Management of Priapism: Results of a Nationwide Survey and Comparison with International Guidelines.

OBJECTIVE: The aim of this study is to evaluate current urologic practice regarding the management of priapism in Turkey and compare with international guidelines. METHODS: Urologists and urology residents were invited to an online survey consisting of 30 multiple-choice questions on priapism-related clinical practices that were consid- ered most important and relevant to practices by using Google Forms. RESULTS: Total number of responses was 340. Respondents reported that they recorded a detailed patient's medical history and physical examination findings (n = 340, 100%) and laboratory testing, which includes corporal blood gas analysis (n=323, 95%). Participants announced that they performed Doppler ultrasound for 1/4 cases (n = 106, 31%), but 22% of the participants (n=75) replied that they performed in >75% of cases. Participants (n=311, 91%) responded that the first-line treatment of ischemic priapism is decompression of the corpus cavernosum. Moreover, most respondents (n = 320, 94%) stated that sympathomimetic injection drugs should be applied as the second step. About three-quarters of respondents (n = 247, 73%) indicated adrenaline as their drug of choice. Phosphodiesterase type 5 inhibitors seems to be the most pre- ferred drug for stuttering priapism (n=141, 41%). Participants (n=284, 84%) replied that corpora-glanular shunts should be preferred as the first. A large number of par- ticipants (n = 239, 70%) declared that magnetic resonance imaging can be performed in cases with delayed (>24 hours) priapism to diagnose corporal necrosis. Most of the participants (84%) responded that penile prosthesis should be preferred to shunts in cases with delayed (>48 hours) priapism. CONCLUSION: It would be appropriate to improve the training offered by professional associations and to give more training time to the management of priapism during residency.

COVID Pandemic Aftermath: Changing Dynamics on Cosmetic and Aesthetic Surgery Demands.

BACKGROUND: After the WHO's announcement of the pandemic, the quarantine process started in the country. Suspension of elective surgeries was part of these measures. Having most of its cases as elective operations, plastic and aesthetic surgery became one of the branches most affected by the pandemic process. According to the annual statistical reports of the American Society of Plastic Surgeons, 2020 has been the first year in which a decline was experienced in the number of plastic surgery cases performed since the early 2000s. However, presumably, an increase in demand that occurred in the period after the restrictions was reported as well. In this study, we aim to analyze the role of the pandemic on this increased volume of cosmetic surgeries. METHODS: Data about the number of cosmetic operations were collected from a multidisciplinary hospital, centrally located in Istanbul, Turkey. A prospective survey was conducted to question the sources of motivation of the patients who would undergo surgery. RESULTS: A total of 95 (out of 118) patients fully completed the questionnaires. The number of cosmetic operations in the plastic surgery department of the hospital increased by 49.4% in 2021, compared to 2020, and increased by 29.7% compared to 2019. The number of operations in all disciplines increased by 33.4% in 2021, compared to 2020, and increased by 13.3% compared to 2019. The six most marked motivations were evaluated separately according to the types of surgery. Despite the variation due to the type of the operations, "the desire to look better after the pandemic" was the leading reason for undergoing surgery with 46.3% (n = 44). It was also seen that the most significant motivation was "had cosmetic surgery before" with approximately 44.2% among the patients who had undergone cosmetic surgery. CONCLUSIONS: One of the branches most affected by the outcomes of COVID-19 in many aspects is plastic surgery. The wave of excessive demand following the great decline in the number of operations during the pandemic cannot be evaluated independently from the effects of the pandemic on individuals. Although some of the rules that the pandemic has brought to our lives have begun to lose their validity, social life virtualized and isolated by the 'new normal' will be affecting patients for years. At this point, it is of primary importance for plastic surgeons to understand the needs and concerns of patients in order to adapt to the changing patient demands. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Evaluation of Visual Field and Balance Function Alterations in Patients Who Underwent Dermatochalasis Surgery.

