Machine learning-based classification of varicocoele grading: A promising approach for diagnosis and treatment optimization.

BACKGROUND: Varicocoele is a correctable cause of male infertility. Although physical examination is still being used in diagnosis and grading, it gives conflicting results when compared to ultrasonography-based varicocoele grading. OBJECTIVES: We aimed to develop a multi-class machine learning model for the grading of varicocoeles based on ultrasonographic measurements. METHOD: Between January and May 2024, we enrolled unilateral varicocoele patients at an infertility clinic, assessing their varicocoele stages using the Dubin and Amelar system. We measured vascular diameter and reflux time at the testicular apex and the subinguinal region ultrasonography in both the supine and standing positions. Using these measurements, we developed four multi-class machine learning models, evaluating their performance metrics and determining which patient position and projection were most influential in varicocoele grading. RESULTS: We included 248 patients with unilateral varicocoele in the study, their average age was 26.61 ± 4.95 years old. Of these, 212 had left-sided and 36 had right-sided varicocoeles. According to the Dubin and Amelar system, there were 66 grade I, 96 grade II, and 86 grade III varicocoeles. Among the models we created, the random forest (RF) model performed best, with an overall accuracy of 0.81 ± 0.06, an F1 score of 0.79 ± 0.02, a sensitivity of 0.69 ± 0.02, and a specificity of 0.8 ± 0.03. Vascular diameter measurement at the testicular apex in the supine position had the most impact on grading across all models. In support vector machine and multi-layer perceptron models, reflux time measurements from the subinguinal projection in the standing position contributed the most, while in RF and k-nearest neighbors models, measurements from the subinguinal projection in the supine position were the most influential. CONCLUSIONS: Machine learning methods have demonstrated superior accuracy in predicting disease compared to traditional statistical regressions and nomograms. These advancements hold promise for clinically automated prediction of varicocoele grades in patients. Tailored varicocoele grading for individuals has the potential to enhance treatment effectiveness and overall quality of life.

Quality of information in Youtube videos on disorder of sexual development.

The aim of this study was to evaluate the accuracy and quality of the videos published on YouTube on the subject of disorder of sexual development. The search was performed by using term 'disorder of sexual development', 'differences in sex development', 'variations in sex development' and 'intersex' on YouTube. Videos in languages other than English and whose sound or image quality was poor were excluded from the study. The videos were evaluated in terms of source, content, intended audience, commercial bias, and accuracy of information. Video features were recorded. Journal of the American Medical Association (JAMA) criteria, modified DISCERN scale and Global Quality Score (GQS) were used for quality evaluation. A total of 150 videos were evaluated. The source of 30% of the videos was medical education sites, the content of 43.3% was general information and the target audience of 40.6% was patients/society. Accuracy of information rate was 90% and commercial bias rate was 7.3%. The median JAMA, GQS and Modified DISCERN score were 1 (IQR value:2, range:0-2), 3 (IQR value:2, range:2-4) and 3 (IQR value:2, range:1-3) respectively. These scores were correlated with each other (rho = 0.834-0.909 p < 0.001). Scores of the videos whose source was academic journal/university were higher compared to other videos (p < 0.001). The median duration of the videos with good quality was longer (p < 0.001). A negative correlation was found between all scoring systems and number of views/likes/comments, view/comment per day and days since upload date (rho = -0.332, rho = -0.273, rho = -0.382, rho = -0.249, rho = -0.323 rho = -0.285 respectively; p < 0.05). YouTube is a good platform to learn about disorder of sexual development, but the quality may vary depending on the video source.

Can preoperative inflammatory markers predict the success of varicocelectomy?

