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.

Effect of Different Musical Types on Patient's Relaxation, Anxiety and Pain Perception during Shock Wave Lithotripsy: A Randomized Controlled Study.

PURPOSE: The aim of this study was to investigate the effects of listening to different music types during extracorporeal shock wave lithotripsy (SWL) on the patients' pain control, anxiety level, and satisfaction. MATERIALS AND METHODS: This study was a prospective single-blinded, paral-lel-group randomized clinical trial with balanced ran-domization [1:1]. A total of 150 patients who underwent first-session SWL were included in the study. The patients were randomly divided in to five groups (30 participants in each group) as follows: headphones were not put on and no music was played in Group 1 (control group); headphones were put on but no music was played in Group 2; Turkish art music was listened to with headphones in Group 3; Western classical music was listened to with headphones in Group 4; thetype of music the patient liked was listened to with headphones in Group 5. Demographic data related to patients and procedure, State-Trait Anxiety Inventory-State Anxiety (STAI-SA), Visual Analog Scale (VAS) scores, willingness to repeat procedure (0: never 4: happily), and patient satisfaction rates (0: poor 4: excellent) were recorded immediately after the procedure. RESULTS: There was a statistically significant difference between groups in terms of median VAS scores (7, 6, 4.5, 5, and 4, respectively, P<.001), whereas the VAS scores in Groups 3, 4, and 5 were significantly lower than those in Group 1 and 2 (P<.001). The median STAI-SA scores between the groups were significantly different (45, 45, 42, 45, and 40, respectively, P<.001), while the anxiety levels in Groups 3, 4, and 5 were significantly lower than those in Group 1 (P=.008, P=.018, and P<.001, respectively). Moreover, there were statistically significant differences between the groups in terms of willingness to repeat the procedure and patient satisfaction rates (P<.001). CONCLUSIONS: Music therapy during SWL reduced the patients' pain and anxiety scores, moreover listening to the patient's preferred music type provided greater satisfaction. Listening to the patient's preferred music type could be standardized and routinely used during SWL.

Comparison of inflammatory markers between brucella and non-brucella epididymo-orchitis

ABSTRACT Objectives: Brucellosis is a multi-system infectious disease that is associated with inflammation, which causes an increase in acute phase reactants. Hematological inflammatory markers of brucellosis include mean platelet volume (MPV), red cell distribution width (RDW), neutrophil/lymphocyte ratio (NLR), and platelet/lymphocyte ratio (PLR). In this study, we aimed to evaluate the diagnostic value of hematological inflammatory markers in Brucella epididymo-orchitis (BEO), and to investigate the utility of these markers for differential diagnosis from non-Brucella epididymo-orchitis (non-BEO). Materials and Methods: We retrospectively reviewed the records of 22 BEO and 50 non-BEO patients. Hematological parameters were recorded and compared between the two groups. The main diagnostic criteria for BEO were positive clinical findings (i.e., testicular pain, tenderness and scrotal swelling), a positive Rose Bengal test result, standard tube agglutination (STA) titer ≥ 1/160, and/or a positive blood culture. Results: The most decisive factors in discriminating between BEO and non-BEO were NLR, RDW, and MPV, in decreasing order of their strength. Regardless of other factors, NLR values < 2.3 significantly increased the odds of BEO (OR=8.080, 95% CI: 1.929-33.843, p=0.004). After adjusting for other factors, RDW values >14.45% significantly increased the odds of BEO (OR=7.020, 95% CI: 1.749-28.176, p=0.006). Independent of the other factors, patients with MPV < 7.65 fL had a 6.336 times higher risk for BEO (95% CI: 1.393 - 28.822, p=0.017). Conclusion: Hematological inflammatory markers such as NLR, RDW, and MPV can aid in the differential diagnosis of BEO and non-BEO.

Outcomes of microsurgical subinguinal varicocelectomy to treat painful recurrent varicocele.

