The effect of ureteral double J stent insertion on work performance in patients undergoing endoscopic stone treatment.

Introduction: Despite the developments in the material of the double J (DJ) stents and the production of thinner ones of desired sizes, patients continue to experience troublesome DJ stent-related symptoms in their lives. This study aimed to determine how DJ stenting affects patients' work performance after endoscopic stone surgery. Material and methods: A total of 107 patients underwent placement of a ureteral stent after ureterorenoscopy (URS)/retrograde intrarenal surgery (RIRS), and only active and full-time working patients were included. All patients were asked to complete the validated Turkish version of the work performance score (WPS) questionnaire in the Ureteral Stent Symptom Questionnaire (USSQ) the day before stent removal and again one month after stent removal. Results: Of the participants, 32.7% (n = 35) were female and 67.3% (n = 72) were male; the mean age was 41 (19-80) years. The workday loss had no statistically significant correlation with patient BMI, stone size, or stent indwelling time (p >0.005); however, a statistically significant negative correlation was detected with patient age (r = -0.335, p <0.001). The medians of WPSs with the stent and without the stent were 6 (3-15) and 3 (3-12), respectively (p <0.001). Conclusions: Although DJ catheterization is a crucial tool for urological practice, it may increase the social and economic burden of patients due to reduced work performance and lost workdays. Therefore, limiting the duration of the DJ stent's stay and providing treatments to minimize patient symptoms will positively impact their professional lives. It would be beneficial to avoid DJ stenting in routine practice unless medically necessary.

Expression of nectin-4 in prostate cancer.

OBJECTIVE: Nectin-4 is a transmembrane protein belonging to the nectin family of immunoglobulin-like molecules which is found in the placenta and trachea under physiological conditions and its expression has been shown in many cancer types. We aimed to investigate for the 1st time nectin-4 expression in human prostate cancer tissues. METHODS: We retrospectively analyzed the prostate pathology specimens of 82 patients who underwent initial transrectal ultrasound-guided prostate biopsy or transurethral prostate resection and were found to have atypical small acinar proliferation (ASAP) and incidentally prostate cancer. Tissue samples with prostatic cancer were used as a control for alpha-methylacyl-CoA racemase (AMACR), and benign prostatic glands in the same tissue provided the negative control. The intensity and extent of nectin-4 expression were determined microscopically using the histochemical scoring system which was defined as the product of the staining intensity (score: 0-3) and percentage of stained cells (0-100) at a given intensity. RESULTS: We conducted immunohistochemical analysis of nectin-4 and AMACR expression in all 82 samples. While AMACR expression was positive in prostate cancer tissues with a GS of <7 (n=24, 100%), 7 (n=18, 100%), and ≥8 (n=15, 100%), it was negative in all ASAP samples (n=25, 100%) (p<0.001). Nectin-4 expression was not detected in any of the GS <7, GS 7, or GS ≥8 samples but was found in benign prostatic gland tissues and all 25 (100%) ASAP samples (p<0.001). CONCLUSION: We found that nectin-4 was not expressed in prostate cancer tissues but was expressed in ASAP-and benign prostate gland containing tissues. We believe that prospective studies with more patients and samples including radical prostatectomy materials will reveal the relationship between nectin-4 and prostate cancer more clearly.

Could Testicular Tissue Be a New Arena for the Holmium Laser?

