A Retrospective Study of 1076 Cases of Shoulder Dislocation at a Single Center in Türkiye to Evaluate the Role of Post-Reduction Radiography in the Detection of Clinically Significant Fractures.

BACKGROUND The role of post-reduction radiography in patients with shoulder dislocation remains controversial. Therefore, this retrospective study of 1076 cases of shoulder dislocation at a single center in Türkiye aimed to evaluate the role of post-reduction radiography in the detection of clinically significant fractures. MATERIAL AND METHODS Patients with radiographically confirmed anterior shoulder dislocation were included in the study, and their demographic data, mechanism of injury, pre- and post-reduction radiograph readings, reduction method, and patient outcome were recorded. The study analyzed patients who had pre- and post-reduction anterior-posterior and axillary shoulder radiographs. RESULTS During the 44-month study period, a total of 1076 patients were examined, and their pre- and post-reduction radiographs were reviewed by an independent radiologist. Of these patients, 27 (2.6%) had a fracture on their pre-reduction radiographs, while 32 (3.1%) had a fracture on their post-reduction radiographs. The difference between the 2 groups was not statistically significant (P=0.142). The study found that patients who did not undergo a post-reduction radiograph spent an average of 106 min in the emergency department, while patients who had the radiograph and were discharged spent an average of 237 min. The hospital stay of patients who had the radiograph was also significantly longer (P<0.01). CONCLUSIONS Our study supports that routine use of post-reduction radiographs in all cases of anterior shoulder dislocation may not be necessary and could potentially expose patients to unnecessary radiation exposure and healthcare costs. Shortening the examination time in the emergency department by not taking a follow-up radiograph will help prevent overcrowding.

A Retroperitoneal Calcified Mass: Synovial Sarcoma.

Retroperitoneal synovial sarcoma is an extremely rare and aggressive tumor. Although it does not have a typical radiological appearance, it can sometimes appear as a calcified mass. The most important step in the treatment of synovial sarcoma is complete resection. However, despite complete resection, local recurrence and systemic spread rates remain high, and chemo/radiotherapy may be considered in high-risk patients.

Does Post-COVID-19 Erectile Dysfunction Improve over Time?

BACKGROUND: Some studies have shown that there may be an increase in the frequency of erectile dysfunction after COVID-19. However, no long-term study has investigated whether this is permanent or temporary. In this study, we aimed to examine whether there was an increase in the frequency of erectile dysfunction among individuals with a history of COVID-19, and, if there was, whether their condition improved over time. MATERIALS AND METHODS: In this study, a total of 125 healthy male healthcare workers, 95 with and 30 without a history of COVID-19, were evaluated in terms of erectile function. Four study groups were formed. The first three groups consisted of individuals with a history of COVID-19 confirmed by the polymerase chain reaction (PCR) test at different times, who recovered from the disease (time elapsed since COVID-19 positivity: <6 months for Group 1, 6 to 12 months for Group 2, and >12 months for Group 3). The individuals in Group 4 did not have a history of COVID-19 diagnosis. In order to evaluate the erectile function of the participants, they were asked to complete the five-item International Index of Erectile Function questionnaire (IIEF-5). Then, statistical analyses were performed to evaluate whether there was a difference between the groups in terms of the IIEF-5 scores. RESULTS: There was a statistically significant difference between the groups in terms of the IIEF-5 scores (p < 0.001), and this difference was determined to be caused by the significantly higher IIEF-5 scores of Groups 3 and 4 compared to Group 1 (p = 0.004 and p < 0.001, respectively). In addition, the IIEF-5 score of Group 4 was statistically significantly higher than that of Group 2 (p < 0.001). However, the IIEF-5 scores did not statistically significantly differ between Groups 1 and 2, Groups 2 and 3, and Groups 3 and 4 (p > 0.999, p = 0.204, and p = 0.592, respectively). CONCLUSION: There may be deterioration in erectile function after COVID-19; however, this tends to improve over time, especially from the first year after active infection. Given that vascular, hormonal, and/or psychogenic factors may lead to the development of erectile dysfunction after COVID-19, we consider that in order to easily manage this process, it is important to determine the underlying cause, initiate appropriate treatment, and inform couples that this situation can be temporary.

