What is the safe and effective dilator number during access in PCNL? Three-shot dilation versus classical sequential Amplatz dilation.

BACKGROUND: Although PCNL has been used for a long time to treat nephrolithiasis, there is still contradictory information concerning the use of the dilation method. In this study, we aimed to compare conventional sequential Amplatz dilatation (SAD) using ten dilators and a method using three dilators (12, 20, and 30 Fr), which we named "three-shot dilatation" (3SD), in terms of fluoroscopy time (FT), operation time, bleeding and stone-free rates. METHODS: The study included patients who underwent PCNL with the SAD and 3SD methods. A different surgeon with extensive endourology experience applied each technique. One of the surgeons operated on the patients using the SAD method with ten dilators, and the other surgeon performed the operations using the 3SD method involving three Amplatz dilators (12, 20, and 30 Fr). RESULTS: A total of 283 patients, 138 in the 3SD group and 145 in the SAD group, were included in the study. The mean age of the patients was 47.32 ± 13.71 years. There was no statistically significant difference between the two groups regarding preoperative characteristics (p > 0.05). The FTs of access 2, total access, and total operation were significantly shorter in the 3SD group (p = 0.0001). The decrease in hemoglobin was statistically significant in the 3SD group compared to the SAD group (p = 0.022), while the blood transfusion requirements of the groups were similar (p = 0.176). There was no statistically significant difference between the two groups regarding stone-free rates (p = 0.973). In four patients in the SAD group, re-access was necessary due to the loss of passage due to the guide wire slipping out of its place. CONCLUSION: Intraoperative FT can be shortened using the described 3SD method without compromising surgical safety. However, this method can be used as an intermediate step in the transition to one-shot dilation by surgeons experienced in performing SAD.

Regular penis-root masturbation: A promising behavioral treatment method for lifelong premature ejaculation.

AIM: We aimed to determine the effectiveness of penis-root masturbation (PRM), a newly defined behavioral therapy (BT) technique, in patients with unsuccessful medical treatment due to premature ejaculation (PE). MATERIAL AND METHODS: The study included 35 patients aged 25-43 years, who were diagnosed with lifelong PE. Patients and their partners were informed about the PRM technique and asked to practice PRM three times a week for three months, with or without sexual intercourse. The patients' Premature Ejaculation Diagnostic Tool (PEDT) scores and intravaginal ejaculatory latency time (IELT) were recorded and compared before PRM training (T0) and at the third (T3) month after the start of PRM training. RESULTS: The mean±SD PEDT scores were 16.26±1.94 at T0, 10.63±1.14 at T3. When compared to T0, the PEDT values at T3 were significantly lower (P=0.021). In terms of IELT, the mean T3 values (192.43±56.71) were significantly longer (P=0.035) than at T0 (50.43±13.84seconds). CONCLUSION: PRM BT shows promise for lifelong PE patients who do not benefit from or discontinue to pharmacotherapy. Larger prospective trials are required to confirm these findings.

Significance of PPD Test for the Relationship Between BCG Vaccine and COVID-19 in Patients on Kidney Transplant Waiting List.

BACKGROUND: The aim of this study was to determine the relationship between purified protein derivative of tuberculin (PPD) values, an indicator of BCG protection, and COVID-19 disease in patients with end-stage renal disease (ESRD) on the kidney transplant waiting list. METHODS: Age, sex, dialysis type, ERSD etiologies, and PPD values of patients on the renal transplant waiting list were recorded. SARS-CoV-2 PCR data, whether the patients were previously infected with the virus, and, if infected, the severity of the disease were noted. Data were statistically compared. RESULTS: PCR of 87 (47.02%) of 185 patients were studied; 107 of the patients were male and 78 were female, with a mean age of 52.8 years. The test result was positive for 28 patients. Of the patients for whom PCR was studied, 41 had a negative PPD result, while 46 had a positive PPD result. There was no correlation with SARS-CoV-2 PCR positivity in patients with a PPD ≤ 5 mm and > 5 mm. However, patients with pneumonic infiltration who required hospitalization had a significantly higher PPD value. CONCLUSIONS: The PPD measurement, which is an indicator of BCG protection, might be a significant parameter for predicting the course of the disease in SARS-CoV-2 pneumonia.

A new percutaneous nephrolithotomy position in horseshoe kidney: 45 degrees sided prone.