Introduction We aimed to observe the effects of holmium:yttrium-aluminum-garnet (Ho:YAG) laser on testicular tissue. Methods An ex vivo experiment was conducted using calf testicles. A 100 W laser generator with broad-spectrum settings of 10-80 W, 20-40 Hz, and 0.5-2 J, with a medium pulse duration, was tested. The laser effects on testicular tissues with and without the tunica layer were evaluated histopathologically by calculating the incision depth (ID), vaporization area (VA), coagulation area (CA), and total laser area (TLA=VA+CA) of the specimens. Results A total of 48 experiments were conducted. In testicular tissue without a tunica layer, the highest mean ID was determined at 1 J-20 Hz (0.247±0.0208 mm) and with a tunica layer at 2 J-40 Hz (2.673±0.032 mm). In the testicular tissue without a tunica layer, the highest mean VA was determined at 1.5 J-40 Hz (0.029±0.0016 mm2) and in tissue with a tunica at 2 J-40 Hz (6.173±0.114 mm2). The highest mean TLA in tissue without a tunica was detected at 2 J-20 Hz (0.038±0.0008 mm2) and in tissue with a tunica at 2 J-40 Hz (7.292±0.07 mm2). The mean ID, VA, CA, and TLA values of all the power outputs used were found to be statistically significantly higher in the testicular tissue with the tunica layer than in that without it (p<0.001). Conclusion The Ho:YAG laser has different effects on testicular tissue with and without a tunica layer. In testicular tissue without a tunica, the laser's effect was minimal on the surrounding tissue, especially in terms of the ID, VA, and TLA. This minimal effect of the laser can be an advantage in testicular surgery procedures such as testis-sparing surgery (TSS) or testicular sperm extraction (TESE).

Is day-case surgery feasible for laser endoscopic enucleation of the prostate? A systematic review.

PURPOSE: Laser endoscopic enucleation of the prostate (EEP) for benign prostatic obstruction has become increasingly prevalent worldwide. Considering the medical cost-savings and concomitantly fewer nosocomial infections, the feasibility of same-day postoperative discharge of patients who have undergone laser EEP in terms of its safety and effectiveness has become a subject matter of growing interest. We aimed to review those studies focussing on day-case surgery (DCS) in patients undergoing laser EEP. METHODS: A systematic search was conducted using PubMed-MEDLINE and Web of Science databases until October 2022 with the following search terms: "same day discharge AND laser enucleation of the prostate", "day-case AND laser enucleation of the prostate", "same day surgery AND laser enucleation of the prostate" and "one day surgery AND laser enucleation of the prostate" by combining PICO (population, intervention, comparison, outcome) terms. We identified 15 eligible studies. RESULTS: While 14 of the studies focussed on holmium laser EEP, one focused on thulium laser vapoenucleation of the prostate. We observed an improvement in functional parameters in all studies we reviewed, and DCS success and readmission rates ranged between 35.3-100% and 0-17.8%, respectively. The complication rates varied between 0 and 36.7%, most of the complicatons were Clavien-Dindo (CD) I and II. CD ≥ III complications did not significantly differ between same day discharge (SDD) and non-SDD groups in the studies. CONCLUSION: Laser EEP is feasible and promising DCS treatment option delivering improved functional parameters compared to baseline values, and lower perioperative complication and readmission rates in certain patients.

Effect of Ho:YAG laser on kidney tissue with Virtual Basket™ and Bubble Blast™ pulse modulation: an experimental ex vivo study.

PURPOSE: There is a lack of studies in the literature on effects of Virtual Basket™ (VB) and Bubble Blast™ (BB) laser pulse modulations of the Ho:YAG laser on tissue. We aimed to compare the effects of standard modulation (SM), VB, and BB pulse modulations of Ho:YAG laser on kidney tissue. METHODS: An ex vivo experiment was conducted using veal kidneys. The Quanta System Cyber Ho 100W laser generator with a broad setting spectrum at 15-80 W, 10-40 Hz, 1.5-2 J, and medium pulse duration were tested. Incision depth (ID), vaporization area (VA), coagulation area (CA), and total laser area (TLA = VA + CA) were evaluated. Histopathological measurement outcomes were grouped as a low-power group (15, 20, and 30 W) and a high-power group (40, 60, and 80 W) according to the power outputs used. RESULTS: A total of 108 experiments were performed. In saline and high-power output (40, 60, 80 W), mean VA, TLA, and ID, histopathological measurements were higher in BB pulse modulation than VB and SM pulse modulations (p: 0.03, p: 0.001, and p: 0.003, respectively). In contrast, mean CA and LE measurements were higher in SM than in VB and BB pulse modulations (p < 0.001 and p < 0.001, respectively). There was no statistically significant difference in mean histopathological measurements of VA, CA, TLA, and ID, among SM, VB, and BB pulse modulations in the low-power output group in saline (p > 0.05). CONCLUSION: VB can allow controlled dissection, as it does not create a large VA during surgical procedures. BB should be used in a controlled manner in soft tissue surgery due to its strong effect on tissues.

