Micro-RNA-371a-3p in Germ Cell Testicular Tumors on Diagnosis: A Prospective Case-Control Study in Turkish Population.

PURPOSE: We aimed to evaluate the diagnostic sensitivity and specificity of the miRNA-371a-3p for the primary diagnosis of germ cell tumors (GCT) and to investigate its relationship with pathological factors and clinical stage in the Turkish population. MATERIALS AND METHODS: In this prospective study, a total of 60 patients with GCTs, and 40 healthy male controls were examined for serum levels of miRNA-371a-3p before orchiectomy and again two weeks after surgery. The miRNA-371a-3p, alpha-fetoprotein (AFP), and beta-human chorionic gonadotropin (bHCG) levels in the preoperative and postoperative periods were compared at different clinical stages. Receiver operating characteristics curve analyses were performed to determine the sensitivity and specificity of miRNA-371a-3p. Clinical and pathological factors such as clinical stage (CS), tumor size, histology, rete testis invasion, and lymphovascular invasion, potentially impacting miRNA-371a-3p expression levels (relative quantity, RQ), were evaluated statistically. RESULTS: The sensitivity of miR-371a-3p in GCT patients was 98.3%, and the specificity was 95% (AUC = 0.997 [95%Cl:0.99-1], p < .001). miR-371a-3p expression was not detected in two patients with teratoma. The median miR-371a-3p RQ was 489 times in GCT and 2.2 times in the Control group (p < .001). In the postoperative period, there was a significant decrease in AFP and bHCG levels in all CS-1 (p = .01) and 30% of the other CS (p = .3). Throughout this time there was a decrease of 19 times at the miR-371a-3p RQ in CS-1(p < .001) and 1.6 times in the other CS (p < .001). The miR-371a-3p RQs were correlated with tumor size and CS. CONCLUSION: The miR-371a-3p seems to have higher diagnostic accuracy than classical serum tumor markers in GCT.

Observation and comparison of gas formation during holmium:YAG laser lithotripsy of cystine, uric acid, and calcium oxalate stones: a chromatographic and electron microscopic analysis.

The primary aim of the present in vitro study is to analyze the chemical content of the bubbles occurring during the fragmentation of cystine stones with both the high-power and low-power holmium:YAG (Ho:YAG) lasers. The secondary aim is to discuss their clinical importance. Three types of human renal calculi calcium oxalate monohydrate (COM), cystine, and uric acid were fragmented with both low-power and high-power Ho:YAG lasers in separate experimental setups at room temperature, during which time it was observed whether gas was produced. After laser lithotripsy, a cloudy white gas was obtained, after the fragmentation of cystine stones only. A qualitative gas content analysis was performed with a gas chromatography-mass spectrometry (GC-MS) device. The fragments in the aqueous cystine calculi setup were dried and taken to the laboratory to be examined by scanning electron microscopy with energy dispersive X-ray spectroscopy (SEM-EDX) and X-ray diffraction analysis. No gas production was observed after fragmentation in the COM and uric acid stones. Free cystine, sulfur, thiophene, and hydrogen sulfide gas were produced by both low-power and high-power Ho:YAG laser lithotripsy of the cystine stones. In the SEM-EDX mapping analysis, a free cystine molecule containing 42.8% sulfur (S), 21% oxygen (O), 14.9% carbon (C), and 21% nitrogen (N) atoms was detected in the cystine stone experimental setup. The evidence obtained, which shows that hydrogen sulfide emerges in the gaseous environment during Ho:YAG laser fragmentation of cystine stones, indicates that caution is required to prevent the risk of in vivo production and toxicity.

Female urinary incontinence on TikTok and YouTube: is online video content sufficient?

INTRODUCTION AND HYPOTHESIS: The objective of the study is to evaluate the reliability and quality of the most-viewed female urinary incontinence-related TikTok and YouTube posts. Our second goal is to analyze the differences in the quality and content of videos between these platforms. METHODS: We searched for the keyword "female urinary incontinence" on TikTok and YouTube on 1 March 2023. We sorted the videos that appeared out of searches for this keyword by "top" results on TikTok and by "relevance" on YouTube. We excluded the videos that were not in English, whose narrator was unclear, unrelated videos, advertising videos, and duplicate videos. In this study, we included the top 50 videos on both platforms that were directly related to female urinary incontinence. The characteristics of the videos, such as likes, video duration, views, and type of narrator (patient, physician, nonphysician practitioner, and health care company), and DISCERN scores were analyzed. RESULTS: We observed that the median view count (p<0.001) and the median video duration (p<0.001) were higher and longer respectively on YouTube than on TikTok. In addition, the median DISCERN score of these videos was higher on YouTube than on TikTok (p<0.001). Similarly, the overall quality of videos was higher on YouTube than on TikTok (p=0.002). Only in two TikTok and two YouTube videos have the narrators cited a reference. CONCLUSIONS: Our findings emphasize the present lack of high-quality content available on TikTok and YouTube from both health care and nonhealth care experts. To address this lack of information, health care providers, especially urologists, should take an active role in creating video content.