The change in Thiol-Disulphide Homeostasis levels as an oxidative stress marker after varicocelectomy: Is there a relationship with sperm parameters?

One of the most important causes of varicocele-related infertility is oxidative stress (OS). One of the markers considered as an indicator of OS is thiol-disulphide homeostasis (TDH). Based on the hypothesis that OS should decrease after varicocelectomy in the light of this information, in our current study, we investigated the relationship between TDH levels and sperm parameters. The data of 56 infertile varicocele men were prospectively analysed. The post-operative total and native thiol levels were significantly higher than those pre-operative total and native thiol levels (477.7 & 436.7 nmol/L, 417.6 & 372.1 nmol/L). Positive correlation was found between total thiol change and change in semen volume (ρ: .277, p: .039), ratio of spermatozoa with normal morphology (ρ: .342, p: .01), progressive (ρ: .334, p: .012) and nonprogressive motility (ρ: .385, p: .003). Positive correlation was also found between native thiol change and semen volume (ρ: .349, p: .008), ratio of spermatozoa with normal morphology (ρ: .362, p: .006), progressive (ρ: .297, p: .026) and nonprogressive motility (ρ: .368, p: .005). Change in the level of TDH was found as positively correlated with progressive and nonprogressive motility change. According to these results, OS decreases with varicocelectomy in infertile patients and TDH can be used as a useful method for measuring OS.

Assessing prognosis with modified early warning score, rapid emergency medicine score and worthing physiological scoring system in patients admitted to intensive care unit from emergency department.

INTRODUCTION: In this study our purpose is to examine the effectiveness and reliability of MEWS (Modified Early Warning Score), REMS (Rapid Emergency Medicine Score) and WPS (Worthing Physiological Scoring System) scoring systems for prediction of the prognosis and mortality rate of critically ill patients scheduled to be admitted to intensive care unit (ICU) among emergency department (ED) patients. METHODS: This single-centered retrospective study was performed on medical, surgical and trauma patients referred to the ED and admitted to ICU of University Hospital between 23 July 2013 and 26 November 2015. RESULTS: Mortality and the duration of stay in ICU were significantly correlated with systolic blood pressure (SBP) and WPS score compared to other variables (p = 0.014, p = 0.010 respectively). The decrease in SBP increased the mortality by 2 (OR: %95 CI 1.1-3.5) fold and the increase in WPS increased the mortality by 2.4 (OR: %95 CI 1.2-4.5) fold. CONCLUSIONS: In our study, there was a more significant correlation between WPS score and mortality and duration of stay in ICU compared to other scores.

Primary Signet Ring Cell Carcinoma of the Prostate: A Rare Case Report.

Primary prostatic signet ring cell carcinoma is a rare form of cancer with a poor prognosis, which is generally treated with a traditional prostate adenocarcinoma therapy. This case report presents a 70-year-old diagnosed with primary prostatic signet ring cell carcinoma, treated with a combination of radiotherapy and hormone therapy and a 16 month survival without an evidence of the disease at follow up.

Does Tadalafil Increase The Uptake of Finasteride into Prostate Tissue? A Biochemical and Histological Evaluation in Rats.

PURPOSE: To histopathologically and biochemically evaluate the hypothesis that tadalafil increases the uptake of a second medication into the prostate tissue by increasing the blood supply in the prostate. METHODS: Forty 12-week-old Sprague Dawley male rats were equally divided into 5 groups and were administered drugs orally as follows: Group 1 - no drugs, Group 2 - 10 days of finasteride, Group 3 - 10 days of finasteride + tadalafil, Group 4 - 30 days of finasteride, and Group 5 - 30 days of finasteride + tadalafil. At the end of 10 days of drug administration in Group1, 2, and 3, and at the end of 30 days of drug administration in Group 4 and 5,blood samples were collected from rats and analyzed for serum androgen levels. In addition, prostate tissues were removed for histological examination. RESULTS: The mean DHT level as well as the minimum and maximum epithelial thicknesses in Group 3 were lower than those in Group 2. However, there was no statistical significant difference (P = 0.989, P = 0.176, and P = 0.070, respectively). The mean DHT level as well as the minimum and maximum epithelial thicknesses in Group 5 were lower than those in Group 4. However, there was no statistical significant difference (P = 0.984, P = 0.147, and P= 0.478, respectively). The mean minimum and maximum epithelial thicknesses in Group 3 and Group 4 were not statistically different (P = 0.488 and P = 0.996, respectively). CONCLUSION: The similarity of the mean minimum and maximum epithelial thickness in Group 3 and Group 4 may be indicate that the combination therapy provides an early histological effect. However, the fact that there was no statistical significant difference between Group 2 and Group 3, and between Group 4 and Group 5, in terms of the mean DHT level and minimum-maximum epithelial thicknesses suggests that longer term studies with more rats are necessary to test the validity of our hypothesis.

