A Case of Primary Renal Allograft Dysfunction Caused by Missed Monoclonal Disease.

We present an unusual etiology of primary renal allograft dysfunction attributed to myeloma cast nephropathy in a patient with no history of multiple myeloma before kidney transplant. The patient, a 54-year-old woman, had been on hemodialysis for 6 months before transplant for presumed diabetic nephropathy; she developed graft dysfunction immediately after transplant. Graft biopsy specimens were consistent with myeloma cast nephropathy, and she was treated with bortezomib, cyclophosphamide, and dexamethasone. She achieved a complete hematological response and regained excellent graft function 3 months after transplant. The patient then received autologous stem cell transplant 8 months after kidney transplant. To our knowledge, this is the second report of a successful graft outcome after chemotherapy and the first report treated with autologous stem cell transplantation after remission of monoclonal disease.

Management of urological injuries following gynecologic and obstetric surgery: A retrospective multicenter study.

OBJECTIVE: Urinary system injuries may occur iatrogenically during some surgical procedures especially gynecological and obstetrical surgeries. Unfortunately, these injuries can lead to serious complications in patients. In this multicentric study, we aimed to review and report our experiences and results of urinary tract injuries identified during gynecological and obstetrical surgery. METHODS: We included women with urinary tract injuries during gynecological and obstetrical surgeries between January 2018 and October 2023 at four centers. Detailed data collected include patient demographics, surgical details, injury characteristics, diagnostic and treatment methods, timing of injury diagnosis and management reports of the patients. The incidence of bladder and ureter injuries was evaluated and the rate of intraoperative urological consultations was recorded. RESULTS: In a total of 328 patients with a median age of 47 years (24-90), urinary tract injuries were diagnosed, including 227 (69.2%) iatrogenic bladder injuries (IBI) and 101 (30.8%) iatrogenic ureteral injuries (IUI). These injuries were diagnosed in 299 patients (91.2%) during surgery and in 29 patients (8.8%) after the surgical procedure. We observed intraoperative detection rates of 71.9% for IBI and 28.1% for IUI. IBI (71.9%) was diagnosed significantly more frequently than IUI (28.1%) (p=0.001). Cesarean section resulted in significantly more frequent IBI, whereas tumor debulking surgeries resulted in more IUI (n=52, 56.5%) than the other types of procedures (p<0.001). CONCLUSION: Our study provides a comprehensive overview of iatrogenic urological injuries during gynecological and obstetrical surgeries. Although the bladder is the most frequently injured organ during gynecological and obstetric surgeries, early diagnosis and urological intervention are mandatory to prevent delayed complications. Surgeons must have a thorough understanding of the pelvic anatomy and appropriate surgical techniques to prevent iatrogenic injuries during surgery and ensure timely diagnosis and treatment of urinary tract injuries.

Growth kinetics and predictive factors in renal angiomyolipomas.

BACKGROUND: Although renal angiomyolipomas (AMLs) are benign lesions, they can grow and cause serious complications. In this study, we aimed to determine the factors affecting the growth of renal AMLs. METHOD: Patients followed up for AMLs between January 2014 and January 2024 were screened. By accepting 2.5 mm/year as the limit for a significant growth rate, the patients were divided into two groups: those with and without significant growth. Demographic characteristics, tumor characteristics, and laboratory parameters, platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and aspartate aminotransferase-to-alanine aminotransferase (De Ritis) ratio, were compared between the groups. RESULTS: The study included a total of 98 patients. Of the entire cohort, 78.6% were women. Significant growth was detected in nine (9.2%) patients. Multivariate analysis revealed that the baseline scan tumor size, PLR, and De Ritis ratio were significant independent predictors of significant AML growth (p = 0.011, p = 0.017, and p = 0.030, respectively). In the receiver operating characteristic curve analysis, the cut-off value of PLR in predicting significant growth was 131.85 (sensitivity: 77.8%, specificity: 73%, area under the curve [AUC] 0754), while the cut-off value of the De Ritis ratio was 1.33 (sensitivity: 66.7%, specificity: 95.8%, AUC 0.721). CONCLUSION: Tumor size at the time of initial diagnosis, as well as PLR and De Ritis ratio, were found to be independent predictors of AML growth rate. The use of these factors in patient follow-up has the potential to assist clinicians in predicting tumor growth and related complications.

