Effect of different alpha-receptor antagonists on metabolic parameters: a head-to-head comparison.

PURPOSE: Although it is known that alpha-adrenergic receptor antagonists have positive effects on metabolic parameters such as glucose metabolism, lipid profile, and insulin sensitivity, it is unclear whether this is a class effect. Tamsulosin is reported to have adverse effects on glucose metabolism and insulin resistance, and this may be because of its lack of glycolysis-enhancing effect compared with other alpha-adrenergic receptor antagonists with glycolysis-enhancing effects such as doxazosin, terazosin, and alfuzosin. The aim of this study was to compare the effect of tamsulosin on metabolic parameters with another alpha-1 adrenergic receptor antagonist, doxazosin. METHODS: In this prospective, observational, controlled, 12-week clinical study, a total of 60 male patients aged ≥ 40 years who were first started on tamsulosin (n = 30; 0.4 mg/day, oral; mean age, 59.20 ± 8.97 years) or doxazosin (n = 30; 4 or 8 mg/day, oral; mean age, 58.50 ± 8.93 years) for benign prostatic hyperplasia (BPH) or lower urinary tract symptoms (LUTS) were enrolled. The groups were compared according to the changes in anthropometric and biochemical parameters (glycemia, lipid profile, and insulin sensitivity) at the end of treatment. RESULTS: In intragroup analyses, systolic blood pressure, diastolic blood pressure, total cholesterol, and HbA1c levels decreased significantly in the doxazosin group compared with baseline (p < 0.05 for all), while no significant change was observed in the tamsulosin group. In comparisons between groups, systolic blood pressure, total cholesterol, and low-density lipoprotein cholesterol levels showed a significant decrease in the doxazosin group compared with the tamsulosin group (percent change: - 6.68 ± 13.08 vs. 0.53 ± 11.02, p = 0.025; - 3.63 ± 9.56 vs. 4.02 ± 10.86, p = 0.005; and - 5.62 ± 18.18 vs. 5.24 ± 15.42, p = 0.015, respectively). CONCLUSION: Although these results do not support previous findings that tamsulosin has adverse effects on metabolic parameters, they suggest that doxazosin treatment may be a reason for preference in patients with BPH or LUTS accompanied by metabolic disorder.

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.

Clinical preferences and treatment attitudes among urologists, gynecologists, and geriatricians: An independent online questionnaire survey for comparison of treatment choices in the management of overactive bladder.

OBJECTIVE: Overactive bladder (OAB) is a common clinical problem with associated morbidities both in men and women. Although real-life management strategies have been examined among urologists (URO), treatment choices may differ between different specialties. In the present study, an online survey was conducted to determine and compare the management strategies and clinical preferences of UROs, obstetricians/gynecologists (OB/GYN), and geriatricians (GER) in the treatment of OAB in their daily practices. METHODS: Between December 2020 and February 2021, an online questionnaire was sent to URO, OB/GYN, and GER specialists/residents. Current strategies and attitudes toward treatment of OAB in patients <65 years were compared between URO and OB/GYN, whereas the responses were compared between all three specialties in patients ≥65 years. RESULTS: A total of 733 specialists/physicians (433 URO, 236 OB/GYN, and 64 GER) completed the online survey. Patients with OAB were more likely to present to URO compared to OB/GYN and GER (p = 0.001). A combination of behavioral modification and pharmacotherapy (antimuscarinics and/or beta-3 agonists) were chosen for the initial treatment of patients with OAB in both specialties with a significantly higher proportion by URO than by OB/GYN (51.9% vs. 38.1%; p = 0.001). Antimuscarinics were the most frequently prescribed medications by both the URO and OB/GYN specialties (81.8% vs. 78.4%; p = 0.27). Combination therapy with antimuscarinics was preferred more often by URO (91.5% vs. 77.1%; p = 0.001) when no or an inadequate response after initial treatment occurred. Multiple medication use, comorbidities, and risk of cognitive side effects affected medication preference by all specialists, especially by GER (p = 0.018). CONCLUSIONS: Patients with OAB present to UROs, OB/GYN and GER more frequently compared to other specialities. Although antimuscarinics and beta-3 adrenoceptor agonists are equally recommended as first-line pharmacotherapy for OAB, antimuscarinics were preferred for most patients as the initial molecule by all specialties. Beta-3 agonists are increasingly preferred for elderly patients.

The Epidemiology and Population-Based Studies of Women with Lower Urinary Tract Symptoms: A Systematic Review.