PURPOSE: To compare perioperative visual field (VF), balance functions (BF), and changes in the other ocular parameters in patients undergoing upper eyelid dermatochalasis (DC) surgery. METHODS: One hundred and fifty-eight eyes of 79 patients who underwent DC surgery were included in the study. The VF, BF, intraocular pressure (IOP), pachymetry (PM), macular, and optic nerve measurements were recorded. Measurements were repeated at postoperative month 1. The preoperative and postoperative ocular measurements and the balance data were compared. RESULTS: Nineteen of 79 (24.05%) patients were male and 60 of 79 (75.95%) were female, while the mean age of the patients was 58.65 ± 7.38 years. There were statistically significant differences in terms of VF and macular thickness between the preoperative and postoperative values. The improvements in mean defect, standard loss variance, and mean sensitivity values of global VF parameters in both eyes were statistically significant after surgery. Central macular thickness, mean macular thickness, and macular volume decreased significantly in all eyes after surgery (p < 0.05). CONCLUSIONS: Although a marked improvement was observed in VF and peripheral vision after surgery, no significant change was found in BF parameters including primarily falling risk. The significant change in the macular parameters was only remarkable, and we think that the decrease was due to subtle vasospasm. There is a need for further comprehensive studies including especially patients older than 65 with a view to understanding the effect of DC surgery on BF.

Patterns, risks and outcomes of urethral recurrence after radical cystectomy for urothelial cancer; over 20 year single center experience.

PURPOSE: To evaluate the factors affecting urethral recurrence after radical cystectomy for bladder cancer and relationship between urinary diversion type and urethral recurrence rates. PATIENTS AND METHODS: In our 504 radical cystectomy series, 287 male patients whose final pathological were urothelial carcinoma were included in the study. The relationship between urethral recurrence and pathological stage, grade, lymph node involvement and diversion type was researched in addition to risk factors for urethral recurrence. RESULTS: A Total of 287 patients. Orthotopic continent urinary diversion (OCD) and ileal conduit (IC) was performed after radical cystectomy in 141 (49.1%) and 146 (50.9%) patients respectively. Urethral recurrence was observed in 11 (3.8%) patients and urethral recurrence rates in OCD and IC groups were 1.4% and 6.2% (p=0.034). Pathological stages of recurrent patients were 2 pT1, 1 pT2 and 8 pT4 respectively (p<0.001). Urethral recurrence was significantly lower in OCD group when compared to IC group (p=0.036). When all parameters were analyzed using Cox multivariate regression analysis, the most important factor that affects urethral recurrence was pathological T stage (p<0.001). Risk factors for urethral recurrence were present in 92 patients. Urethral recurrence rates in patients with and without risk factors were 8.69% and 1.53% (p<0.01). CONCLUSIONS: In this study, pathological stage was found to be the most important factor affecting urethral recurrence and prostatic stromal invasion was an important prognostic factor in these cases. Although risk factors for urethral recurrence were similar in both groups, urethral recurrence rates were significantly lower in OCD group when compared to IC group.

The feasibility of radical cystectomy in elderly patients.

OBJECTIVE: In this study, we aimed to investigate the relationship between age and tumor characteristics and to evaluate oncologic results after radical cystectomy in bladder cancer with respect to age. MATERIAL AND METHODS: We reviewed 460 patients retrospectively who underwent radical cystectomy. Patients were divided into two groups according to age: ≥70 (Group 1), and <70 (Group 2). We compared tumor pathological characteristics and the results of long-term follow-up in both groups. The first group included 76 (16.7%), and the second group 379 (83.3%) patients. The mean age of the patients was 73.3±3.01 years (70-85) in Group 1 and 58.3±7.47 years (34-69) in Group 2. The American Society of Anesthesiologists (ASA) score was less than three in all of the patients, and there was no risk for major surgery. RESULTS: No statistically significant difference was found between groups with respect to pathological T stage (p=0.567), lymph node involvement (p=0.179), or histological grade (p=0.567). Perioperative mortality rates were 3.9, and 3.4% in groups 1 and 2, respectively (p=0.218). Perioperative complication rates were 14.7, and 17.5% for groups 1, and 2 respectively (p=0.578). Five-year disease-specific survival (DSS) rates were 57.0, and 51.6% Groups 1, and 2, respectively. The mean DSS periods were 82.05±4.88 and 71.68±8.53 months for Groups 1, and 2, respectively. Five-year overall survival rates were 43.9% for Group 1 and 45.9% for Group 2. The mean overall survival times were 54.02±8.47, and 69.25±4.97 months for Groups 1, and 2, respectively. In Cox regression analysis, tumor stage (p=0.012) and lymph node involvement (p<0.001) were significant factors that affected the survival in both groups. None of the patients received neoadjuvant radiotherapy or chemotherapy. CONCLUSION: We found that oncological outcomes of radical cystectomy performed with the indication of bladder tumor were comparable between young and elderly. We believe that age per se should not constitute a contraindication for radical cystectomy operations.