The Impact of COVID-19 on Renal Resistive Index in Kidney Transplant Recipients.

BACKGROUND: There is a lack of renal resistive index (RRI)-based data on the effects of COVID-19 in transplant patients. We aimed to investigate the effect of COVID-19 on the RRI of renal transplant recipients and to review the outcomes of patients who underwent renal transplantation (RT) before and during the COVID-19 pandemic. METHODS: The data of 90 recipients were retrospectively reviewed. The age, sex, body mass index, dialysis time before transplantation, history of COVID-19, postoperative serum creatinine levels (1, 6, and 12 months), and complications of the recipients were recorded. The before and after COVID-19 RRI values of 13 recipients at 1 week after transplant and 3 months after COVID-19 were compared. The outcomes and complications of recipients who underwent RT before the COVID-19 pandemic (group 1, n = 47) and during the COVID-19 pandemic (group 2, n = 43) were also compared. RESULTS: There was a statistically significant difference in terms of the median RRI values of 13 recipients before and after COVID-19 (0.6 [0.53-0.76] vs 0.7 [0.62-0.9], respectively [P = .032]). At the 12-month follow-up, the serum creatinine and estimated glomerular filtration rate levels were found to be statistically significantly higher in group 1 than in group 2 (P = .001 and P = .004, respectively). There was no statistically significant difference between group 1 and group 2 regarding complication rates (53.2% vs 60.5%, respectively; P > .05). CONCLUSIONS: We found that COVID-19 affected RRI values in RT recipients. Our findings show that the outcomes of kidney transplants performed during the COVID-19 pandemic were no worse than those of transplants performed before the pandemic.

Is There Any Association Between Triglyceride-Glucose Index and Graft Function in Kidney Transplant Recipients?

BACKGROUND: Although previous studies have illustrated the relationship between chronic kidney disease, coronary artery disease, erectile dysfunction, and the triglyceride-glucose index (TyGi), the relationship between this index and postoperative graft function in patients undergoing renal transplantation has yet to be investigated. In the present study, we aimed to reveal the association between the TyGi and renal graft outcomes in patients who underwent renal transplantation. METHODS: We retrospectively collected data on living and cadaveric kidney donor recipients between May 2019 and April 2022. The recipients' age, sex, body mass index, preoperative fasting glucose and triglyceride levels, TyGi, estimated glomerular filtration rate (eGFR), and serum creatinine measurement data were recorded. The patients were divided into 2 groups according to their GFR values (group 1: GFR <60 mL/min/1.73 m2; group 2: GFR ≥60 mL/min/1.73 m2). Follow-up serum creatinine-eGFR levels and TyGi measurements were compared between the recipients in group 1 and group 2. RESULTS: The mean TyGi measurements of the recipients were 8.79 ± 0.64 in group 1 and 8.83 ± 0.72 in group 2. There was no statistically significant difference in terms of the TyGi measurements between the 2 groups (P >. 05). No statistically significant correlation was found between the recipients' creatinine, eGFR, and TyGi at 1st, 6th, and 12th postoperative months (P > .05). CONCLUSIONS: We believe that the relationship between the TyGi and renal graft function can be more clearly understood in prospective studies that include a higher number of patients and a longer follow-up period.

Laser enucleation of the prostate in men with very large glands ≥175 ml: A systematic review.