The Status of Spermatogenesis in Germ Cell Tumor Bearing Testis and Its Association with Metastatic Disease.

INTRODUCTION: We aimed to evaluate the status of spermatogenesis detected by histological examination of non-tumoral testicular tissues in tumor bearing testis and its association with advanced stage disease. PATIENTS AND METHODS: We retrospectively reviewed patients with testicular germ cell tumors (TGCTs) that undergone radical orchiectomy. All non-tumoral areas of the orchiectomy specimens were examined for the status of spermatogenesis. Patients were divided into two groups as localized (stage I) and metastatic (stage II-III) disease and analyzed separately for seminomatous (SGCT) and nonseminomatous germ cell tumors (NSGCT). RESULTS: Four hundred fifty-four patients were included in our final analysis. Of those, 195 patients had SGCT, and 259 patients had NSGCT. Three hundred and six patients had localized disease at the time of diagnosis. Median (Q1-Q3) age was 31 (26 - 38) years and 102 (22.5%) patients had normal spermatogenesis, 177 (39.0%) patients had hypospermatogenesis and 175 (38.5%) patients had no mature spermatozoa. On multivariate logistic regression analysis, embryonal carcinoma >50% (1.944, 95 %CI 1.054-3.585, P = .033) and spermatogenesis status (2.796 95% CI 1.251-6.250, P = .012 for hypospermatogenesis, and 3.907, 95% CI 1.692-9.021, P = .001 for absence of mature spermatozoa) were independently associated with metastatic NSGCT. However, there was not any variables significantly associated with metastatic SGCT on multivariate logistic regression analysis. CONCLUSION: Our study demonstrated that only 22.5% of patients with TGCTs had normal spermatogenesis in tumor bearing testis. Impaired spermatogenesis (hypospermatogenesis or no mature spermatozoa) and predominant embryonal carcinoma are associated with advanced stage NSGCT.

Effect of constipation on acute urinary retention following transrectal prostate biopsy.

PURPOSE: To evaluate the possible effect of constipation on the acute urinary retention (AUR) after transrectal ultrasound-guided prostate biopsy (TRUS PB). MATERIALS AND METHODS: A total of 1,167 patients with prostate-specific antigen (PSA) >4 ng/mL and/or abnormal digital rectal examination underwent a standard 12 core transrectal ultrasound-guided prostate needle biopsy in our hospital and the findings were examined prospectively. Chronic constipation (CC) was defined according to the Rome IV criteria. All cases were well evaluated with respect to clinical-histopathological factors; International Prostate Symptom Score (IPSS), prostate volume, post-void residue, age, body mass index, histopathological inflammation, and AUR. RESULTS: The mean age of patients was 64.63±8.31 years, the PSA level was 11.60±16.83 ng/mL, and the prostate volume was 54.66±25.44 mL. In 265 cases (22.7%), CC anamnesis was present and AUR developed in 28 (2.4%) of the cases. In the multivariate analysis for the risk of developing urinary retention, prostate volume, pre-operative IPSS, and presence of CC requiring manual maneuvers to facilitate defecation were found to be risk factors (p=0.023, 0.010, and 0.001, respectively). CONCLUSIONS: Our findings demonstrated that CC may be a critical factor in the prediction of AUR formation following TRUS PB.

Ultrapreservation in Robotic Assisted Radical Prostatectomy Provides Early Continence Recovery.