In this study, was evaluated the outcomes of patients undergoing microsurgical varicocelectomy to treat scrotal pain due to recurrent varicocele were evaluated. A total of 27 patients who underwent microsurgical varicocele ligation for recurrent varicocele and scrotal and/or testicular pain were included in this retrospective study. Recurrent varicocele in all patients was diagnosed with by physical examination and coloured Doppler ultrasonography (CDUSG). All patients underwent pre-operative follow-up and post-operative follow-up at 3 and 6 months by physical examination, assessment of using the Visual Analog Scale (VAS) score, and CDUSG. The rRecurrent varicocele was grade 3 in 24 patients (88.9%) and grade 2 in 3 patients (11.1%). In all cases, the varicocele was on the left side. The mean VAS score was 6.5 (range 5-8) pre-operatively, 0.7 (range 0-5) at 3 months post-operatively, and 0.3 (range 0-4) at 6 months post-operatively (p < 0.001). Post-operative complete responseresolution, partial resolutionponse, and non-responsiveness rates were 85.2%, 11.1%, and 3.7% at the 3rd month post-operatively, respectively, and 88.8%, 7.5%, and 3.7% at the 6th month post-operatively, respectively. During follow-up, there was recurrence in 1 patient (3.7%) and hydrocele in 1 patient (3.7%). Microsurgical subinguinal varicocelectomy is an effective treatment for patients with scrotal pain caused by recurrent varicocele.

Comparison of inflammatory markers between brucella and non-brucella epididymo-orchitis.

OBJECTIVES: Brucellosis is a multi-system infectious disease that is associated with inflammation, which causes an increase in acute phase reactants. Hematological inflammatory markers of brucellosis include mean platelet volume (MPV), red cell distribution width (RDW), neutrophil/lymphocyte ratio (NLR), and platelet/lymphocyte ratio (PLR). In this study, we aimed to evaluate the diagnostic value of hematological inflammatory markers in Brucella epididymo-orchitis (BEO), and to investigate the utility of these markers for differential diagnosis from non-Brucella epididymo-orchitis (non-BEO). MATERIALS AND METHODS: We retrospectively reviewed the records of 22 BEO and 50 non-BEO patients. Hematological parameters were recorded and compared between the two groups. The main diagnostic criteria for BEO were positive clinical findings (i.e., testicular pain, tenderness and scrotal swelling), a positive Rose Bengal test result, standard tube agglutination (STA) titer ≥ 1/160, and/or a positive blood culture. RESULTS: The most decisive factors in discriminating between BEO and non-BEO were NLR, RDW, and MPV, in decreasing order of their strength. Regardless of other factors, NLR values < 2.3 significantly increased the odds of BEO (OR=8.080, 95% CI: 1.929- 33.843, p=0.004). After adjusting for other factors, RDW values >14.45% significantly increased the odds of BEO (OR=7.020, 95% CI: 1.749-28.176, p=0.006). Independent of the other factors, patients with MPV < 7.65 fL had a 6.336 times higher risk for BEO (95% CI: 1.393 - 28.822, p=0.017). CONCLUSION: Hematological inflammatory markers such as NLR, RDW, and MPV can aid in the differential diagnosis of BEO and non-BEO.

Complete penile skin necrosis.

Superficial penile skin infections may be presented in different clinical situations that vary from simple infection to organ loss and serious morbidity and mortality. Antibiotic treatment and, if necessary, urgent debridement is required. A 46-year-old male patient with the complaints of urethral discharge and pain admitted to our outpatient clinic. He declared that there were midpenil tenderness and erythema 14 days ago which occurred after sexual intercourse. Complete penile skin necrosis with purulent discharge was detected in physical examination. After wound debridement and 14-days of intravenous antibiotic treatment, wound site culture was negative and then full-thickness skin grafting was performed. Urgent antibiotic treatment should be given, especially for the skin infections of the genital area. Despite the rapid spread of antibiotic treatment, clinical presentation may worsen within hours. It should be noted that especially in diabetics and elderly patients with poor hygiene, the infection may spread to anogenital region and may lead to fulminant necrotizing fasciitis which can present with severe morbidity and mortality. Reconstructive surgery is planned after the control of infection and according to the amount of tissue loss.

Management of Forgotten Ureteral Stents: Relationship Between Indwelling Time and Required Treatment Approaches.