The aim of this study was to evaluate the effect of inflammation on the success of varicocelectomy by using some inflammatory markers. Adult male patients aged ≥18 years who were evaluated for infertility, had abnormal parameters in at least two preoperative semen analyses and underwent subinguinal microscopic varicocelectomy were retrospectively evaluated. The patients were divided into two groups; those showing improvement in semen parameters were determined as Group A and those without improvement as Group B and compared with each other. A total of 102 patients were included in this study. Group A contained 32 (31.4%) patients while Group B had 70 (68.6%) patients. Monocyte/lymphocyte ratio (MLR) and neutrophil/lymphocyte ratio (NLR) were found to be statistically significantly higher in Group B (p = 0.014 and p = 0.028 respectively). Although preoperative sperm concentration and total motile sperm count were higher in Group B, postoperative all semen parameters were significantly higher in Group A. The cutoff points that were determined using the Youden test were <2.02 for NLR (AUC = 0.636, CI = 0.519-0.754; p = 0.028) and <0.22 for MLR (AUC = 0.652, CI = 0.531-0.773; p = 0.014). Pre-varicocelectomy low NLR and MLR values were found to be significant parameters in predicting the success of the surgery.

The effect of ejaculation time on varicose vein diameter and reflux level.

The aim of this study was to investigate whether the time interval between ejaculation and scrotal Doppler ultrasonography affects the results of the varicose vein diameter and reflux time. Age, medication use, operation history, physical examination and semen analysis findings, varicose vein diameters and the presence of reflux and reflux time were evaluated prospectively in the patients older than 18 years of age who presented to the urology outpatient clinic with infertility and underwent scrotal Doppler ultrasonography and semen analysis. The time interval between the two scrotal Doppler ultrasonography for semen analysis was noted, the two results were compared. The patients were divided into four groups according to the time interval between ejaculation and scrotal Doppler ultrasonography. The study included 81 varicocele cases, with 57 left-sided and 12 bilateral varicocele. The varicose vein diameters were significantly larger after ejaculation than before ejaculation (p < .001). Similarly, the reflux time after ejaculation in all patients was significantly higher in scrotal Doppler ultrasonography performed before and after ejaculation at rest and during Valsalva manoeuvre (p < .001). In conclusion, the results of the present study suggest that a waiting time of at least 90 min must be allowed between ejaculation and scrotal Doppler ultrasonography.

Parameters predicting sperm retrieval rates during microscopic testicular sperm extraction in nonobstructive azoospermia.

The aim of this study was to investigate the predictive value of the parameters that might have an effect on the success of microscopic testicular sperm extraction (micro-TESE) in infertile patients with nonobstructive azoospermia (NOA). Between 2003 and 2014, 860 patients with NOA were retrospectively analysed. The effect of age, infertility duration, history of varicocelectomy, herniorrhaphy or orchiopexy, presence of solitary testis, tobacco use, previous testicular biopsy results, history of orchitis, usage of human chorionic gonadotropin in the past three months, presence of undescended or retractile testis, presence of varicocele, testicular volume, levels of serum follicle-stimulating hormone, luteinising hormone, and testosterone, presence of Klinefelter syndrome and micro-deletion of Y chromosome on sperm retrieval rates were evaluated. In 45.8% (n = 394) of the patients who underwent micro-TESE, spermatozoon was adequately obtained. Multiple logistic regression analysis demonstrated that previous successful testicular biopsy (OR = 15.346; GA = 5.45-43.16; p < .001) and higher testicular volumes significantly increase sperm retrieval rate in micro-TESE. The testicular volume cut-off as 11 ml was found to be the most significant factor. Although currently testicular biopsy result is not being used as a diagnostic method, it is significantly associated with micro-TESE result.

Comparison of the Histopathological Findings of Testis Tissues of Non-Obstructive Azoospermia with the Findings after Microscopic Testicular Sperm Extraction.