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.

Influencing factors of acute kidney injury following retrograde intrarenal surgery.

PURPOSE: To investigate the influencing factors of acute kidney injury (AKI) following retrograde intrarenal surgery (RIRS). METHODS: The data of patients who underwent RIRS for kidney stones between January 2018 and June 2022 at two tertiary centers were retrospectively analyzed. Demographic data of patients were obtained. According to kidney disease: Improving Global Outcomes (KDIGO) criteria, those with and without AKI were divided into two groups. Preoperative, intraoperative, and postoperative predictive factors of patients were investigated between the groups. In addition, the influencing factors of AKI were examined by multivariate analysis. RESULTS: This study included 295 (35.7%) women and 532 (64.3%) men. The mean age was 50.03 ± 15.4 years (range 18-89), and mean stone size was 15.5 ± 6.1 mm (range 6-47). Overall, 672 of patients (81.3%) were stone-free after the initial treatment. According to KDIGO, 110 of patients (13.3%) had AKI during the postoperative period. Univariate analysis showed that stone size (P = .003), previous stone surgery (P = .010), renal malformations (P = .017), high operative time (P = < .001), high preoperative creatinine value (P = .036), intraoperative complications (P = .018), and postoperative urinary tract infection (P = .003) had significant influence on the AKI after RIRS. Multivariate analysis excluded previous stone surgery, high preoperative creatinine value, renal malformations, and intraoperative complications from the logistic regression model, whereas other factors maintained their statistically significant effect on AKI, indicating that they were independent predictors. CONCLUSIONS: Stone size, operative time, postoperative urinary tract infection, and diabetes mellitus are significant predictors of AKI. During RIRS, urologists should consider the factors that increase the risk of AKI and evaluate the treatment outcomes based on these factors.

Digitalization and Urological Diseases: Severity of Cyberchondria and Level of Health Anxiety in Patients Visiting Outpatient Urology Clinics.

This study aimed to evaluate the cyberchondria levels of patients who applied to the urology outpatient clinic. The second goal of this study was to evaluate the relationship between cyberchondria severity and health anxiety in these patients. The present prospective observational study was conducted at the urology outpatient clinic of two tertiary centers in our city between September and December 2021. Eligible patients were the adult patients (>18 and ≤60 years) who used the Internet for health purposes and had no self-reported psychological or mental disease. The patients were divided into following groups according to their complaints: general urology, uro-oncology, andrology, functional urology, and endourology (stone disease). The level of cyberchondria and health anxiety was evaluated for these patients by using the Short Health Anxiety Inventory (SHAI) and a short-form version of the Cyberchondria Severity Scale (CSS-12). This study enrolled 578 patients (190 female, 388 male). The mean age of patients was 43.4 ± 13.3 years (18-60 years). The mean CSS-12 was 28.1 ± 12.1, and the mean value of SHAI was 18.9 ± 13.6. The patients had andrological symptoms, is uniquely related to higher CSS and health anxiety, and followed by uro-oncological diseases. However, the least relationship was observed in patients with functional urological diseases (analysis of variance [ANOVA], p < 0.001 for CSS-12; p < 0.001 for SHAI). In addition, a positive correlation was observed between the CSS and SHAI (Pearson's correlation = 0.782). The increased level of cyberchondria causes increased health anxiety and an increased disease burden in these patients. Therefore, physicians should consider this increased treatment burden during the treatment of patients.

The Role of Acidic Urine on Detrusor Pressure in Patients with Overactive Bladder: A Urodynamic Evaluation.