The Association of Encrustation and Ureteral Stent Indwelling Time in Urolithiasis and KUB Grading System.

PURPOSE: To evaluate the management of prolonged indwelling ureteral stents and the newly developed KUB (kidney, ureter, and bladder) grading system for the classification of encrusted stents in urolithiasis. METHOD: This study involved 69 patients that had indwelling and forgotten ureteral stents for more than 6 months after urolithiasis treatment. They were categorized into 4 groups based on indwelling time and were reviewed retrospectively. Patients whose ureteral stent could not be removed with simple cystoscopy were graded according to stone surface area and the KUB system. RESULTS: The mean stent indwelling time was 23.1 months. Stone burden in KUB and, in proportion to that, total KUB (T) score showed increased association that was directly proportional to indwelling time (p < 0.001, p = 0.008). Surgical intervention was required in 73.9% of patients. Among patients requiring surgery, 78.4% were treated in a single session and multi-modal interventions were performed in 70.5%. K score ? 3 was found to be associated with multiple surgery requirements (odds ratio [OR];11.25, %95 confidence interval [CI]:2.132-59.375),multi-modal procedure requirements (OR;16.50, %95 CI:3.434-79.826 ), and lower stone-free rates (p = 0.04). Bscore ? 3 was associated with multi-modal procedure requirements (OR;8.90, %95 CI:1.052-75.462). U score ? 3and T score ? 9 were associated with an operating time >180 minutes (p < 0.001, p = 0.008). CONCLUSION: Prolonged indwelling time of the ureteral stent in urolithiasis is associated with increased encrustation and stone burden. Since the KUB system specifies stone burden and its particular localization, it can be used as a simple, convenient method for the planning treatment of encrusted ureteral stents.

Transurethral Resection of a Large Urinary Bladder Leiomyoma: A Rare Case Report.

Bladder leiomyoma constitutes less than 0.5% of all bladder tumors. Until now, there have been about 250 case reports of bladder leiomyoma. We present a case of large bladder leiomyoma, that was treated successfully with transurethral resection. The patient presented to our clinic with both obstructive and irritative urinary complaints. Cystoscopy showed a mass lesion completely obstructing the bladder neck at the junction of right lateral wall and floor, which did not extend to ureteral orifices. A transurethral resection was performed at the same sessionof cystoscopy. At the postoperative 3rd month control visit, the patient's obstructive symptoms were completely healed but her irritative symptoms continued. A repeat cystoscopy revealed residual tumoral tissue remaining at the floor of the previous surgical area. Transurethral resection was performed, and these tissues were completely resected. At the control visit that was 3 months after the second transurethral resection procedure, the patient was free from any urinary complaints. In conclusion, large bladder leiomyomas can be treated successfully with endoscopic approaches.

Management of Forgotten Ureteral Stents: Relationship Between Indwelling Time and Required Treatment Approaches.

BACKGROUND: Double-J stents are widely used in urology practice, and removal of these stents can sometimes be forgotten. AIMS: To investigate whether indwelling time of double-J stent can predict which treatment modality is required for removal of the stent from the body. STUDY DESIGN: A multicentre, retrospective observational study. METHODS: The data of 57 patients who were treated for forgotten ureteral stents between January 2007 and December 2014 were evaluated retrospectively. Patients were classified into four groups according to indwelling time of the stents: 6-12 months, 13-24 months, 25-36 months, and <36 months. Encrustation and associated stone burden of the stents were evaluated with non-contrast stone protocol computerised tomography. RESULTS: Patients were classified according to their duration of the stent indwelling time. Simple cystoscopic stent retrieval was performed in 71.4% of patients in the 6-12 months group, 44% of patients in the 13-24 months group, 6.2% of patients in the 25-36 months group, and 11.1% of patients in the <36 months group. A percutaneous or open surgery was required in no patients with an indwelling time of double-J stent shorter than 30 months. CONCLUSION: Transurethral and/or percutaneous combined endo-urological approaches are usually sufficient for the removal of forgotten double-J stents. Transurethral procedures are sufficient for the treatment of patients with double-J stent indwelling times less than 30 months.