Purpose: To investigate the relationship between the histopathological findings of testis tissue samples and sperm retrieval success of micro-TESE in non-obstructive azoospermia (NOA) patients. METHOD: Histopathological examination results of the testis tissue samples of 795 NOA patients who underwent micro-TESE operation in our clinic between 2003 and 2014 were included. Histopathological findings were grouped as hypospermatogenesis, incomplete spermatocytic arrest, complete spermatocytic arrest, Sertoli cell only syndrome (SCOS), and fibrosis/atrophy. Chi-square analysis was used to compare the histopathological findings with the sperm retrieval rates of micro-TESE. RESULT: Sperm was found in 341 (42,9%) patients following micro-TESE compared to 454(57,1%) patients where sperm were not detected (P < 0.001). Sperm retrieval rates of micro TESE were significantly higher in hyposper-matogenesis and incomplete maturation arrest groups (93.2% (P < 0.001) and 72.5% (P < 0.001), respectively). Complete maturation arrest, SCOS and fibrosis/atrophy were determined at significantly higher rates in patients (220.2%) with no sperm found compared to patients with sperm (P < 0.001). CONCLUSION: The findings of this study are consistent with those of previous studies in the literature. Testicular histopathological findings can provide additional data when informing NOA patients about the expected success of further micro-TESE operations.

Factors predicting postoperative febrile urinary tract infection following percutaneous nephrolithotomy in prepubertal children.

BACKGROUND: Predictive tables and scoring systems can predict stone clearance. However, there is a paucity of evidence regarding the prediction of complications during percutaneous nephrolithotomy (PCNL), particularly in children, which remains under-researched. To our knowledge, no studies have evaluated the risk factors for febrile urinary tract infection (FUTI) after pediatric PCNL. OBJECTIVES: To assess the predictive factors of FUTI in prepubertal children after PCNL and determine whether any prophylactic cephalosporins are superior for decreasing the FUTI rate. STUDY DESIGN: Data from 1157 children who underwent PCNL between 1991 and 2012 were retrieved from the multicenter database of the Turkish Pediatric Urology Society. Children >12 years of age were excluded, leaving 830 children (364 girls, 466 boys). Data were analyzed according to the presence of FUTI and compared between the FUTI and non-FUTI groups. RESULTS: Mean age was 6.46 ± 3.38 years. Twenty-nine (3.5%) children had FUTI which was confirmed by urine culture. FUTI occurred more frequently in young children (5.5%) than school-age children (2.4%). In univariate analysis, there were significant differences between the FUTI and non-FUTI groups regarding age, cephalosporin subgroup (first, second and third generation cephalosporin), side of PCNL, staghorn stones, tract size, operative time, postoperative ureteral catheter usage, perioperative complications (SATAVA), and blood transfusion. Multivariate analysis revealed that age, side of PCNL, staghorn stones, tract size, operative time, and blood transfusion were independent predictors of FUTI. DISCUSSION: The smaller tract size could cause FUTI with poor fluid drainage that may lead to elevate renal pelvic pressure and trigger bacteremia-causing pyelovenous backflow. Filling the calyx and renal pelvis by a staghorn stone and the resulting obstruction of fluid drainage may elevate intrarenal pelvis pressure. Longer operative time is likely to increase renal pelvic pressure over longer periods, which may account for FUTI after pediatric PCNL. CONCLUSIONS: Younger age, right-sided PCNL, staghorn stones, mini-PCNL, longer operative time, and blood transfusion are risk factors for FUTI. First-, second-, and third-generation cephalosporins are equally effective for prophylaxis in prepubertal children undergoing PCNL.

Renal stone composition does not affect the outcome of percutaneous nephrolithotomy in children.