Background and Objectives: We aimed to evaluate oncological and functional results of the ultrapreservation anterior-sparing technique in patients with localized prostate cancer. Methods: In this single-center study, patients with low to intermediate risk prostate cancer, who were treated with the ultrapreservation anterior-sparing technique, were included retrospectively. The oncological and functional outcomes were recorded. After the functional and pathological evaluation in the first month, patients' prostate-specific antigen levels were followed, as well as continence and potency status bimonthly for one year. Continence is defined as no leakage and zero pads for security. Patients' potency was evaluated using the Sexual Health Inventory for Men, with ≥ 17 considered potent. Results: A total of 118 patients were included in the study. The pathological stage was pT2 in 78% (n = 92) of patients, with pT3 in 22% (n = 26). Surgical margin positivity occurred in 13.5% (n = 16) of patients. No complications were observed intraoperatively. Continence rates were 25.4% after catheter removal, rising to 88.9% in the first month, 91.5% in the third, 93.2% in the fifth, and 95.7% a year later. Thirty-five (40%) of 86 potent patients were potent in the first postoperative month, 48 patients (55.8%) were potent in the third month, and 58 patients (67.4%) were potent in the twelfth. The total complication rate was 8.4%, with no major complications observed. Conclusion: The ultrapreservation anterior-sparing technique for patients with prostate cancer shows safe, acceptable functional and oncological results in short-term follow-up. However, long-term comparative studies with a larger number of patients are needed.

Quality of life is improved after urethroplasty in women with urethral stricture.

INTRODUCTION AND HYPOTHESIS: To evaluate the quality of life (QoL) in women who underwent urethroplasty for urethral stricture. METHODS: Twenty-two women who underwent ventral labium minus graft urethroplasty were included. Patients were assessed with uroflowmetry, urethral caliber and post-voiding residual urine (PVR). American Urological Association (AUA) symptom score, Urogenital Distress Inventory (UDI)-6 and Short Form-36 (SF-36) were used to evaluate QoL. Preoperative values were compared with patients' last visit data. The cure of the surgery was defined as a maximum flow rate > 15 ml/s in uroflowmetry and no need for any further intervention. RESULTS: Median age was 55 (40-66) years. Cure was achieved in 20 (90.3%) patients with median 37 (13-52) months follow-up duration. The median Qmax increased from 4 (0-5) ml/s to 27.5 (8-55) ml/s (p < 0.001). Median post-void residual volume (PVR) decreased from 52.5 (0-120) ml to 20(0-60) ml (p = 0.011). Both AUA symptom score [from median 30 (24-35) to 4.5 (0-20), p < 0.001] and AUA-QoL score [from median 5 (4-6) to 0(0-3), p < 0.001] decreased after surgery. Median UDI summary score at the last follow-up was 0 (0-44.4), which was 33.3 (22.2-61.05) at baseline visit. Improvement was observed in all domains except the 'Energy/Fatigue' domain of the SF-36. CONCLUSIONS: Urethroplasty is an effective surgical method to improve patients' QoL which is impaired because of female urethral stricture.

The Role of CO-RADS Scoring System in the Diagnosis of COVID-19 Infection and its Correlation with Clinical Signs.

BACKGROUND: Computed tomography (CT) evaluation systematics has become necessary to eliminate the difference of opinion among radiologists in evaluating COVID-19 CT findings. INTRODUCTION: The objectives of this study were to evaluate the efficiency of CO-RADS scoring system in our patients with COVID-19 as well as to examine its correlation with clinical and laboratory findings. METHODS: The CO-RADS category of all patients included in the study was determined by a radiologist who did not know the rtRT-PCR test result of the patients, according to the Covid-19 reporting and data system of Mathias Prokop et al. Results: A total of 1338 patients were included. CT findings were positive in 66.3%, with a mean CO-RADS score of 3,4 ± 1,7. 444 (33.1%) of the patients were in the CO-RADS 1-2, 894 (66.9%) were in the CO-RADS 3-5 group. There were positive correlations between CO-RADS score and age, CMI, hypertension, diabetes mellitus, chronic pulmonary diseases presence of symptoms, symptom duration, presence of cough, shortness of breath, malaise, CRP, and LDH, while CORADS score was negatively correlated with lymphocyte count. The results of the ROC analysis suggested that those with age ≥40 years, symptom duration >2 days, CMI score >1 and/or comorbid conditions were more likely to have a CO-RADS score of 3-5. CONCLUSION: The CO-RADS classification system is a CT findings assessment system that can be used to diagnose COVID-19 in patients with symptoms of cough, shortness of breath, myalgia and fatigue for more than two days.

The effect of interleukin-6 level at the time of hospitalisation on erectile functions in hospitalised patients with COVID-19.