OBJECTIVES: To evaluate the relationship between urine pH value and urodynamic parameters in patients with overactive bladder. METHODS: The patients' data whose underwent standard urodynamic study at two tertiary centers in our city. The period between January 2015-January 2021 was reviewed retrospectively. The inclusion criteria were the patients with overactive bladder, over 18 years of age, and with urine analysis before urodynamic study. Patients were divided into two groups as those with acidic urine pH (Group 1) and without (Group 2). The detrusor pressures obtained from filling cystometry were compared between the groups. In addition, the correlation between detrusor pressure and urine pH was examined. RESULTS: The data from 211 patients (109 females, 102 males) were analyzed during the screening period. Eighty-two patients were in Group 1 and 129 patients in Group 2. The mean age was similar between the groups (p = 0.244). The bladder volume at first sensation of filling and urodynamic maximal bladder capacity was lower in Group 1 than Group 2 (p = 0.004; p < 0.001, respectively). The maximum detrusor pressure was higher in the acidic urine pH group (Group 1, 55.8 ± 20.6) than non-acidic urine pH group (Group 2, 14.5 ± 10.2), and it was statistically significant (p < 0.001). In addition, a significant negative correlation was observed between urine pH level and detrusor pressure (p < 0.001). CONCLUSIONS: The presence of acidic urinalysis is associated with many urodynamic findings. Significantly, the patients with detrusor overactivity had more acidic urine than without detrusor overactivity. Therefore, for patients with high detrusor pressure, urinalysis should be evaluated carefully.

The Role of Acidic Urine on Detrusor Pressure in Patients with Overactive Bladder: A Urodynamic Evaluation

Objectives: To evaluate the relationship between urine pH value and urodynamic parameters in patients with overactive bladder. Methods: The patients’ data whose underwent standard urodynamic study at two tertiary centers in our city. The period between January 2015–January 2021 was reviewed retrospectively. The inclusion criteria were the patients with overactive bladder, over 18 years of age, and with urine analysis before urodynamic study. Patients were divided into two groups as those with acidic urine pH (Group 1) and without (Group 2). The detrusor pressures obtained from filling cystometry were compared between the groups. In addition, the correlation between detrusor pressure and urine pH was examined. Results: The data from 211 patients (109 females, 102 males) were analyzed during the screening period. Eighty-two patients were in Group 1 and 129 patients in Group 2. The mean age was similar between the groups (p = 0.244). The bladder volume at first sensation of filling and urodynamic maximal bladder capacity was lower in Group 1 than Group 2 (p = 0.004; p < 0.001, respectively). The maximum detrusor pressure was higher in the acidic urine pH group (Group 1, 55.8 ± 20.6) than non-acidic urine pH group (Group 2, 14.5 ± 10.2), and it was statistically significant (p < 0.001). In addition, a significant negative correlation was observed between urine pH level and detrusor pressure (p < 0.001). Conclusions: The presence of acidic urinalysis is associated with many urodynamic findings. Significantly, the patients with detrusor overactivity had more acidic urine than without detrusor overactivity. Therefore, for patients with high detrusor pressure, urinalysis should be evaluated carefully (AU)

Visceral adiposity index in kidney stone patients who have undergone surgery.

Introduction: The visceral adiposity index (VAI) is a gender-specific metabolic index that indirectly measures visceral adipose function and distribution using waist circumference, body mass index (BMI), and triglyceride and high-density lipoprotein (HDL) cholesterol values. To assess visceral fat in the diagnostic pathway of urinary stone patients, we investigated the relationship between the VAI and nephrolithiasis as well as the relationship between the VAI and stone and surgery-related parameters. Material and methods: Patients who underwent percutaneous nephrolithotomy and retrograde intrarenal surgery for kidney stones were included in the study. The control group comprised of healthy individuals who volunteered to take part in study and did not have urolithiasis as confirmed by abdominal computed tomography imaging. A total of 148 patients were divided into the nephrolithiasis (n = 103) and the control (n = 45) groups. Weight, height, BMI, waist circumference measurements, and VAI were among the metabolic parameters measured. Stone and surgical parameters were evaluated. Results: VAI (4.57 vs 2.76), waist circumference (92.1 vs 87.1), and BMI (28.31 vs 26.51) values were higher in the nephrolithiasis group(p = 0.02,p = 0.04, p <0.001,respectively). The VAI was statistically significant in the multivariate analysis for the presence of nephrolithiasis (p <0.001). The VAI negatively correlated with the stone Hounsfield unit (HU) and positively correlated with very-low-density lipoprotein (VLDL), blood creatinine, and calcium levels. The relationship between VAI and surgical parameters was not significant. Conclusions: A significant relationship was detected between nephrolithiasis and VAI, a new gender-specific metabolic index that distinguishes between subcutaneous and visceral adipose mass and demonstrates metabolic syndrome. No significant effect of this relationship on surgical parameters was demonstrated in the present study.