Background: Surgical treatment options for lower urinary tract symptoms can differ according to prostate size. There are few studies on the efficacy and safety of endoscopic enucleation of prostate (EEP) in patients with very large prostates focusing on laser as energy source. In this systematic review, we aimed to examine the efficacy and safety of laser-based EEP on prostate glands ≥150 ml. Methods: A systematic search was conducted using Web of Science, PubMed-MEDLINE, Wiley Online Library and Cochrane Library databases with the following search terms solely or in combination: "large prostate", "laser enucleation", "laser prostatectomy"by combining PICO (population, intervention, comparison, and outcome) terms. Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines were followed. Results: We retrieved 6 studies included 375 patients with prostate sizes ≥175 ml treated with laser-based EEP for symptomatic benign prostatic obstruction. Three studies examined Holmium laser enucleation of prostate (HoLEP) outcomes with a prostate volume (PV) >200 ml, one evaluated HoLEP outcomes with a PV of 200-299 and ≥ 300 ml, two studies evaluated HoLEP outcomes with a PV > 175 ml. We observed improvement in postoperative functional outcomes in patients with a PV > 175, >200 and >300 ml. The retreatment rate was 0-1.3% in all studies involving prostate size ≥175 ml. Most of the complications were Clavien-Dindo I (%0-9) and II (%12.7-16.6). Conclusions: Laser-based EEP is an efficient, safe and feasible procedure even in very large prostates with good functional outcomes, low perioperative complication and retreatment rates.

High Perirenal Fat Volume Affect Negatively Renal Function in Living Renal Transplantation.

OBJECTIVE: We aimed to investigate the effect of perirenal fat volume (PFV) on graft functions by calculating the PFV of donor kidney with routine computed tomography before renal transplantation. METHODS: From May 2019 to December 2020, a total of 54 living donors and recipients who met the criteria for kidney donor were included in the study. Left donor nephrectomy was performed to all donors. Data of age, sex, body mass index (BMI), PFV of the donors, estimated glomerular filtration rate (eGFR), and serum creatinine measurement data of the recipients were recorded. Serum creatinine and eGFR of the recipients were recorded at the 12th month controls. The patients were sorted into 2 groups (G) according to their GFR values. G1, GFR <60 mL/min/1.73 m2; G2, GFR ≥ 60 mL/min/1.73 m2. RESULTS: There was no difference in terms of recipient sex, recipient age, donor sex, recipient BMI, and donor BMI between the 2 groups. The mean of PFV was higher in G1 and was statistically significant (P= 0.01). The ability of the donor BMI and PFV to predict G2 was evaluated by receiver operating characteristic curve analysis. It was determined that PFV predicted G2 to be statistically significant. In the multivariate logistic regression analysis, PFV (odds ratio = 0.988, 95% GA = 0.977-0.999, P = 0.03) was found as an independent predictor of G2. CONCLUSIONS: In conclusion, our study showed PFV as an independent risk factor for low eGFR, revealing that the previously documented relevance of increased BMI with a low eGFR can be partially explained by PFV.

The Impact of Living Donor Nephrectomy With Multiple Renal Arteries on Graft Function and Complications in Renal Transplantation.

BACKGROUND: The aim of this study was to investigate the early outcome of living donor kidney transplantation using allografts with a single artery and multiple arteries. METHODS: From February 2018 to December 2019, a total of 62 patients underwent living donor nephrectomy at our institution: 20 multiple artery donor nephrectomies (MADNs) and 42 single artery donor nephrectomies (SADNs). All operations were performed by the same surgeon as the laparoscopic procedure. The MADN and SADN groups were compared regarding donor and recipient hospital stay, operative time, warm ischemia time, and postoperative complications with Clavien-Dindo classification. Graft function was evaluated considering episodes of acute tubular necrosis during the first week, delayed graft function, serum creatinine (SCr), and glomerular filtration rate for 6 months after transplantation. RESULTS: Sixty-two patients were included in this study. There was no difference in terms of age, sex, body mass index, nephrectomy side, smoking status, preoperative SCr, or preoperative glomerular filtration rate between the 2 groups. Warm ischemia time and operation time were statistically significantly higher in the MADN group (P < .001 and P < .001). Regarding graft function, the prevalence of acute tubular necrosis did not differ between groups. There was also no significant difference in the acute rejection or mortality rates after transplantation. Although SCr levels were lower in multiple renal artery recipients, there was no statistical difference during the 6 months of follow-up. Recipient morbidity and mortality were not different between the 2 groups. CONCLUSIONS: Renal allograft transplantation with multiple renal arteries can be performed with reasonable complications and acceptable results.