BACKGROUND: Double-J stents are widely used in urology practice, and removal of these stents can sometimes be forgotten. AIMS: To investigate whether indwelling time of double-J stent can predict which treatment modality is required for removal of the stent from the body. STUDY DESIGN: A multicentre, retrospective observational study. METHODS: The data of 57 patients who were treated for forgotten ureteral stents between January 2007 and December 2014 were evaluated retrospectively. Patients were classified into four groups according to indwelling time of the stents: 6-12 months, 13-24 months, 25-36 months, and <36 months. Encrustation and associated stone burden of the stents were evaluated with non-contrast stone protocol computerised tomography. RESULTS: Patients were classified according to their duration of the stent indwelling time. Simple cystoscopic stent retrieval was performed in 71.4% of patients in the 6-12 months group, 44% of patients in the 13-24 months group, 6.2% of patients in the 25-36 months group, and 11.1% of patients in the <36 months group. A percutaneous or open surgery was required in no patients with an indwelling time of double-J stent shorter than 30 months. CONCLUSION: Transurethral and/or percutaneous combined endo-urological approaches are usually sufficient for the removal of forgotten double-J stents. Transurethral procedures are sufficient for the treatment of patients with double-J stent indwelling times less than 30 months.

Urothelial neoplasm of the bladder in childhood and adolescence: a rare disease.

PURPOSE: Bladder tumors are rare in children and adolescents. For this reason, the diagnosis is sometimes delayed in pediatric patients. We aimed to describe the diagnosis, treatment, and follow-up methods of bladder urothelial neoplasms in children and adolescents. MATERIALS AND METHODS: We carried out a retrospective multicenter study involving patients who were treated between 2008 and 2014. Eleven patients aged younger than 18 years were enrolled in the study. In all the patients, a bladder tumor was diagnosed using ultrasonography and was treated through transurethral resection of the bladder (TURBT). RESULTS: Nine of the 11 patients (82%) were admitted with gross hematuria. The average delay in diagnosis was 3 months (range, 0-16 months) until the ultrasonographic diagnosis was performed from the first episodes of macroscopic hematuria. A single exophytic tumor (1-4cm) was present in each patient. The pathology of all patients was reported as superficial urothelial neoplasm: two with papilloma, one with papillary urothelial neoplasm of low malignant potential (PUNLMP), four with low grade pTa, and four with low grade pT1. No recurrence was observed during regular cystoscopic and ultrasonographic follow-up. CONCLUSIONS: Regardless of the presence of hematuria, bladder tumors in children are usually not considered because urothelial carcinoma in this population is extremely rare, which causes a delay in diagnosis. Fortunately, the disease has a good prognosis and recurrences are infrequent. Cystoscopy may be unnecessary in the follow-up of children with bladder tumors. We believe that ultrasonography is sufficient in follow-up.

The success of tubularized-incised plate urethroplasty in adults and children.

PURPOSE: Hypospadias repair is rarely performed in adults. It is believed that the success rate is lower in adulthood. We aimed to compare the success rate of primary hypospadias repair with tubularized-incised plate (TIP) urethroplasty in adults and children. PATIENTS AND METHODS: The databases of consecutive boys and adults who were treated with TIP urethroplasty for primary hypospadias between 2012 and 2015 were evaluated. All operations in the boys and adult patients were performed by a single surgeon. We considered urethroplasty complications to include a urethrocutaneous fistula, neourethral stricture, meatal stenosis, diverticulum, and glans dehiscence. Urine flow was also evaluated using uroflowmetry. RESULTS: Seventy-seven consecutive patients underwent surgery by a single surgeon in the last 3 years for hypospadias repair. Nineteen of these patients were adults. Urethrocutaneous fistulae developed in 2 of the 19 (10.5 %) adults, and 3 of the 58 (5.2 %) boys. In addition, there were urinary tract infections in 2 (3.4 %) children, meatal stenosis in 1 (1.7 %) child, and glans dehiscence in 1 (5.3 %) adult. Uroflowmetry was normal in all patients. There was no difference in outcomes between boys and adults. CONCLUSION: Our data showed that the success rate of hypospadias repair with TIP urethroplasty is similar in adults and children. TIP urethroplasty is associated with good results in adults and boys.