We evaluated the relationship between erectile dysfunction (ED) and IL-6 levels in males with COVID-19. The study included 80 male patients aged 30-45 years who were hospitalised due to COVID-19. The International Index of Erectile Function (IIEF-5) questionnaire was used to assess erectile function. The IIEF-5 questionnaire was re-administered at a 3-month control visit after discharge, and the change score from baseline was recorded. The patients were divided into three groups according to the IIEF-5 score at 3 months as Group 1 (severe ED), Group 2 (moderate ED) and Group 3 (no ED), and into two groups according to IL-6 level at the time of admission as Group A (IL-6 ≤ 50 ng/ml) and Group B (IL-6 > 50 ng/ml). The change in the IIEF-5 score (p < .001) was significantly greater in Group B than in Group A. There was also significant difference in IL-6 between Group 1 and Group 2 (p = .008). The correlation analysis revealed a moderate correlation between IL-6 level and the change in IIEF-5 score and D-dimer level (r:0.529, p < .001) and a weak correlation between IL-6 level and FSH (r:0.309, p = .005). The present study suggests that elevated IL-6 levels in male patients hospitalised due to COVID-19 might be related to the risk of developing ED.

Infectious complications after transrectal prostate biopsy is increased in patients with chronic idiopathic constipation / Las complicaciones infecciosas tras la biopsia prostática transrectal aumentan en pacientes con estreñimiento idiopático crónico

Objetive: This study aims to compareinfectious complications after a prostate biopsy in patients with or without chronic idiopathic constipation(CIC). Methods: Six hundred and sixty-three patients whounderwent a transrectal ultrasound-guided biopsy (TRUSBx) of the prostate between 2012 and 2018 wereevaluated prospectively. Patients were divided into twogroups according to their CIC status and monitored forcomplications. CIC was defined by the Rome III criteria.Multivariate analysis was performed to assess the riskfactors. Results: Thirty-five patients (5.8%) developed a urinarytract infection (UTI) while sepsis occurred in only threecases (0.5%). CIC was found as a risk factor for infection. Infection occurred in 18.1% of the men with CICcompared to 2.3% of those without CIC (p=0.001).Sepsis occurred in 1.4% of the men with CIC comparedto vs 0.2% of those without CIC (p=0.68). In multivariateanalysis, CIC (OR of 9.27 and 95% CI 4.40-19.54,p<0.05) and Diabetes Mellitus (OR of 3.11 and 95%CI 1.52-6.36, p=0.002) were associated with an increased risk factor of UTI and sepsis. Conclusions: We demonstrated that CIC is an important risk factor of infection after a prostate biopsy.Prevention is important to minimize complications afterthis very common worldwide procedure.(AU)

Objetivo: Este estudio tiene como objetivo comparar las complicaciones infecciosas después deuna biopsia de próstata en pacientes con o sin estreñimiento idiopático crónico (CIC). Métodos: Se evaluó prospectivamente a seiscientos sesenta y tres pacientes que se sometieron a una biopsiade próstata guiada por ecografía transrectal (TRUS-Bx)entre 2012 y 2018. Los pacientes se dividieron en dosgrupos según su estado CIC y se monitorizaron paradetectar complicaciones. El CIC fue definido por loscriterios de Roma III. Se realizó un análisis multivariadopara evaluar los factores de riesgo. Resultados: Treinta y cinco pacientes (5,8%) desarrollaron una infección del tracto urinario (ITU), mientrasque la sepsis se produjo en sólo tres casos (0,5%). CICse encontró como un factor de riesgo de infección. Lainfección ocurrió en el 18,1% de los hombres con CICen comparación con el 2,3% de los que no tenían CIC(p=0,001). La sepsis ocurrió en el 1,4% de los hombres con CIC en comparación con el 0,2% de los queno tenían CIC (p=0,68).En el análisis multivariado, CIC (OR de 9,27 e IC del95% 4,40-19,54, p <0,05) y Diabetes Mellitus (OR de3,11 e IC del 95% 1,52-6,36, p=0,002) se asociaroncon un mayor factor de riesgo de ITU y septicemia. Cnclusión: Demostramos que la CIC es un factor de riesgo importante de infección después de unabiopsia de próstata. La prevención es importante paraminimizar las complicaciones después de este procedimiento muy común en todo el mundo.(AU)

Infectious complications after transrectal prostate biopsy is increased in patients with chronic idiopathic constipation. / Las complicaciones infecciosas después de biopsia próstata transrectal están incrementadas en pacientes con estreñimiento crónico idiopático.