Primary non-Hodgkin follicular lymphoma of the prostate: A case report.

Primary lymphoma of the prostate is a rare condition, representing 0.09% of prostatic malignancies. The clinical presentation of malignant lymphoma of the prostate is difficult to distinguish from other prostatic diseases. Systemic symptoms are rare. Treatments include surgery, chemotherapy and/or radiotherapy. We report a case of primary lymphoma of the prostate in a male patient who presented with lower urinary tract symptoms.

Splenogonadal fusion: a very rare congenital anomaly in the differential diagnosis of a testicular mass.

Splenogonadal fusion is a rare congenital anomaly characterized by congenital fusion between the spleen and testicular tissue. In the literature, there are approximately 175 reported cases, and most of them are associated with cryptorchidism. In this article, we report an unusual case of splenogonadal fusion that was pre-diagnosed as a solid testicular mass in a patient who underwent orchiectomy.

Comparison of microscopic (pT3a) and gross extravesical extension (pT3b) in pathological staging of bladder cancer: analysis of patient outcomes.

OBJECTIVE: To determine the prognostic value of pT3 bladder urothelial carcinoma substaging in patients without lymphatic involvement. PATIENTS AND METHODS: Pathologic and clinical data were reviewed on patients who underwent radical cystectomy for urothelial carcinoma between 1991 and 2010. Of the 460 reviewed patients, 74 patients were diagnosed with pathologic T3No urothelial carcinoma of the bladder. The impact of pathologic substaging (pT3a vs. pT3b) was examined to determine the effect on overall and disease-specific survival. RESULTS: Five years disease-specific and overall survival rates were 46.9 % and 39.6 % for patients with pT3aNo tumor, whereas these ratios were 34.4 and 30.3 %, respectively, for patients with pT3bNo tumor (p > 0.05). Mean disease-specific survival time was 43.94 ± 6.50 months for pT3aNo, while it was 39.01 ± 7.19 months for pT3bNo (p = 0.539). In multivariate cox regression analysis, age (p = 0.459), gender (p = 0.710), urinary diversion type (p = 0.088), and pT3 substaging (p = 0.554) were not noticed as an independent predictive factor for survival. CONCLUSION: Macroscopic extravesical extension (pT3b) is not associated with a worse outcome than pT3a disease in lymph node-negative cases of bladder urothelial carcinoma.

Do pure squamous cell carcinomas and urothelial carcinomas have similar prognosis after radical cystectomy?