Urothelial neoplasm of the bladder in childhood and adolescence: a rare disease

ABSTRACT Purpose: Bladder tumors are rare in children and adolescents. For this reason, the diagnosis is sometimes delayed in pediatric patients. We aimed to describe the diagnosis, treatment, and follow-up methods of bladder urothelial neoplasms in children and adolescents. Materials and Methods: We carried out a retrospective multicenter study involving patients who were treated between 2008 and 2014. Eleven patients aged younger than 18 years were enrolled in the study. In all the patients, a bladder tumor was diagnosed using ultrasonography and was treated through transurethral resection of the bladder (TURBT). Results: Nine of the 11 patients (82%) were admitted with gross hematuria. The average delay in diagnosis was 3 months (range, 0–16 months) until the ultrasonographic diagnosis was performed from the first episodes of macroscopic hematuria. A single exophytic tumor (1–4cm) was present in each patient. The pathology of all patients was reported as superficial urothelial neoplasm: two with papilloma, one with papillary urothelial neoplasm of low malignant potential (PUNLMP), four with low grade pTa, and four with low grade pT1. No recurrence was observed during regular cystoscopic and ultrasonographic follow-up. Conclusions: Regardless of the presence of hematuria, bladder tumors in children are usually not considered because urothelial carcinoma in this population is extremely rare, which causes a delay in diagnosis. Fortunately, the disease has a good prognosis and recurrences are infrequent. Cystoscopy may be unnecessary in the follow-up of children with bladder tumors. We believe that ultrasonography is sufficient in follow-up.

Comparison of the efficacy and histopathological effects of three hemostatic agents in a partial nephrectomy rat model.

PURPOSE: The major complications of partial nephrectomy are bleeding and urine leakage. While various hemostatic agents are used to control bleeding, the histopathological characteristics of these hemostatic agents have not been investigated adequately. We aimed to investigate and compare the histopathological and hemostatic effects of local hemostatic agents in a partial nephrectomy rat model. METHODS: Thirty-two rats were divided into four equal groups, and partial nephrectomy was done to all rats. Conventional suture repair, Glubran2®, FloSeal®, and Celox™ were applied to every single group. The period of warm ischemia and hemostasis during surgical process was timed. Rats were killed later 3 weeks, and their partial nephrectomy applied kidneys were evaluated histopathologically. RESULTS: The fastest hemostasis was provided with Glubran2® (32.87 s). FloSeal® was the second (40.85 s), and Celox™ was the third (55.75 s). Glomerular necrosis and calcification were seen more in the suture group than other groups (p < 0.001). Fibrosis was found significantly less in Celox™ group. Fibroblast activation was found significantly less comparing to other groups (p < 0.01). The erythrocyte aggregation was significantly greater in the Glubran2® and FloSeal® groups than suture group (p < 0.01 and p < 0.001). CONCLUSION: The negative effects of hemostatic agents to the renal histopathology were less than conventional suture repair. Celox™ was the best biocompatible agent. In comparison with three agents, it was observed that Glubran2® provided hemostasis faster than other agents.

The use of latex foley catheter in repair of hypospadias the most common seen congenital penile anomaly.

OBJECTIVE: Hypospadias is the most common congenital penile anomaly occurring in 1/300 live births. Various surgery techniques are used in repair of hypospadias. Infant and children with hypospadias are usually admitted to emergency services by worried their parents for the first time. TIP urethroplasty is widely used in the repair of hypospadias, but the use of urethral catheters is still a matter for discussion. Herein, we described our experiences with the use of an unsutured latex foley catheter placed in the glans for 24 to 48 hours. METHODS: A retrospective chart review was performed on 38 patients who underwent Tubularized incised plate (TIP) hypospadias repair from 2009 to 2011. Of these, 35 patients who had two-way latex Foley catheters placed for 24 h to 48 hands were followed for at least 12 month. RESULTS: Excellent cosmetic results were obtained in all patients. Urinary tract infection developed in two patients (5.7%). one patient (2.8%) who had mild urethral repair breakdown was repaired in the office environment. CONCLUSION: We observed very low complication rates in application of a two-way latex Foley catheter in hypospadias surgery and found that this method can be used safely. Moreover, the catheter can be used for traction purposes during the procedure. At the end of the 24 to 48 h period, removal of the two-way latex urethral catheter with balloon does not harm the urethral repair. To reach a definite conclusion, larger studies are needed.

The relationship between mean platelet volume and other platelet indices with testicular artery blood flow and fertility: a preliminary study.