The success of tubularized-incised plate urethroplasty in adults and children.

PURPOSE: Hypospadias repair is rarely performed in adults. It is believed that the success rate is lower in adulthood. We aimed to compare the success rate of primary hypospadias repair with tubularized-incised plate (TIP) urethroplasty in adults and children. PATIENTS AND METHODS: The databases of consecutive boys and adults who were treated with TIP urethroplasty for primary hypospadias between 2012 and 2015 were evaluated. All operations in the boys and adult patients were performed by a single surgeon. We considered urethroplasty complications to include a urethrocutaneous fistula, neourethral stricture, meatal stenosis, diverticulum, and glans dehiscence. Urine flow was also evaluated using uroflowmetry. RESULTS: Seventy-seven consecutive patients underwent surgery by a single surgeon in the last 3 years for hypospadias repair. Nineteen of these patients were adults. Urethrocutaneous fistulae developed in 2 of the 19 (10.5 %) adults, and 3 of the 58 (5.2 %) boys. In addition, there were urinary tract infections in 2 (3.4 %) children, meatal stenosis in 1 (1.7 %) child, and glans dehiscence in 1 (5.3 %) adult. Uroflowmetry was normal in all patients. There was no difference in outcomes between boys and adults. CONCLUSION: Our data showed that the success rate of hypospadias repair with TIP urethroplasty is similar in adults and children. TIP urethroplasty is associated with good results in adults and boys.

Comparison of the efficacy and histopathological effects of three hemostatic agents in a partial nephrectomy rat model.

PURPOSE: The major complications of partial nephrectomy are bleeding and urine leakage. While various hemostatic agents are used to control bleeding, the histopathological characteristics of these hemostatic agents have not been investigated adequately. We aimed to investigate and compare the histopathological and hemostatic effects of local hemostatic agents in a partial nephrectomy rat model. METHODS: Thirty-two rats were divided into four equal groups, and partial nephrectomy was done to all rats. Conventional suture repair, Glubran2®, FloSeal®, and Celox™ were applied to every single group. The period of warm ischemia and hemostasis during surgical process was timed. Rats were killed later 3 weeks, and their partial nephrectomy applied kidneys were evaluated histopathologically. RESULTS: The fastest hemostasis was provided with Glubran2® (32.87 s). FloSeal® was the second (40.85 s), and Celox™ was the third (55.75 s). Glomerular necrosis and calcification were seen more in the suture group than other groups (p < 0.001). Fibrosis was found significantly less in Celox™ group. Fibroblast activation was found significantly less comparing to other groups (p < 0.01). The erythrocyte aggregation was significantly greater in the Glubran2® and FloSeal® groups than suture group (p < 0.01 and p < 0.001). CONCLUSION: The negative effects of hemostatic agents to the renal histopathology were less than conventional suture repair. Celox™ was the best biocompatible agent. In comparison with three agents, it was observed that Glubran2® provided hemostasis faster than other agents.

The use of latex foley catheter in repair of hypospadias the most common seen congenital penile anomaly.

OBJECTIVE: Hypospadias is the most common congenital penile anomaly occurring in 1/300 live births. Various surgery techniques are used in repair of hypospadias. Infant and children with hypospadias are usually admitted to emergency services by worried their parents for the first time. TIP urethroplasty is widely used in the repair of hypospadias, but the use of urethral catheters is still a matter for discussion. Herein, we described our experiences with the use of an unsutured latex foley catheter placed in the glans for 24 to 48 hours. METHODS: A retrospective chart review was performed on 38 patients who underwent Tubularized incised plate (TIP) hypospadias repair from 2009 to 2011. Of these, 35 patients who had two-way latex Foley catheters placed for 24 h to 48 hands were followed for at least 12 month. RESULTS: Excellent cosmetic results were obtained in all patients. Urinary tract infection developed in two patients (5.7%). one patient (2.8%) who had mild urethral repair breakdown was repaired in the office environment. CONCLUSION: We observed very low complication rates in application of a two-way latex Foley catheter in hypospadias surgery and found that this method can be used safely. Moreover, the catheter can be used for traction purposes during the procedure. At the end of the 24 to 48 h period, removal of the two-way latex urethral catheter with balloon does not harm the urethral repair. To reach a definite conclusion, larger studies are needed.