In this systematic review, we focused on epidemiology and population-based studies to identify recent realworld data of women with lower urinary tract symptoms. The PubMed, Scopus, and Cochrane databases were used for the literature search using the following keywords: epidemiology, population-based studies, women, female, lower urinary tract symptoms, and urinary incontinence. A total of 20 articles in the English language were found to be eligible for this review. The prevalence of LUTS in women was 11.8%-88.5%. The prevalence of storage symptoms was 23.6%-79%, voiding symptoms was 1.8%-51%, and post-micturition symptoms was 0.3%-46%. The prevalence of voiding and storage symptoms was 8.3%-26.6% and the prevalence of combined voiding, storage, and post-micturition symptoms was 6.6%-19.2%. Any incontinence was observed in 5.8%-45.8% of women. The majority of patients suffered from stress urinary incontinence with 1.9%-31.8%. The prevalence of urgency urinary incontinence and mixed-type urinary incontinence was 0.7%-24.4% and 2.1%-12%, respectively. Increased age, marital and work status, comorbidities, alcohol consumption, higher parity, vaginal delivery, instrumental delivery, prolonged labor, laceration, and postmenopausal status were found to be risk factors for lower urinary tract symptoms. The prevalence of lower urinary tract symptoms in women is increasing, especially with age. Since the worldwide prevalence of lower urinary tract symptoms remains unknown, multi-continental studies, especially in the developing world, with less heterogeneity and more standardized definitions, are needed to better evaluate real-world data in women with lower urinary tract symptoms.

Impact of the COVID-19 Pandemic on Functional Urology Practice: A Nationwide Survey From Turkey.

Objective: Routine urology practice has changed with the coronavirus disease-2019 pandemic. We aim to determine the urologists' functional urology practice during the pandemic by an online questionnaire. Methods: An online questionnaire was conducted to assess the functional urology practice of Turkish urologists' during the pandemic. The workplace, positioning as a pandemic hospital, involvement in pandemic clinics, and the relevance to functional urology were questioned. We also inquired about outpatient services, diagnostic tests, and elective surgeries during the pandemic compared with their routine practice. Results: One hundred and fifty-two participants completed the questionnaire. Of these, 32.2% replied that more than half of their daily practice was related to diagnosing and treating incontinence, prolapse, and neurourology. According to 123 participants (80.9%), there was a decrease in outpatient clinics. Diagnostic tests were also reduced, such as uroflowmetry (68.4%) and urodynamics (81.3%). The majority of respondents declared a decrease in elective surgeries as Botox injection (92.1%), surgery for urinary incontinence (93.4%), and surgery for prolapse (85%). Nearly one-quarter of respondents' (28.9%) stated that their diagnostic methods for neurourology patients did not differ. Conclusions: One of the most affected areas in urology during a pandemic is functional urology. Although diagnostic tests and surgery for functional urology are classified as "optional," the quality of life of patients will be affected by the delayed intervention.

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.

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.

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)

Turkish validation and reliability of the symptoms of Lower Urinary Tract Dysfunction Research Network Symptom Index-29 (LURN SI-29) questionnaire in patients with lower urinary tract symptoms.

AIMS: To evaluate the validity and reliability of the Turkish version of the Symptoms of Lower Urinary Tract Dysfunction Research Network Symptom Index-29 (LURN SI-29). METHODS: Patients with lower urinary tract symptoms (LUTS) were included in a single-center study between January and April 2021. Patients' demographics, such as age, sex, and level of education, were recorded. The Turkish version of the LURN SI-29 and the International Prostate Symptom Score (IPSS) were administered to all patients, and the Urogenital Distress Inventory (UDI-6) was additionally administered to female patients. Construct validity was evaluated by confirmatory factor analysis. Concurrent validity was evaluated with correlations to similar measures. Internal consistency (Cronbach's alpha) and split-half reliability analyses were used to establish the scale's reliability. RESULTS: A total of 295 participants, 35.3% females and 64.7% males, were included in the final analysis. The mean age was 56.4 ± 11.7 years. The median total LURN SI-29 scores were 38.0 (26-50) and 26.0 (18-43) for female and male patients, respectively. The LURN SI-29 scale showed a high correlation with IPSS and UDI-6 scales (r = .758, p < .001; r = .774, p < .001, respectively) in concurrent validity analysis. Cronbach's alpha coefficient of the scale and all subscales were greater than 0.70 for both female and male patients. CONCLUSIONS: This measurement tool can potentially be used to evaluate LUTS in Turkish women and men. Further studies should be performed to reveal the clinical usefulness of this scale.