INTRODUCTION: In this study we aimed to determine the effects of the 45 degrees sided prone position to the surgeon's comfort, operation time, fluoroscopy time and complications at the operation of percutaneous nephrolithotomy (PCNL) for the treatment of kidney stone of horseshoe kidney (HK) or rotation anomaly kidney. MATERIAL AND METHODS: Thirty eight patients (25 male, 13 female) with renal calculi and HK, underwent PCNL. After the amplatz sheath was inserted into the collecting system, the patients in group 1 (n:20) were taken to the 45 degrees side position to the side of the operation and patients in group 2 (n:18) were operated in classical prone position. Operative data of two groups were compared statistically. RESULTS: Mean stone size of group 1 was 557.8 ±244.8 mm3 (188-1175) and group 2 was 590.7 ±172.8 mm3 (423-909) (p = 0.639). In group 1 mean operation time was 78.6 ±21.8 (45-120) minutes and in group 2 was 95.05 ±11.5 (69-120) minutes. The difference for operation time was statistically significant and shorter in the sided group (p = 0.02). CONCLUSIONS: The working position of rigid nephroscope is 90 degrees to the body after the dorsomedial or dorsolateral access. In our study the position of patient is laterally sided 45 degree and the flexion on the surgeon's shoulder was minimised. This new position described for PCNL in HK allows comfortable working position for surgeon after upper pole posterior calyces access.

Using texture analysis as a predictive factor of subtype, grade and stage of renal cell carcinoma.

OBJECTIVE: The aim of this study was to evaluate the correlation between the tissue texture analysis and the histological subtypes, grade and stage of the disease in patients with renal cell carcinoma (RCC). MATERIALS AND METHODS: Seventy-seven patients who underwent computed tomography due to renal mass and diagnosed with RCC as a result of pathological examination were retrospectively analyzed. In these analyses, the demographic characteristics, pathological and radiological findings of the patients were evaluated. The masses were introduced to the Radiomics extension of the software and the first- and second-order texture analysis parameters were obtained. The correlation of these parameters with histological subtype, Fuhrman grade and TNM stage was investigated. RESULTS: In the comparison of the Radiomics values by stages, "minimum", "Long Run Low Gray-level Emphasis" values were higher in the stage 1-2 group, while "Energy", "Total energy", "Range", "Joint Average", "Sum Average", "Gray-Level Non-Uniformity", "Short-Run High Gray-level Emphasis ", "Run Length Non-Uniformity "and "High Gray-Level Run Emphasis "values were higher in the stage 3-4 group. Of these parameters, only "Gray-Level Non-Uniformity" and "Run Length Non-Uniformity'' values were significantly lower in tumors with low Fuhrman grade (1-2) and low TNM stage (1-2). There was no statistically significant correlation between the parameters found to be significant in histological subtype differentiation and Fuhrman grade and TNM stage. CONCLUSION: This study demonstrates that "Gray-Level Non-Uniformity" and "Run Length Non-Uniformity "parameters in the texture analysis method can be used to evaluate the prognosis in patients with RCC.

Screening Mammography Findings in Women With Chronic Kidney Disease on a Renal Transplant Waiting List.

BACKGROUND: The incidence of breast cancer has been reported to be increased in people with chronic kidney disease (CKD). Thus, breast cancer screening is stated to be mandatory. However, it is as yet unclear what age group or what type of breast structure indicate a need for mammography. This study aimed to evaluate the effects of age and breast parenchymal density on mammography findings. The rate of detection of calcification from mammographies increased in dialysis patients with CKD. The associations of calcifications with comorbid pathologies were also evaluated. PATIENTS AND METHODS: Patients were divided into the two age groups of 40 to 49.9 years and ≥ 50 years. The patients were asked about smoking habits, hypertension, diabetes mellitus, the pathology that caused CKD, state of hemodialysis, and, if relevant, the type and duration of dialysis. RESULTS: The mean age of the 55 patients included in this study was 54.8 years, and 78.2% (n = 43) were ≥ 50 years old. The rate of malignancy across the entire group was 3.6%. No association was found between breast arterial calcification and cigarette smoking, hypertension, diabetes mellitus, state of dialysis, duration of dialysis, and breast parenchymal density in any age group. CONCLUSION: A pretransplantation evaluation of CKD patients may include a breast screening program for patients aged 40 to 49.9 and for the patients aged ≥ 50. Breast parenchymal density was demonstrated to have no effect on the findings, and no association was found between calcifications and comorbid pathologies.