OBJECTIVE: This study aims to compare infectious complications after a prostate biopsy in patients with or without chronic idiopathic constipation (CIC). METHODS: Six hundred and sixty-three patients who underwent a transrectal ultrasound-guided biopsy (TRUSBx) of the prostate between 2012 and 2018 were evaluated prospectively. Patients were divided into two groups according to their CIC status and monitored for complications. CIC was defined by the Rome III criteria. Multivariate analysis was performed to assess the risk factors. RESULTS: Thirty-five patients (5.8%) developed a urinary tract infection (UTI) while sepsis occurred in only three cases (0.5%). CIC was found as a risk factor for infection. Infection occurred in 18.1% of the men with CIC compared to 2.3% of those without CIC (p=0.001). Sepsis occurred in 1.4% of the men with CIC compared to vs 0.2% of those without CIC (p=0.68). In multivariate analysis, CIC (OR of 9.27 and 95% CI 4.40-19.54, p<0.05) and Diabetes Mellitus (OR of 3.11 and 95% CI 1.52-6.36, p=0.002) were associated with an increased risk factor of UTI and sepsis. CONCLUSIONS: We demonstrated that CIC is an important risk factor of infection after a prostate biopsy. Prevention is important to minimize complications after this very common worldwide procedure.

OBJETIVO: Este estudio tiene como objetivo comparar las complicaciones infecciosas después de una biopsia de próstata en pacientes con o sin estreñimiento idiopático crónico (CIC).MÉTODO: Se evaluó prospectivamente a seiscientos sesenta y tres pacientes que se sometieron a una biopsia de próstata guiada por ecografía transrectal (TRUS-Bx) entre 2012 y 2018. Los pacientes se dividieron en dos grupos según su estado CIC y se monitorizaron para detectar complicaciones. El CIC fue definido por los criterios de Roma III. Se realizó un análisis multivariado para evaluar los factores de riesgo. RESULTADOS: Treinta y cinco pacientes (5,8%) desarrollaron una infección del tracto urinario (ITU), mientras que la sepsis se produjo en sólo tres casos (0,5%). CIC se encontró como un factor de riesgo de infección. La infección ocurrió en el 18,1% de los hombres con CIC en comparación con el 2,3% de los que no tenían CIC (p=0,001). La sepsis ocurrió en el 1,4% de los hombres con CIC en comparación con el 0,2% de los que no tenían CIC (p=0,68).En el análisis multivariado, CIC (OR de 9,27 e IC del 95% 4,40-19,54, p <0,05) y Diabetes Mellitus (OR de 3,11 e IC del 95% 1,52-6,36, p=0,002) se asociaron con un mayor factor de riesgo de ITU y septicemia.CONCLUSIÓN: Demostramos que la CIC es un factor de riesgo importante de infección después de una biopsia de próstata. La prevención es importante para minimizar las complicaciones después de este procedimiento muy común en todo el mundo.

Impact of delay in cystoscopic surveillance on recurrence and progression rates in patients with non-muscle-invasive bladder cancer during the COVID-19 pandemic.