PURPOSE: We sought to investigate the association between renal stone composition and percutaneous nephrolithotomy outcomes in pediatric patients and define the characterization of the stone composition. METHODS: The data of 1157 children who underwent percutaneous nephrolithotomy between 1991 and 2012 were retrieved from the multicenter database of the Turkish Pediatric Urology Society. The study population comprised 359 children (160 girls, 199 boys) with stone analyses. Patients were divided into five groups according to the stone composition [group 1: calcium oxalate; group 2: calcium phosphate; group 3: infection stones (magnesium ammonium phosphate, ammonium urate); group 4: cystine; group 5: uric acid, xanthine stones]. RESULTS: Patient characteristics, perioperative, postoperative, and stone characteristics were compared considering the stone composition. There were no significant differences between the groups concerning age, sex, side involved, preoperative hematocrit levels, and solitary renal unit. Patients with cystine stones were more likely to have a history of stone treatment. Groups 2 and 5 had mostly solitary stones. However, group 3 had staghorn stone more often, and group 4 frequently had multiple stones. Overall stone-free rate (79.4%) was similar among the groups. Although stone composition was related to blood transfusion and prolonged operative and fluoroscopy screening times on univariate analysis, it was not a significant predictor of them on multivariate analysis. CONCLUSIONS: Stone composition was not a predictor of outcomes of pediatric percutaneous nephrolithotomy. However, cystine and infection stones, which are larger and filled multiple calyxes due to the nature of stone forming, were more challenging cases that need multiple tracts.

The effect of American Society of Anesthesiology scores on percutaneous nephrolithotomy outcomes.

INTRODUCTION: To evaluate the effect of American Society of Anesthesiology (ASA) scores on percutaneous nephrolithotomy (PNL) outcomes. MATERIALS AND METHODS: The records of 186 consecutive patients undergoing PNL procedures from 2006 to 2011 at a single institution were evaluated. Patients were divided into a low-risk group with a preoperative ASA of I or II and a high-risk group with ASA of III or IV. Postoperative complications were classified according to the modified Clavien classification system. RESULTS AND CONCLUSIONS: There were 140 cases in the low-risk and 46 cases in the high-risk groups. The mean operative time was 72 min (40-120 min) and 86 min (55-125 min) and the complication rates were 17.8 and 19.5% for the low- and high-risk groups, respectively. The average duration of nephrostomy tube drainage was 3.3 ± 1 and 4.2 ± 1.5 days for the low- and high-risk groups, respectively. Stone-free rates were 85 and 82% for the low- and high-risk groups, respectively. PNL can be safely performed in the ASA high-risk patient population.

Pseudosarcomatous fibromyxoid tumor of the prostate revealed on suprapubic prostatectomy.

We report a rare case of inflammatory pseudotumor of the prostate revealed on suprapubic prostatectomy. A 70-year-old man presented with nocturia, urgency and difficulty in voiding. The histopathological examination of the suprapubic adenomectomy specimen reported fibromyxoid pseudosarcomatous tumor (inflammatory prostatic pseudotumor). It is important to take this benign lesion under consideration to avoid unnecessary aggressive radical complementary treatments.

Tranexamic acid decreases blood loss during transurethral resection of the prostate (TUR -P).

INTRODUCTION: Postoperative blood loss after prostate surgery is thought to be associated with an increase in urinary fibrinolytic activity. Tranexamic acid (TXA) is both a potent inhibitor of plasminogen and urokinase activators and a low molecular weight substance that is excreted unchanged in the urinary tract and can be administered both orally and intravenously. We investigated the effect of TXA on the amount of blood loss during transurethral resection of the prostate (TURP). MATERIALS AND METHODS: Forty patients with registry numbers ending in even numbers were allocated to the treatment group; those ending in odd numbers were used as controls and received no treatment. The treatment group received 10 mg/kg TXA by intravenous infusion during the first half hour of the operation, while the control group of patients received no medication. Serum hemoglobin was measured before and after surgery. The volume and hemoglobin concentration of the irrigation fluid, resected prostate weight, and duration of resection were recorded. RESULTS: The mean loss of hemoglobin per gram of resected prostate tissue was 1.25 g in the TXA group and 2.84 g in the control group. Total hemoglobin loss in the irrigating fluid and hemoglobin loss per 1 gram of prostate tissue was lower in the group of patients given TXA than in the control group (p = 0.018 and p <0.001). CONCLUSION: Reduced bleeding during TURP as a result of TXA treatment may lead to better surgical conditions and, as a consequence, shorter operative times and lower irrigating fluid volumes.