Efficiency of retrograde intrarenal surgery in lower pole stones: disposable flexible ureterorenoscope or reusable flexible ureterorenoscope?

PURPOSE: The primary aim of this study to comparison of reusable and disposable flexible ureterorenoscope (fURS) efficiency in lower pole renal stone disease management. In addition, the secondary goal of this study was to evaluate the factors affecting stone-free rates (SFR) in lower pole stones. MATERIALS AND METHODS: A prospective case-control study utilizing data from 122 consecutive ureteroscopic cases. The patients were divided into two groups according to the ureterorenoscope employed in the surgical intervention as disposable fURS (Group1, n:52) and reusable fURS (Group 2, n:70). Demographic characteristics, stone size, infundibulopelvic angle (IPA), SFR, hospitalization time, intraoperative complication rate (CR), operative time, preoperative or postoperative JJ stenting, and postoperative CR were analyzed. RESULTS: There was no statistical difference between the demographic and renal stone-related data between the groups. Likewise, no difference is observed in term of intraoperative and postoperative outcomes such as fluoroscopy time, CR, and hospitalization time between the groups. Although SFR was higher in the disposable fURS group, there was no difference statistically. However, the operative time was longer in reusable fURS Group (47.02 ± 9.91 min in Group 1, and it was 57.97 ± 14.28 in Group 2) (p: 0.001). The multivariate regression analysis result to evaluate the factors of effect to operative time; the use of disposable fURS was associated with a 10.95-min decrease in procedure duration (p < 0.001). CONCLUSIONS: Disposable fURS and reusable fURS have similar clinical efficiency and complication rates in the treatment of lower calyceal stones with RIRS. Nevertheless, disposable fURS is a useful treatment option for increased stone volume due to the advantages such as shorter operative time.

Is erectile dysfunction related to self-esteem and depression? A prospective case-control study.

Sexual activity is important role in life of men. Decreased sexual function has a negative impact on the quality of life of the patients and their partners. In this study, we aimed to evaluate the relationship of erectile dysfunction (ED) with self-esteem, symptom severity and depression. The 80 patients were evaluated prospectively. Group 1 (cases group) included 40 patients who with ED an age range of up to 18-70 years. Group 2 (healthy control group) included 40 patients who apply to the urology clinic for various reasons without ED. All patients were filled international index of erectile function-5 (IIEF-5), Beck Depression questionnaire (BDI-2) and Rosenberg self-esteem questionnaires (RESQ). Demographic characteristics and inventory results of the patients were compared between the two groups. Significant differences were found between the two groups in IIEF-5, RESQ and BDI-2 scores. In Group 1, IIEF-5 score was low, RESQ, BDI-2 scores were significantly higher (All scores p < 0.001). As a result people significantly reflect their sexual satisfaction in their social life. The patients with mild ED are not entirely satisfied in spite of normal sexual frequency. This situation causes significantly low the self-esteem of men. Prevention of ED will contribute to increased self-esteem and happy lives.

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.

Efficiency of intracavernosal alprostadil and oral clomiphene citrate combination treatment in penile vasculogenic erectile dysfunction patients accompanied by late-onset hypogonadism.

In this study, the efficiency of intracavernosal alprostadil + oral clomiphene citrate (CC) treatment in late-onset hypogonadism (LOH) accompanied by penile vasculogenic erectile dysfunction (PVED) in patients irresponsive to phosphodiesterase type 5 inhibitor treatment was evaluated. A total of 31 patients with concurrent PVED and LOH were included in the study. The patients were given intracavernosal alprostadil (10-20 µg) and oral CC (50 mg) every day for 12 weeks. Before and after treatment, a 15-question International Index of Erectile Function (IIEF-15) questionnaire, Erection Hardness Score (EHS), Sexual Encounter Profile (SEP)2 and SEP3 levels were analysed, and follicle stimulating hormone (FSH), luteinising hormone (LH), total testosterone and prostate-specific antigen (PSA) levels were measured. In all, 41.9% of patients had pure arterial deficiency, 19.3% had pure venous deficiency, and 38.7% had arterial + venous (mixed) deficiency. A significant increase was detected in total testosterone, FSH, LH and PSA values after treatment when compared to values before treatment (p < .001, p < .001, p < .001 and p = .034 respectively). A significant recovery was observed in IIEF-15 subscores, EHS and SEP2-SEP3 results. In PVED patients accompanied by LOH, intracavernosal alprostadil and oral CC combination is an efficient, low cost, safely applicable and tolerable 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.