7.2 ± 0.66, p < 0.001), but not in blood pH values (7.369 ± 0.33 to 7.384 ± 0.28, p = 0.14). After treatment, a significant decrease was detected in daily frequency, nocturia, urgency, and urge incontinence prevalence (p < 0.001,p = 0.003, p < 0.001, p = 0.002, respectively) and PPBC, PPIUS, PUFSS, and OAB-V8 symptom scores (p = 0.004, p = 0.002, p < 0.001, p < 0.001, respectively). A significant decrease was detected in all KHQ subunit scores. CONCLUSION: Urine alkalinization with NaHCO3 orally in female patients with LUTS and acidic urine pH has a significant level of positive effects on symptoms and symptom scores. Our results show that this new treatment modality-which is inexpensive, easy to use, and has a low side-effect profile is effective in this chronic patient group.