OBJECTIVES: To examine the relationship between platelets (PLT) and platelets indices such as mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit (PCT) as noninvasive biomarkers with testicular artery blood flow and fertility. METHODS: Fifty-seven healthy and fertile men with normal semen values and 52 patients with abnormal semen values were included in the study. The participants' PLT, MPV, PDW and PCT values were analyzed. Four different levels of the testicular artery, peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI) were measured using color Doppler ultrasound. RESULTS: There was no significant difference in terms of platelet and platelet indices (MPV, PDW and PCT) between the fertile and infertile group. There were no between group differences in the RI values of the testicular- and intra-testicular artery. When all fertile and infertile participants were considered together, there was no statistically significant correlation between the parameters of the testicular artery blood flow (PSV, EDV and RI) and platelet and platelet indices (MPV, PDW and PCT) (P > 0.05). CONCLUSIONS: There is not statistically significant correlation between any of the following parameters: platelets and platelet indices such as MPV, PDW and PCT, RI of the testicular artery, and fertility.

Penile Mondor's Disease: Primum Non Nocere!

PURPOSE: Penile Mondor's disease (superficial thrombophlebitis of the dorsal vein of the penis) is a rare clinical diagnosis. It is an easily diagnosed and treated disease. Nevertheless, when reviewing the literature, we considered that unnecessary tests are carried out for diagnosis. In this study, we aimed to indicate the redundancy of Doppler ultrasonography for diagnosis of penile Mondor's disease. MATERIALS AND METHODS: Seven patients with the clinical presentation of penile Mondor's disease were included in the study. In the first two patients, penile Doppler ultrasonography was performed for diagnostic purposes by applying a vasoactive intracavernosal agent. This diagnostic procedure was not implemented in the next five patients. RESULTS: Physical examinations revealed cord-like thickening lesions on dorsal and dorsolateral penis. In the first two patients, who penile Doppler ultrasonography with an intracavernosal vasoactive agent was used for diagnostic purposes, was developed priapism. We did not use penile Doppler for more patients as this would be unethical according to us. CONCLUSION: Recovery from penile Mondor's disease is usually spontaneous and smooth. A simple physical examination is sufficient for diagnosis, and palliative treatment is effective. For the diagnosis of this disease, unnecessary tests should be avoided so that patients are not harmed.

The hounsfield unit value calculated with the aid of non-contrast computed tomography and its effect on the outcome of percutaneous nephrolithotomy.

To evaluate the effect of the Hounsfield unit (HU) value, calculated with the aid of non-contrast computed tomography, on the outcome of percutaneous nephrolithotomy (PCNL). Data for 83 patients evaluated in our clinic between November 2011 and February 2014 that had similar stone sizes, localizations, and radio opacities were retrospectively reviewed. The patients were grouped according to their HU value, in a low HU group (HU ≤ 1000) or a high HU group (HU > 1000). The two groups were compared based on their PCNL success rates, complications, duration of surgery, duration of fluoroscopy, and decrease in the hematocrit. There were no significant differences in terms of mean age, female-male ratio, or mean body mass index between the two groups (p > 0.05). The stone size and stone surface area did not differ significantly between the groups (p = 0.820 and p = 0.394, respectively). The unsuccessful PCNL rate and the prevalence of complications did not differ significantly between the two groups (p > 0.05). The duration of surgery, duration of fluoroscopy, and decrease in the hematocrit were significantly greater in the high HU group compared to the low HU group (p < 0.001). Calculating the HU value using this imaging method may predict cases with longer surgery durations, longer fluoroscopy durations, and greater decreases in hematocrite levels, but this value is not related to the success rate of PCNL.

The Damage of Penile Doppler Ultrasonoghraphy in Diagnosis of Penile Mondor's Disease: A Report of Two Cases.

Penile Mondor's disease is a thrombophlebitis of the superficial dorsal vein of the penis. It is a rare clinical diagnosis and generally resolves spontaneously. A simple physical examination is sufficient for diagnosis but color Doppler ultrasonography is often carried out as a further investigation. We describe two patients who developed priapism due to penile Doppler ultrasonography which was used for diagnosis of these patients. Now, in our opinion this examination was unnecessary.