The relationship between mean platelet volume and other platelet indices with testicular artery blood flow and fertility: a preliminary study.

OBJECTIVES: To examine the relationship between platelets (PLT) and platelets indices such as mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit (PCT) as noninvasive biomarkers with testicular artery blood flow and fertility. METHODS: Fifty-seven healthy and fertile men with normal semen values and 52 patients with abnormal semen values were included in the study. The participants' PLT, MPV, PDW and PCT values were analyzed. Four different levels of the testicular artery, peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI) were measured using color Doppler ultrasound. RESULTS: There was no significant difference in terms of platelet and platelet indices (MPV, PDW and PCT) between the fertile and infertile group. There were no between group differences in the RI values of the testicular- and intra-testicular artery. When all fertile and infertile participants were considered together, there was no statistically significant correlation between the parameters of the testicular artery blood flow (PSV, EDV and RI) and platelet and platelet indices (MPV, PDW and PCT) (P > 0.05). CONCLUSIONS: There is not statistically significant correlation between any of the following parameters: platelets and platelet indices such as MPV, PDW and PCT, RI of the testicular artery, and fertility.

Penile Mondor's Disease: Primum Non Nocere!

PURPOSE: Penile Mondor's disease (superficial thrombophlebitis of the dorsal vein of the penis) is a rare clinical diagnosis. It is an easily diagnosed and treated disease. Nevertheless, when reviewing the literature, we considered that unnecessary tests are carried out for diagnosis. In this study, we aimed to indicate the redundancy of Doppler ultrasonography for diagnosis of penile Mondor's disease. MATERIALS AND METHODS: Seven patients with the clinical presentation of penile Mondor's disease were included in the study. In the first two patients, penile Doppler ultrasonography was performed for diagnostic purposes by applying a vasoactive intracavernosal agent. This diagnostic procedure was not implemented in the next five patients. RESULTS: Physical examinations revealed cord-like thickening lesions on dorsal and dorsolateral penis. In the first two patients, who penile Doppler ultrasonography with an intracavernosal vasoactive agent was used for diagnostic purposes, was developed priapism. We did not use penile Doppler for more patients as this would be unethical according to us. CONCLUSION: Recovery from penile Mondor's disease is usually spontaneous and smooth. A simple physical examination is sufficient for diagnosis, and palliative treatment is effective. For the diagnosis of this disease, unnecessary tests should be avoided so that patients are not harmed.

The hounsfield unit value calculated with the aid of non-contrast computed tomography and its effect on the outcome of percutaneous nephrolithotomy.

To evaluate the effect of the Hounsfield unit (HU) value, calculated with the aid of non-contrast computed tomography, on the outcome of percutaneous nephrolithotomy (PCNL). Data for 83 patients evaluated in our clinic between November 2011 and February 2014 that had similar stone sizes, localizations, and radio opacities were retrospectively reviewed. The patients were grouped according to their HU value, in a low HU group (HU ≤ 1000) or a high HU group (HU > 1000). The two groups were compared based on their PCNL success rates, complications, duration of surgery, duration of fluoroscopy, and decrease in the hematocrit. There were no significant differences in terms of mean age, female-male ratio, or mean body mass index between the two groups (p > 0.05). The stone size and stone surface area did not differ significantly between the groups (p = 0.820 and p = 0.394, respectively). The unsuccessful PCNL rate and the prevalence of complications did not differ significantly between the two groups (p > 0.05). The duration of surgery, duration of fluoroscopy, and decrease in the hematocrit were significantly greater in the high HU group compared to the low HU group (p < 0.001). Calculating the HU value using this imaging method may predict cases with longer surgery durations, longer fluoroscopy durations, and greater decreases in hematocrite levels, but this value is not related to the success rate of PCNL.