Overactive bladder syndrome and bladder wall thickness in patients with obstructive sleep apnea syndrome

ABSTRACT Objective The main objective of the present study was to evaluate the presence of overactive bladder (OAB) syndrome, nocturia, urgency, and urge incontinence in patients with obstructive sleep apnea syndrome (OSAS), and measure bladder wall thickness (BWT) in these patients. Materials and Methods The patient group was composed of 38 patients with OSAS. The control group was composed of 15 healthy individuals. All patients were evaluated using the Epworth Sleepiness Scale (ESS) and Overactive Bladder Symptom Score (OABSS). The bladder wall thickness was measured by transabdominal ultrasound (US). The presence of nocturia, urinary urgency, and urge incontinence were also evaluated. Results The mean OABSS was significantly higher in the patient group compared with the control group (p=0.048). The minimum oxygen saturation (Min.SO2) of patients with urgency was found to be significantly lower (p=0.014). The time spent below 90% of oxygen saturation (SO2) was significantly longer in patients with urinary urgency (p=0.009). There was no difference in BWT measurements between the patient group and the control group. There was a significant relationship between BWT values and OABSS in patients with OSAS (p=0.002). Conclusion The results of the present study suggest that OSAS is associated with OAB syndrome. As a key symptom of OAB, urgency correlates with hypoxia in cases with OSAS. Although the present study did not observe any difference in BWT measurements between the patients and the control group, there was a correlation between BWT measurements and OABSS in patients with OSAS.

Overactive bladder syndrome and bladder wall thickness in patients with obstructive sleep apnea syndrome.

OBJECTIVE: The main objective of the present study was to evaluate the presence of overactive bladder (OAB) syndrome, nocturia, urgency, and urge incontinence in patients with obstructive sleep apnea syndrome (OSAS), and measure bladder wall thickness (BWT) in these patients. MATERIALS AND METHODS: The patient group was composed of 38 patients with OSAS. The control group was composed of 15 healthy individuals. All patients were evaluated using the Epworth Sleepiness Scale (ESS) and Overactive Bladder Symptom Score (OABSS). The bladder wall thickness was measured by transabdominal ultrasound (US). The presence of nocturia, urinary urgency, and urge incontinence were also evaluated. RESULTS: The mean OABSS was significantly higher in the patient group compared with the control group (p=0.048). The minimum oxygen saturation (Min.SO2) of patients with urgency was found to be significantly lower (p=0.014). The time spent below 90% of oxygen saturation (SO2) was significantly longer in patients with urinary urgency (p=0.009). There was no difference in BWT measurements between the patient group and the control group. There was a significant relationship between BWT values and OABSS in patients with OSAS (p=0.002). CONCLUSION: The results of the present study suggest that OSAS is associated with OAB syndrome. As a key symptom of OAB, urgency correlates with hypoxia in cases with OSAS. Although the present study did not observe any difference in BWT measurements between the patients and the control group, there was a correlation between BWT measurements and OABSS in patients with OSAS.

Sexual Dysfunction in Premenopausal Women With Obstructive Sleep Apnea.

PURPOSE: Sexual functions in the males with obstructive sleep apnea syndrome (OSAS) have been well investigated in the literature; however sexual functions in the premenopausal women with OSAS have been studied to a lesser extent. MATERIALS AND METHODS: The study included 22 premenopausal women diagnosed as OSAS by the polysomnographic (PSG) evaluation. The control group included 13 premenopausal women suspected of sleep-relatedrespiratory disorder, but whose PSG tests were determined to be normal. Both groups were administered Epworth Sleep Scale (ESS), Beck Depression Scale (BDS), and Female Sexual Function Index (FSFI) questionnaire forms. Relations between disease parameters, and the total FSFI score, and scores of the six FSFI parameter were analyzed. RESULTS: The total FSFI score in the cases with OSAS, was determined to be significantly lower than that of the control subjects (P = .031). Scores of the desire, arousal, and orgasm were determined to be significantly lower inthe patient group, compared to control group (P = .034; P = .048; P = .039). The total FSFI scores, and scores of the desire, arousal, lubrication, orgasm, satisfaction and pain subscales in the cases did not correlate significantly with the apnea-hypopnea index (AHI), Non-Rapid Eye Movement 1 (NREM1)%, NREM2%, NREM3%, REM%, the time spent with saturation O2< 90%, minimum oxygen saturation (%), ESS scores, and BDS scores (all P > .05). CONCLUSION: Women with OSAS experience sexual dysfunction when compared with normal population. Clinical evaluation has to include also the evaluation of sexual life in women.