PURPOSE: To evaluate the impact of delay in cystoscopic surveillance on recurrence and progression rates in non-muscle-invasive bladder cancer (NMIBC). MATERIALS AND METHODS: A total of 407 patients from four high-volume centres with NMIBC that applied for follow-up cystoscopy were included in our study prospectively. Patients' demographics and previous tumour characteristics, the presence of tumour in follow-up cystoscopy, the pathology results of the latest transurethral resection of bladder tumour (if tumour was detected) and the delay in cystoscopy time were recorded. Our primary outcomes were tumour recurrences detected by follow-up cystoscopy and progression. Multivariate logistic regression analysis was performed using the possible factors identified with univariate analyses (P values ≤ .2). RESULTS: A total of 105 patients (25.8%) had tumour recurrence in follow-up cystoscopy, and 20 (5.1%) of these patients had disease progression according to grade or stage. In multivariate analysis, the number of recurrences (OR: 1.307, P < .001) and the cystoscopy delay time (62-147 days, OR: 2.424, P = .002; >147 days, OR: 4.883, P < .001) were significant risk factors for tumour recurrence on follow-up cystoscopy; the number of recurrences (OR: 1.255, P = .024) and cystoscopy delay time (>90 days, OR: 6.704, P = .002) were significant risk factors for tumour progression. CONCLUSIONS: This study showed that a 2-5 months of delay in follow-up cystoscopy increases the risk of recurrence by 2.4-fold, and delay in cystoscopy for more than 3 months increases the probability of progression by 6.7-fold. We suggest that cystoscopic surveillance should be done during the COVID-19 pandemic according to the schedule set by relevant guidelines.

The first kidney transplantation after recipient and living donor recovered from COVID-19.

SARS-CoV-2 is still a major threat to the world. In this pandemic, transplantation activities have largely been affected worldwide. We are still facing with this pandemic; however, after regulations, we have started our transplantation activities. We report the first kidney transplantation whose recipient and living donor recovered from COVID-19. A 31-year-old male with renal failure was admitted for transplantation with an ABO-compatible relative. The recipient and the donor were tested for COVID-19 before transplantation, and they were both positive with a polymerase chain reaction. The recipient had minor symptoms and received therapy; the living donor also received therapy. Thirty days after recovery, surgery was performed successfully. The recipient was discharged with mycophenolate mofetil (MMF), tacrolimus, and steroid 15 days after surgery. In the follow-up, they were both negative for COVID-19 45 days after surgery. Although there is missing literature regarding safety concerns and short-term follow-up, living-donor transplantation may be considered for patients, who recovered from COVID-19, after careful selection with paying attention to precautions.

The clinical impact of the COVID-19 pandemic on daily urological practice: first 3-month multicenter results from Istanbul

Background/aim: The aim of this paper was to determine the general tendencies of urology patients and effect of COVID-19 pandemic on daily urological practice at tertiary centers located in the most affected area in Turkey. Materials and methods: We retrospectively analyzed the data of 39,677 patients (group 1) that applied to 6 different large-volume tertiary centers in Istanbul for outpatient consultation, surgery, or other procedures in the 3-month period between March 16 and June 14, 2020. The distribution of the number of patients who applied to subspecialty sections of urology outpatient clinics and inpatient services were recorded by weeks. That data was compared to data obtained from 145,247 patients that applied to the same centers in the same period of the previous year (group 2). The reflection of worldwide and Turkish COVID-19 case distribution on the daily urological practice was analyzed. Results: There was a decrease in the number of patients in all subspecialty sections the in group 1 compared to group 2; however, there was a significant proportional increase in urooncology and general urology admissions. A decrease of approximately 75% was observed in the total number of surgeries (p < 0.001). We detected a negative correlation between the numbers of admission to all outpatient clinics and COVID-19 cases or deaths in Turkey (p < 0.05). The same negative correlation was present for all surgical procedures and consultations (p < 0.05). The multivariate linear regression analysis revealed that the number of cases in Turkey, and the number of deaths worldwide affect the number of outpatient clinic admissions (R2 = 0.38, p = 0.028) and urological surgery (R2 = 0.33, p = 0.020) in Turkey negatively. Conclusion: This novel pandemic has implications even for urology practice. Urological surgical procedures were more affected by COVID-19-related deaths in Turkey and worldwide. Outpatient admissions and urological surgeries decreased significantly by increasing COVID-19 case numbers in Turkey and worldwide deaths.

Papillary vs non-papillary access during percutaneous nephrolithotomy: Retrospective, match-paired case-control study.