PURPOSE: The purpose of this study was to evaluate the surgical treatment results of urothelial carcinoma (UC) and pure squamous cell carcinoma of the bladder (SCC). METHODS: The records of 460 patients who have undergone radical cystectomy in our department between the years 1991 and 2011 were analyzed retrospectively, and 364 patients with UC and 60 patients with pure SCC were evaluated. RESULTS: Average ages of the patients with UC and SCC were 61.12 ± 8.9 and 59.38 ± 8.6 years, respectively (p = 0.902). UC group had 29 female patients, whereas SCC group had 9 female patients (p = 0.077). The mean follow-up periods were 26.09 ± 24.75 months for UC group and 22.23 ± 31.01 months for SCC group (p = 0.805). The incidence of organ-confined, extravesical, lymph node-positive diseases in UC and SCC cases was 48.9 and 32.2, 29.3 and 32.2 %, 21.8 and 35.6 %, respectively (p = 0.028). Five-year disease-specific survival (DSS) rates were 57.5 % in UC and 39.1 % in SCC group (p = 0.011). Five-year DSS rates were 81.2 % in UC and 75.0 % in SCC group in organ-confined disease (p = 0.534) and 28.2 % in UC and 40.9 % in SCC group in extravesical disease (p = 0.845). In lymph node-positive patients, DSS time was 20.9 ± 2.85 months in UC and 12.8 ± 2.07 months in SCC patients (p = 0.182). In multivariate analysis, pT stage (HR: 2.221; 95 % CI: 1.695-2.911) and lymph node involvement (HR: 2.863; 95 % CI: 1.819-4.509) were independently associated with DSS (p < 0.001), but histological subtype (HR: 1.423; 95 % CI: 0.798-2.538) was not a statistically significant factor (p = 0.232). CONCLUSIONS: Although pure SCC cases are diagnosed at advanced stages of the disease, UC and pure SCC cases have similar prognosis by stages. Lymph node involvement and stages are the most important prognostic factors after radical cystectomy.

Nucleophosmin expression in renal cell carcinoma and oncocytoma.

The objective of this study was to investigate nucleophosmin/B23 (NPM) expression in renal cell carcinomas (RCC) and renal oncocytomas. The expression of NPM was studied by immunohistochemical methods on 59 RCCs, 9 oncocytomas, and 19 tumour-negative renal tissues. The expression was assessed relative to various clinicopathological variables and histological subtypes, to determine its potential role as a prognostic and diagnostic marker. All tumours showed nuclear staining, and a minority also exhibited cytoplasmic immunoreactivity. Two patterns of nuclear staining were observed: nuclear staining with a prominent nucleolus (nucleolar staining) and nuclear staining without a prominent nucleolus. There were significant differences, in both nuclear staining and cytoplasmic NPM expression, between oncocytomas and chromophobe RCCs (p < 0.001) and clear cell RCCs (p < 0.001). Cytoplasmic NPM expression was markedly lower in RCCs than in oncocytomas. A statistically significant correlation was discovered between nucleolar staining and nuclear grade (p < 0.001, r = 0.5). No relationship was found between cytoplasmic expression of NPM and any of the clinicopathological parameters or survival. NPM might be a useful immunohistochemical marker for differential diagnosis between oncocytoma and chromophobe RCC. In addition, increased nucleolar NPM expression in RCCs appears to be associated with tumour progression.

Malakoplakia of the prostate diagnosed by elevated PSA level and transrectal prostate biopsy.

Malakoplakia is an inflammation which is thought to develop secondary to chronic Escherichia coli infections. Although often seen in the genitourinary tract, it can also be seen in colon, stomach, lung, liver, bone, uterus, and skin. In this case report, we present prostatic malakoplakia diagnosed by elevated prostate-specific antigen level and transrectal prostate biopsy.

Long-term urodynamic and functional analysis of orthotopic "W" ileal neobladder following radical cystectomy.

OBJECTIVES: In this study, we evaluated the long-term functional outcomes and urodynamic results of the "W" orthotopic ileal neobladder. MATERIALS AND METHODS: Twenty patients whose long-term follow-up data were available and willing to participate in this project were enrolled into the study. The operations were performed between 1997 and 2005. Following standard radical cystoprostatectomy and pelvic lymphadenectomy, "W"-shaped orthotopic ileal neobladder with extramural serous-lined tunnel ureteral implantation was performed. Urodynamic evaluation consisted of standard three-channel filling cystometry with 0.09% sodium chloride solution, and uroflowmetry with postvoiding residual (PVR) urine measurement. RESULTS: All patients were men. The mean duration to postoperative urodynamic study was 38.5 months. Mean cytometric capacity (MCC), compliance, maximal pouch pressure (MPP) and PVR were 584.7 ml, 42.4 ml/cmH2O, 34.8 cmH2O, and 83.5 ml, respectively. Seventeen patients (85%) had complete daytime continence. Total continence (nighttime and daytime) rate was 40%. Three patients (15%) were totally incontinent. Pearson correlation test revealed a positive correlation between MCC and compliance (P<0.05). Compliance and urine volume at first sensation was also positively correlated (P<0.01). Urethrapouch anastomosis stricture was found to be significantly related with increased PVR. Continence status was not correlated with any urodynamic parameter. CONCLUSION: In this study, we found that "W" ileal neobladder reconstruction offers similar storage and voiding functions to normal bladder. Urodynamic evaluation of the "W" neobladder revealed similar results to that of a normal bladder. We conclude that "W" ileal neobladder construction results in a near-normal-functioning orthotopic reservoir that can be safely offered to patients.