Predicting risk of erectile dysfunction in patients with nonalcoholic fatty liver disease.

Nonalcoholic fatty liver disease (NAFLD) is one of the risk factors for erectile dysfunction (ED). We aimed to predict the risk of ED in patients with NAFLD. The study included 146 male patients complaining impotence admitted to the urology outpatient clinic aged 24-80 years without a history of alcohol use who underwent abdominal ultrasonography between February 2018 and January 2019. 106 patients with NAFLD and 40 men without NAFLD were included in the study. Clinical and laboratory parameters, ED status according to International Index of Erectile Function-5 were compared between patients with and without NAFLD. The mean age of patients was 51.47 ± 10.34 years. NAFLD was detected in 72.6% of the patients. No statistically significant difference was found regarding mean age, BMI, IIEF-5 scores, DM status, serum glucose levels (p > .05). Fasting insulin levels, hypertension (HT), insulin resistance (IR) and ED status of the patients with NAFLD were significantly higher than patients without NAFLD (p < .05). NAFLD was found to be a significantly independent associated with ED. We also found that patients with NAFLD have risk of ED 2.92 times higher than without NAFLD (OR: 2.92). For the patients presenting with erectile dysfunction, hepatic steatosis should also be considered.

Is there a PSA cut-off value indicating incidental prostate cancer in patients undergoing surgery for benign prostatic hyperplasia?

AIM: To investigate incidental prostate cancer (IPCa) rate and to determine prostate specific antigen (PSA) cut-off value indicating PCa in patients who underwent surgery by being diagnosed with benign prostatic hyperplasia (BPH) clinically or by standard prostate biopsy. METHODS: Data of 317 patients, who underwent transurethral resection of the prostate (TURP) or open prostatectomy (OP) with pre-diagnosis of BPH, were evaluated retrospectively. The examined parameters included patients' demographics, preoperative serum PSA values, digital rectal examination (DRE) findings, surgical method, histopathological findings and Gleason Scores. RESULTS: A total of 317 patients were included the study. The median age of patients was 69 years (min: 51-max: 79) and the median PSA value was 3.24 ng/dl (min: 0.17-max: 34.9). In 21 patients (6.6%); DRE findings were in favor of malignancy, but prostate biopsy resulted as BPH. While 281 (88.6%) of the patients underwent TURP, 36 (11.4%) underwent open prostatectomy. PCa was detected in 21 (6.6%) patients. PSA was statistically higher in patients who underwent OP compared to patient who underwent TUR-P, 5.9 (min: 1.2 - max: 27.6, IR: 8.7) vs. 2.8 (min: 0.1-max: 34.9, IR: 4.2) ng/dl, p < .001. The rate of IPCa among four PSA group was similar (p = 0.46). There was no difference between the rate of IPCa in patients younger and older than 70 years, (p = 0.11). Please change whole sentence as 'The median PSA level was slightly higher in patients diagnosed with BPH compared to patients diagnosed with IPCa, 3.2 (min: 0.1-max: 34.9) vs. 2.7 (min: 0.3-max: 26.5) ng/dL, p = 0.9. CONCLUSIONS: IPCa still remains an important clinical problem. We were not able to find any correlation of PSA and age with incidental PCa.

Triglyceride-Glucose Index (TyG) is associated with erectile dysfunction: A cross-sectional study.