OBJECTIVE: The most crucial steps of percutaneous nephrolithotomy (PCNL) are the percutaneous access and dilation of the access route. Recent literature suggests that papillary access to renal calyx is the accepted method. Despite this rule, we do not always make papillary puncture and we puncture wherever we can to achieve stone-free status and reduce unnecessary access. In this study, we present our results with papillary vs non-papillary access in patients with a kidney stone. MATERIAL AND METHODS: Two hundred and seven patients with non-papillary access and 69 patients with papillary access who had similar demographics (age, body mass index (BMI), stone size) were selected with pair match analysis (3:1). Preoperative and postoperative data were collected from the patient's chart. Operative time (from starting surgery to nephrostomy tube), drop-in hematocrit level, transfusion rate, duration of hospital stay, perioperative and postoperative complications (Clavien-Dindo Classification) and stone-free status (no or < 3 mm residual stone) were also evaluated in both groups. RESULTS: The mean operative time was similar in between two groups. The mean hematocrit decreases not differ between the two groups (p = 0.56). In papillary group, only 2 patients (3.2%) required transfusion and only one patient (1.4%) in the non-papillary group had a transfusion with no statistically significant difference (p = 0.43). The overall complication rates were 7.1% in the papillary group and 7.2% in the non-papillary group (p = 0.89). Postoperative mean creatinine level was similar between the two groups.  Conclusions: In this study, we found that non-papillary access is a feasible option for PCNL in the terms of stone-free status and complication rates.

Comparison of surgical, oncological, and functional outcomes of robot-assisted and laparoscopic radical prostatectomy in patients with prostate cancer.

OBJECTIVE: To compare the oncological and functional outcomes of robot-assisted radical prostatectomy (RARP) and laparoscopic radical prostatectomy (LRP). MATERIAL AND METHODS: We compared patients who underwent the RARP (n=778) and LRP (n=48) techniques for prostate cancer between January 2008 and July 2017 in our clinic. Patient demographics, preoperative and postoperative data, pathologic evaluation, continence, and potency rates were collected and analyzed retrospectively. RESULTS: The preoperative and demographic data of the patients we included in our study were similar. The mean operation time estimated blood loss, length of hospitalization, and catheterization time were significantly shorter in the RARP group. The statistical analysis was in favor of robotic prostatectomy in the terms of the mean length of hospitalization, catheterization time, and early (<30 days) and intermediate (31-90 days) complications. Positive surgical margins and biochemical recurrence rates, and recovery of continence and erectile function, were similar in both groups. CONCLUSION: RARP and LRP in organ-confined prostate cancer are safe and effective methods. Robotic prostatectomy has a shorter operative time, length of hospitalization, catheterization time, and lower early and late complication rates.

Association between sarcopenia and erectile dysfunction in males with type II diabetes mellitus.

BACKGROUND: The prevalence rates for both sarcopenia and erectile dysfunction (ED) gradually increase in middle-aged and elderly diabetic male population and they impair physical functioning, sexual functioning, and quality of life. The aim of the present study was to evaluate the sarcopenia in patients with diabetic ED. METHODS: The study included 98 male patients with type II diabetes mellitus (DM) aged 18-80 years. Blood chemistry and hormone levels were obtained. The International Index of Erectile Function (IIEF-5) questionnaire was administered to the patients. The patients were divided into three groups according to the IIEF-5 score; a score of 5-10 points indicated severe ED, a score of 11-20 indicated moderate ED, and a score of 21-25 points indicated no ED. The muscle mass, handgrip strength, timed up and go test, upper mid-arm circumference, calf circumference, and body mass index were obtained. The statistical analysis was performed using MedCalc Statistical Software version 12.7.7. All parameters were compared between the three groups. RESULTS: Of 98 patients included in the study, 84 patients had severe sarcopenia, 13 had moderate sarcopenia, while only one patient had normal muscle mass. The mean age was 56.59 ± 11.46 years. When patients were divided into three groups according to IIEF-5 score, 38 had severe ED, 39 had moderate ED, and 21 had no ED. There was a significant difference between the three groups in terms of handgrip strength, timed up and go test scores, upper mid-arm circumference, and calf circumference (p < .05 for all). CONCLUSIONS: Although muscle mass remains unchanged, muscle strength and physical performance decrease in diabetic ED patients. Diabetic patients with severe and moderate ED have lower muscle strength and physical performance.