Do hydronephrosis and extracorporeal shock wave lithotripsy affect carbohydrate antigens?

OBJECTIVES: To investigate carbohydrate antigen (CA 19-9, CA 15-3, and CA 125) levels in the patients who had hydronephrosis with renal stones and in whom Extracorporeal shock wave lithotripsy (ESWL) was performed. MATERIALS AND METHODS: This prospective study included 20 people with no known disease for control group and 30 patients who had hydronephrosis with renal stones and in whom ESWL was performed between January 2005 and January 2006. None of patients had urinary infection and malignancy. The blood for carbohydrate antigens was taken pre-ESWL and 30 min after ESWL in both groups. CA 19-9, CA 15-3, and CA 125 in the serum were tested with the electro-immunoassay method on the Roche E-170 apparatus with the original Roche kit. RESULTS: The CA 19-9 and CA 125 values in the patients group were found to be statistically significant when compared with the control group but the CA 15-3 was not found to be significant. However, CA 19-9, CA 15-3, and CA 125 values of post-ESWL were not statistically significant when compared with pre-ESWL group (P > 0.05). CONCLUSIONS: The average serum values of CA 125 and CA 19-9 in patients were found to be significantly high. However, serum values of CA 19-9, CA 15-3, and CA 125 were not affected by ESWL.

Surgical treatment options in proximal hypospadias: retrospective analysis of 171 cases at a single institution.

AIM: So far, various techniques have been used in the surgical treatment of proximal hypospadias. The aim of all techniques is to form a near to normal penis functionally and cosmetically. In the present study, proximal hypospadias cases operated in our clinic were evaluated. MATERIAL METHOD: Overall 171 cases with proximal penile, penoscrotal and scrotal meatus, aged between 3 and 28 were included in the study. Early and late postoperative complication rates and factors affecting success were investigated retrospectively. RESULTS: Sixteen cases underwent Duckett, 20 Onlay, 28 free tube, 56 Belt-Fuqua and 51 Thiersch operations. Success rate at early postoperative period was 60.8%, while it became 81.2% following secondary interventions. CONCLUSION: No effect of operation technique and meatus levels were observed on complication rates whilst previous operation increased complication rates significantly.

Bacteriuria, pyuria and bacteremia frequency following outpatient cystoscopy.

AIM: The assumed necessity of antimicrobial prophylaxis prior to cystoscopy is controversial. In this study, the rate of bacteriuria, pyuria and bacteremia in outpatients who underwent cystoscopy without antimicrobial prophylaxis is investigated prospectively. METHODS: The study included 75 patients who underwent cystoscopy for various indications and had sterile urine prior to intervention. A clean midstream urine sample was obtained 24 h before and 48 h after the procedure. Blood cultures were taken 1 h after cystoscopy. Patients were questioned for newly developed symptoms 48 h after cystoscopy. Blood cultures were taken again from patients who presented with fever. RESULTS: Six patients (8%) developed significant bacteriuria, and six patients (8%) developed pyuria without significant bacteriuria. Bacteremia was not determined in any of the patients. The association between presence of pyuria prior to the procedure and development of bacteriuria after the procedure was significant (P < 0.05). Four patients out of six who had bacteriuria were asymptomatic. In our study we found significant bacteriuria after cystoscopy in 8% of patients, and no bacteremia. CONCLUSIONS: Thus we conclude that cystoscopy is a safe and well-tolerated procedure. Antimicrobial prophylaxis should not be administrated unless specific indications are present.