BACKGROUND: Erectile dysfunction (ED) is often associated with endocrine metabolic diseases such as metabolic syndrome (MetS) and diabetes mellitus (DM), in which insulin resistance (IR) plays a decisive role in pathology. Triglyceride-glucose index (TyG), a simple, inexpensive and easily accessible IR marker, is calculated by fasting serum glucose and triglyceride values. OBJECTIVES: We aimed to reveal the relationship between TyG index and ED. MATERIALS AND METHODS: Of 152 male patients, aged between 24-80 years, admitted to the urology outpatient clinic with complaining erectile insufficiency were evaluated. Liver function tests, complete blood count, fasting serum triglyceride, serum testosterone, fasting glucose, fasting insulin, and hemoglobinA1c (HbA1c) were analyzed. TyG index was calculated. All patients were requested to fill in the validated Turkish version of the 5-item International Index of Erectile Function (IIEF-5) survey. RESULTS: A total of 142 patients were included the study. ED was detected in 91 (64.1%) of the patients. BMI, fasting insulin level, fasting glucose level, IR, GGT, HDL, HbA1c, Triglyceride, TyG, DM, HT, and MetS status of the patients in ED group were statistically significantly higher compared to non-ED group (all P < .05). It was found that the cutoff value of TyG index for ED was 8.88 (AUC = 0.739, sensitivity 67%, specificity = 68.6%). In multivariate logistic regression analysis, age (OR = 1.07, 95% CI = 1026-1115, P = .002) and TyG index above 8.88 (OR = 3.865, 95% CI = 1686-8859, P = .001) were found as independent predictors of ED after accounting for BMI, serum total T and IR. CONCLUSION: TyG index might be useful in the diagnosis and follow-up of ED.

Ureteral access sheath use in retrograde intrarenal surgery.

OBJECTIVE: To determine if there is a difference between postoperative urinary infection rates after retrograde intra-renal surgery (RIRS) when ureteral access sheath (UAS) was used or not used. MATERIALS AND METHODS: We retrospectively analyzed the medical records of all patients who underwent RIRS at our institution between January 2016 and October 2018. RESULTS: 129 patients were included in the study. The mean age of the patients was 48.8 ± 12.1 years; 94 patients were male and 35 were female. The mean stone size (largest diameter), stone attenuation and stone volume were 15.3 ± 5.8 mm, 1038 ± 368 HU and 1098 ± 1031 mm3, respectively. Out of 129 patients, 81 were treated by using UAS (Group 1) and 48 were treated without use of UAS (Group 2). There was no statistically significant difference between the two groups in terms of post-operative infection (p = 0.608). However, the operative time of patients with post-operative infection was statistically higher than the other patients; 88.35 ± 22.5 min versus 59.37 ± 22.1 min (p = 0.017). In multivariate regression analysis, operation time (p = 0.02, r = 1.07) was found to be the sole predictor of post-operative infection. CONCLUSIONS: Using UAS during RIRS might reduce the intrarenal pressure and also has several advantages. However not prolonging the operation time too much could be of higher importance than UAS use in terms of preventing post-operative infection after RIRS.

Prediction of stone-free status after single-session retrograde intrarenal surgery for renal stones.

OBJECTIVE: To determine the possible factors effecting stone-free status (SFS) after single-session retrograde intrarenal surgery (RIRS) for renal stones. MATERIAL AND METHODS: We retrospectively analyzed the charts of 100 consecutive patients who underwent RIRS. Unilateral procedures performed for single renal stones were included in the study. The studied parameters included patient demographics, stone characteristics (size, volume, location and attenuation according to Hounsfield unit [HU]), operation time, presence of preoperative double-J stent (DJS), use of ureteral access sheath (UAS) and SFS. RESULTS: The study population consisted of 100 patients where 43 of them were stone free and remaining 57 had residual stones. The mean age of the patients was 47.2±13.4 years. The mean stone size (largest dimension), stone attenuation and stone volume were 14.8±5.8 mm, 1010±416 HU and 937±929 mm3, respectively. The mean operative time was 60.8±24.2 minutes. Mean stone size, volume and HU were higher in the RS group compared to SF group but without any statistically significant difference, 15.2±6.1 vs. 14.2±5.3 mm, 1056±1037 mm3 vs. 780±745 mm3 and 1061±374 HU vs. 942±462 HU, respectively (p=0.490, p=0.135 and p=0.226). In multivariate regression analysis stone location and UAS use were found to be the significant predictors of SFS. Patients with lower pole stones are 2.25 times likely to have residual stones after RIRS compared to patient's having stones at other localizations (p<0.001). CONCLUSION: Stone volume could be a more reliable parameter than stone size in predicting RIRS success. Lower pole stone location and UAS use could be considered the most significant predictors of SFS after single session RIRS for single renal stones.