Safety and efficacy of PNL vs RIRS in the management of stones located in horseshoe kidneys: A critical comparative evaluation.

AIM: To assess the efficacy and safety of two different techniques (Percutaneous nephrolithotomy (PNL) vs Retrograde intrarenal surgery (RIRS)) in the management of stones in patients with horseshoe kidneys (HSK). PATIENTS AND METHODS: Departmental files of 88 cases with radiopaque kidney stones in horseshoe kidneys undergoing two different approaches (PNL vs RIRS) were evaluated with respect to the success and complication rates of in a retrospective manner. In addition to the factors related with the procedures (success and complication rates, additional procedures), patient and stone characteristics were all well evaluated. Findings obtained in both groups were evaluated in a comparative manner with respect to the statistical significance. RESULTS: Stone free rates were comparable in both groups after 1-week period (81.6% PNL vs 80% RIRS). As well as 3 months evaluation (84.2% PNL and 82.0% RIRS). The percentage of the cases with residual fragments (> 4 mm) were similar in both groups and while all PNL procedures were completed in one session, mean number of RIRS sessions was higher (1.22 ± 0.05). Mean duration of the procedure was slightly higher in RIRS group and based on Clavien scoring system, despite a higher risk of Hb drop noted in patients treated with PNL, all complication rates were found to be similar in both groups. CONCLUSION: Our results demonstrate that of the available minimally invasive treatment alternatives, both PNL and RIRS could be safe and effective alternatives for renal stone removal in patients with HSK.

Analysis of Six Orthodontic Journals in Science Citation Index and Science Citation Index Expanded: A Bibliometric Analysis.

OBJECTIVE: To analyze the article type, origin, main affiliation, number of publications, authors, and affiliations of six orthodontic journals during two intervals of 5 years each (2006-2010 and 2011-2015). METHODS: In total, 4879 articles examined in this study were screened online at the individual journal's website. The types of articles and their authorship characteristics in the six orthodontic journals [three journals indexed by Science Citation Index (SCI) and the others indexed by Science Citation Index Expanded (SCIE)] were recorded. Parameters were tested using the Pearson chi-square for independence at a 0.05 level of significance. RESULTS: Among all the article types, research articles were the most published in the orthodontic journals indexed by SCI and SCIE in the first (2006-2010; 88.1% and 77.6%, respectively) and second periods (2011-2015; 84.4% and 74.6%, respectively). In the first and second intervals, the European Union was the most common origin among articles accepted by the journals listed in SCI (30.1% and 29.2% respectively), whereas Asia/Oceania was the common origin among articles accepted by the journals listed in SCIE (44.1% and 43.4%, respectively). CONCLUSION: The articles published in the orthodontics journals listed under SCI and SCIE for 2006-2010 and 2011-2015 were significantly different in terms of numbers and characteristics.

The relationship between vitamin D level and erectile dysfunction in patients with type 2 diabetes mellitus.

Recent studies have suggested that a relationship could exist between 25-hydroxyvitamin D [25(OH)D] deficiency and erectile dysfunction (ED). The present study evaluated the relationship between 25(OH)D levels and ED in male patients with type 2 diabetes mellitus (DM). The study included 98 patients with type 2 DM aged between 18-80 years. The International Index of Erectile Function (IIEF-5) Questionnaire was administered. The patients were divided into three groups according to IIEF-5 scoring: IIEF-5 score between 5-10, severe ED; IIEF-5 score between 11-20, moderate ED; IIEF-5 score between 21-25, no ED. Biochemical parameters, 25(OH)D and hormonal analysis tests were obtained in all patients. All parameters were compared between these three groups. Of 98 patients included in the study, 32 had severe ED, 45 had moderate ED and 21 had no ED. The mean age was 55.12 ± 9.39 years and the mean 25(OH)D level was 13.69 ± 8.15 ng/ml. When the three groups were compared, 25(OH)D levels were significantly lower in patients with the IIEF-5 score between 5-10 (p = 0.020). There was a moderate positive relationship between IIEF-5 score and 25(OH)D level (r = 0.21, p = 0.038). The patients with severe ED have considerably lower 25(OH)D levels.