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 Relationship between Vitamin D Level and Lower Urinary Tract Symptoms in Women.

OBJECTIVES: In the literature, the effects of vitamin D on lower urinary tract symptoms (LUTS) have been investigated. Conflicting results have been reported in these studies conducted. LUTS is more common in women. In this study, we aimed to evaluate the relationship between vitamin D and LUTS in female patients using the uroflowmetric method. METHODS: This retrospective cohort study included 186 female patients who were admitted with LUTS. Demographic characteristics, medical history, calcium (Ca) and vitamin D, including laboratory studies and uroflowmetry results, as maximum urine flow rate (Qmax), average urine flow rate (Qav) and voided volume (V) were recorded. Patients were divided into two groups according to age (18-50 and ≥51) and vitamin D levels (<20 and ≥20). Laboratory parameters and uroflowmetry results were compared between groups. RESULTS: Mean age was 56.85±12.95 years. Mean vitamin D level was 21.19±13.93 ng/mL (2.5-83.5). Mean Qmax value was 35.41±12.63, whereas the mean Qav was 19.13±9.89, and the mean V was 446.60±165.08 mL. Vitamin D levels differed according to age groups (p=0.044). No significant difference was observed between groups according to Qmax, Qav and V values (p>0.05). No significant correlation was detected between vitamin D level and Qmax, Qav and V values. However, a negative correlation was detected between serum Ca level and V values (p=0.042) in the low vitamin D group. CONCLUSION: There was no direct relationship between vitamin D levels and LUTS in respect to uroflowmetry. However, we determined that Ca levels affect the uroflowmetry parameter in patients with low vitamin D levels. There is a need for further studies emphasizing serum Ca levels in addition to vitamin D levels in patients with LUTS.

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.

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.

Turkish validation of the urethral stricture surgery specific patient-reported outcome measure (USS-PROM) with supplemental assessment of erectile function and morbidity due to oral graft harvesting.

AIMS: We validated a Turkish language version of the urethral stricture surgery specific patient-reported outcome measure (USS-PROM) in men undergoing anterior urethroplasty. We also investigated changes in erectile function (EF) and quality of life (QoL) due to oral mucosa graft (OMG) harvesting. METHODS: The USS-PROM captures lower urinary tract symptoms (LUTS), health related QoL (HRQoL) with EQ-5D visual analogue scale (EQ-VAS). To evaluate EF and OMG morbidity, we used International Index of Erectile Function (IIEF-5) and a self-completed questionnaire, respectively. Psychometric assessment of USS-PROM included test-retest reliability, internal consistency, criterion validity, and responsiveness. Objective evidence for urethroplasty success was demonstrated with fluoroscopic imaging and urethral calibration at post-operative six months. RESULTS: Among the 101 men included during study period, 42 had complete pre- and postoperative 6th month data for analysis. The test-retest intraclass correlation was 0.79. Cronbach's α for internal consistency of the LUTS construct was 0.79. There was a significant negative correlation between total LUTS scores and peak flow rates, both preoperatively (r = -0.478) and postoperatively (r = -0.508). Mean baseline EQ-VAS increased from 70 to 84 postoperatively (P < 0.001), indicating improved HRQoL. IIEF scores did not change significantly after urethroplasty. Early and late-term QoL impairment rates due to OMG harvesting were 28.9 and 13.1%, respectively. Three (7.1%) men required endoscopic intervention for recurrence within 6 months. CONCLUSIONS: Turkish version of USS-PROM showed comparable psychometric properties with the original version. Complementation of this instrument with additional measures that address sexual function and OMG morbidity provides better QoL assessment for urethral reconstruction.

Long-term functional results of aspiration and sclerotherapy with ethanol in patients with autosomal dominant polycystic kidney disease: a non-randomized pilot clinical study.