Comparison between Retroperitoneal and Transperitoneal Approaches in the Laparoscopic Treatment of Bosniak Type I Renal Cysts: A Retrospective Study.

PURPOSE: We retrospectively compared laparoscopic transperitoneal and retroperitoneal approaches for the decor­tication of simple renal cysts with respect to safety, postoperative pain, and clinical results. MATERIALS AND METHODS: The study included 40 patients (28 males and 12 females) with symptomatic simple renal cysts and who underwent laparoscopic cyst decortication, and they were evaluated retrospectively. Patients' age, gender, disease-specific history, comorbid disease and family history, in general and urological and phys­ical examination findings were recorded. Patients prior to surgery were evaluated by urinalysis, serum creati­nine level, blood count, urinary tract ultrasonography, and unenhanced and contrast-enhanced abdominal com­puted tomography. Patients were informed about laparoscopic surgery and their written informed consent was taken. For those who preferred the laparoscopic approach, the placement of the cyst, history of prior surgery and obesity were evaluated. All patients filled out the visual analog scale (VAS) to evaluate postoperative pain. RESULTS: The mean age of the patients were 54.65 ± 5.26 years in the retroperitoneal group and 56.0 ± 4.66 years in the transperitoneal group. For all patients the indication for surgery included right or left flank pain. The mean operative time for the transperitoneal approach was 51.5 min., and that for the retroperitoneal approach was 44.75 min. This difference was statistically significant between the two groups (P < .05). According to VAS scale, the retroperitoneal scoring method was found to be lower than the transperitoneal scoring method. All patients were discharged on the first postoperative day, and the drains were taken out. None of the patients had complications. At the end of six months, no clinical and radiological recurrence was detected in any patient. CONCLUSION: We consider the retroperitoneal approach to be the first-choice because of its shorter operation time and particularly low level of postoperative pain.

Internal urethrotomy versus plasmakinetic energy for surgical treatment of urethral stricture.

PURPOSE: we aimed to compare the longterm outcome of surgical treatment of urethral stricture with the internal urethrotomy and plasmakinetic energy. MATERIAL AND METHODS: 60 patients, who have been operated due to urethral stricture were enrolled in our clinic. None of the patients had a medical history of urethral stricture. The urethral strictures were diagnosed by clinical history, uroflowmetry, ultrasonography and urethrography. The patients were divided two groups. Group 1 consisted of 30 patients treated with plasmakinetic urethrotomy and group 2 comprised 30 men treated with cold knife urethrotomy. RESULTS: There were no statistically significant differences between two groups in terms of patient age, maximum flow rate (Qmax) and quality of life score (Qol) value. A statistical difference between the two groups was observed when we compared the 3rd-month uroflowmetry results. Group 1 patients had a mean postoperative Qmax value of 16,1 ± 2,3 ml/s, whereas group 2 had a mean postoperative Qmax value of 15,1 ± 2,2 ml/s (p < 0.05). In the cold knife group, 3 of 11 (27,7%) recurrences appeared within the first 3 months, whereas in the plasmakinetic group zero recurrences appeared within the first 3 months in our study. The urethral stricture recurrence rate up to the 12 month period was statistically significant for group 1 (n = 7, 23%) compared with group 2 (n = 11, 37%) (p < 0.05). CONCLUSION: We believe that plasmakinetic surgery is better method than the cold knife technique for the treatment of urethral stricture.

Multifocality incidence and accompanying clinicopathological factors in renal cell carcinoma.

INTRODUCTION: The incidence of multifocality and associated clinicopathological factors in renal cell carcinoma were evaluated. MATERIALS AND METHODS: Clinicopathological characteristics were assessed for 122 renal cell carcinoma-pathological specimens from 121 patients. Microscopic and gross tumor pathology, incidence of multifocality as well as association between tumor grade, histological subtype, stage, size and vascular involvement were assessed. RESULTS: Multifocal renal cell carcinoma was diagnosed in 16 of 122 specimens (13.1%). Satellite lesions for 15 of 16 specimens displaying multifocality had the same histological subtype as their primary tumor. The occult multifocality rate was 11.4%. Tumor grade and stage, but not size or volume, histological subtype, and vascular involvement were significantly related to multifocality. CONCLUSIONS: Accurate staging of renal cell carcinoma appears to be essential in determining whether a patient should undergo nephron-sparing surgery or radical nephrectomy. Patients with high stage and grade should receive the highest attention after nephron-sparing surgery. Larger studies are needed to further elucidate the association between clinicopathological factors and multifocality.