PURPOSE: To evaluate the long-term effect of aspiration and sclerotherapy treatment on the pain control, blood pressure regulation, and quality of life (QoL) in patients with autosomal dominant polycystic disease (ADPKD). METHODS: Twenty-five ADPKD patients with a total of 32 dominant cysts were treated with ultrasound guidance percutaneous aspiration and 96% ethanol injection, between 2002 and 2014. Twenty-one dominant cysts of 16 patients who had a minimum of 10-year follow-up were included in this study. The level of pain [visual analog score (VAS)], narcotic usage, blood pressure and serum creatinine level, QoL questionnaire, and radiological dominant cyst size was evaluated before and after procedure, retrospectively. RESULTS: The mean dominant cyst size was even smaller after follow-up of 10 years. Mean dominant cyst size was 7.2 ± 2.3 cm before the procedure and 0.9 ± 0.9 and 3.3 ± 1.2 cm after the one- and 10-year follow-ups, respectively (p < 0.05). VAS and QoL scores were improved after 10 years of follow-up. There was no relation between cyst size and VAS score as well as QoL questionnaire score. End-stage renal disease occurred in 50%, and there was no significant improvement in blood pressure of these patients. CONCLUSIONS: Aspiration and sclerotherapy with ethanol is a minimal-invasive, safe, and inexpensive outpatient treatment method with acceptable short- and long-term results in ADPKD patients. Aspiration and sclerotherapy with ethanol can be an option for patients with ADPKD.

Comparison of long-term efficacy of desmopressin lyophilisate and enuretic alarm for monosymptomatic enuresis and assessment of predictive factors for success: a randomized prospective trial.

PURPOSE: We compared the long-term success of desmopressin sublingual lyophilisate formulation and enuretic alarm therapy in children with primary monosymptomatic nocturnal enuresis, and determined predictive factors for treatment success. MATERIALS AND METHODS: A total of 142 children with primary monosymptomatic nocturnal enuresis were randomized to receive treatment consisting of desmopressin or enuretic alarm for 6 months. Treatment compliance and response were reviewed monthly in each patient using a 30-day bed-wetting diary. Outcomes were assessed according to International Children's Continence Society criteria, and success rates at 6 and 12 months were compared for desmopressin and enuretic alarm. Additional intention to treat analyses were performed, considering cases with missing data as failures. Possible demographic factors predicting success were investigated by logistic regression analysis. RESULTS: Overall 4 children (5.2%) in the desmopressin group and 20 (30.7%) in the enuretic alarm group withdrew after randomization. Based on patients who completed 6 months of treatment, success (more than 90% reduction in wet nights per month) was achieved in 76.8% and 61.8% of children in the desmopressin and enuretic alarm groups, respectively. At 12 months 77.8% of those receiving desmopressin and 75% of those treated with enuretic alarm had success. However, long-term success rate was significantly higher with desmopressin (68.8% vs 46.2%) if intention to treat population was considered. Multivariate analysis revealed treatment group, severity of enuresis and monthly income as independent predictors of cure at 6 months. CONCLUSIONS: In compliant patients desmopressin lyophilisate and enuretic alarm provided equivalent success at the end of treatment and after extended followup. Alarm therapy had a high rate of early withdrawal from therapy and consequently lower rates of success on intention to treat analyses. Severe enuresis (more than 5 wet nights weekly) is an important predictive factor for cure after first-line treatment.

Ventral inlay labia minora graft urethroplasty for the management of female urethral strictures.

OBJECTIVE: To evaluate the functional outcomes of ventral inlay labia minora graft urethroplasty (VILGU) for the management of female urethral strictures. METHODS: Data of 7 consecutive women treated with VILGU between 2011 and 2013 were reviewed. Two patients had cystostomy tubes at repair, and 5 had undergone previous urethral dilations and urethrotomies. Clinical evaluation included assessment of the effect of voiding symptoms with American Urological Association (AUA) symptom score, uroflowmetry, voiding cystourethrography, and intraoperative urethrocystoscopy using a 6.5F pediatric ureterorenoscope. Preoperative AUA symptom score and peak urinary flow rate were compared with postoperative values. Cure was defined as the absence of any restenosis requiring additional intervention with subjective patient satisfaction at the last follow-up. RESULTS: Mean stricture length was 1.5 cm (range, 1-2.5), and mean operative time was 95 minutes (range, 70-110). With a mean follow-up of 18.2 months (range, 3-30), cure was achieved in 6 (86%) women. At the last follow-up, mean maximum urine flow (mL/s) increased from 3.9 ± 3.1 preoperatively to 22.7 ± 8.3 postoperatively (P <.001), and mean AUA symptom score decreased from 25.3 ± 5.2 preoperatively to 6.9 ± 3.7 postoperatively (P = .001). No fistulae developed after surgery. "De-novo" stress urinary incontinence was not evident in any case. CONCLUSION: VILGU effectively provides better urinary flow and significantly improves patient satisfaction in patients with female urethral stricture disease.