Predictors of reflux persistence after endoscopic dextranomer/hyaluronic Acid copolymer injection in pediatric patients with Vesicoureteral reflux: short-term results.

This study aims to investigate the factors effective in predicting the persistence of reflux after the first subureteric transurethral injection (STING) of dextranomer/hyaluronic acid copolymer in pediatric patients with vesicoureteral reflux. The data of patients without a previous history of surgery to treat vesicoureteral reflux and who underwent STING for the first time between September 2011 and November 2020 were investigated retrospectively. After considering exclusion criteria, of 199 patients, 127 patients and 180 renal units were suitable for inclusion. A renal unit-based evaluation was made. Age < 61 months (univariate: p = 0.001, multivariate: p = 0.015, HR: 2.352 (1.181-4.686), OR (95% CI)), moderate reflux level (grade 3) (univariate: p < 0.001, multivariate: p = 0.019, HR: 2.703 (1.177-6.209), OR (95% CI)), DRF (differential renal function) < 45 (univariate: p = 0.020, multivariate: p = 0.047, HR: 1.992 (1.009-3.935), OR (95% CI)), and UDR (ureteral diameter ratio) > 0.15 (univariate: p < 0.001, multivariate: p = 0.005, HR: 2.786 (1.368-5.672), OR (95% CI)) were found predictors of reflux persistence after STING surgery both univariate and multivariate analysis. High reflux level (grade 4-5) was statistically significant in univariate analysis (p < 0.001) but not statistically significant in multivariate analysis (p = 0.215). In our study, UDR and DRF were found to be factors affecting reflux persistence. UDR and DRF should be considered in order to predict reflux resolution in patients who will undergo STING.

Is percutaneous nephrolithotomy effective and safe in infants younger than 2 Years old? Comparison of mini standard percutaneous nephrolithotomy.

BACKGROUND: In this study, we aimed to compare the operative outcomes, postoperative outcomes, stone-free status and complications of SPCNL and MPCNL in infants younger than two years of age. METHODS: We retrospectively analyzed 163 patients younger than two years of age who underwent percutaneous nephrolithotomy (PCNL) in our institution between September 1999 and March 2022. The patients were divided into two groups depending on the tract size. The MPCNL group consisted of 73 patients with a tract of 22 Fr or less, and the SPCNL consisted of 90 patients with a tract greater than 22 Fr. RESULTS: The median age of 163 patients included in the study was 17.3 (range 7-24) months. Although the median stone size was lower in the SPCNL group, no statistically significant difference was found between the two groups in terms of stone size (p = 0.073). The median operative time was 74.8 min in the MPCNL group and 62.8 min in the SPCNL group, with a statistically significant difference (p = 0.002). Stone free rates (SFR) were 89 % and 90.8 % in the MPCNL and SPCNL groups, and the clinically insignificant residual fragments (CIRF) rates were 11 % and 4.6 %, respectively (p = 0.064). The fluoroscopy time, nephrostomy withdrawal time, and hospitalization stay were similar in the two PCNL groups (p = 0.535, p = 0.253, and p = 0.143, respectively). Postoperative fever was similar in MPCNL and SPCNL groups (p = 0.504). Although bleeding (6.7%-2.7 %) and blood transfusion (3.3%-1.4 %) rates were higher in the SPCNL group, there was no statistically significant difference (p = 0.248 and p = 0.420, respectively). Prolonged urinary leakage occurred in 6 (8.2 %) patients in the MPCNL group and 1 (1.1 %) patient in the SPCNL group, with a statistically significant difference (p = 0.026). CONCLUSIONS: With the development of MPCNL, the use of SPCNL in infants has decreased considerably. However, SPCNL continues to be an effective and reliable method when needed in suitable patients. Although PCNL in infants shows some differences from adults, it is an effective and safe method for suitable patients. LEVEL OF EVIDENCE: Although we created our study by retrospectively examining the pediatric urology data that we created prospectively, our study is of a retrospective nature. Therefore the Level of Evidence is 3.

Management Patterns of Male Urethral Stricture Disease among Urologists: What Do the Guidelines Say? What Do Urologists Do?

BACKGROUND: The aim of the present study is to evaluate and analyze the daily clinical practice for male urethral stricture disease (MUSD) among urologists. METHODS: Considering the latest guidelines on urethral stricture disease, a survey was developed regarding the various treatment options and preferences in different sites of male urethral stricture disease. The survey was sent to urologists via e-mail and phone application. RESULTS: A total of 266 urologists completed the survey and were included in the final analysis. In regard to workplace, 62 (23.3%), 58 (21.8%), 71 (26.7%), and 75 (28.2%) respondents worked in university hospitals, training and research hospitals, state hospitals, and private practice hospitals, respectively. In regard to the diagnostic method used in male urethral strictures, 88.7% of the participants would choose uroflowmetry + postvoiding residual (UF + PVR), and 64.6% would choose retrograde urethrography (RUG). Direct vision internal urethrotomy (DVIU) was the most frequently chosen method in penile urethral strictures (PUS), being chosen by 72.9%. Direct vision anterior internal urethrotomy was the most common method for both ≤2 cm and >2 cm strictures, 63.1%, and 30.8%, respectively. The most preferred graft for augmentation urethroplasty was buccal mucosa (75.8%). Endoscopic incision/resection (transurethral resection (TUR)) is the most frequently applied treatment method for posterior urethral/vesicourethral anastomotic strictures (86.4%). CONCLUSIONS: The present study clearly shows that most urologists still prefer DVIU and urethral dilatation to urethroplasty in MUSD, which contradicts current guidelines. Urologists should be encouraged to perform urethroplasty and/or refer patients to experienced centres for recurrent MUSD.

Management Patterns of Male Urethral Stricture Disease among Urologists: What Do the Guidelines Say? What Do Urologists Do?

Background: The aim of the present study is to evaluate and analyze the daily clinical practice for male urethral stricture disease (MUSD) among urologists. Methods: Considering the latest guidelines on urethral stricture disease, a survey was developed regarding the various treatment options and preferences in different sites of male urethral stricture disease. The survey was sent to urologists via e-mail and phone application. Results: A total of 266 urologists completed the survey and were included in the final analysis. In regard to workplace, 62 (23.3%), 58 (21.8%), 71 (26.7%), and 75 (28.2%) respondents worked in university hospitals, training and research hospitals, state hospitals, and private practice hospitals, respectively. In regard to the diagnostic method used in male urethral strictures, 88.7% of the participants would choose uroflowmetry + postvoiding residual (UF + PVR), and 64.6% would choose retrograde urethrography (RUG). Direct vision internal urethrotomy (DVIU) was the most frequently chosen method in penile urethral strictures (PUS), being chosen by 72.9%. Direct vision anterior internal urethrotomy was the most common method for both ≤2 cm and >2 cm strictures, 63.1%, and 30.8%, respectively. The most preferred graft for augmentation urethroplasty was buccal mucosa (75.8%). Endoscopic incision/resection (transurethral resection (TUR)) is the most frequently applied treatment method for posterior urethral/vesicourethral anastomotic strictures (86.4%). Conclusions: The present study clearly shows that most urologists still prefer DVIU and urethral dilatation to urethroplasty in MUSD, which contradicts current guidelines. Urologists should be encouraged to perform urethroplasty and/or refer patients to experienced centres for recurrent MUSD (AU)

Protective effect of dapagliflozin against cyclosporine A-induced nephrotoxicity.

This study aimed to reveal the possible protective effect of dapagliflozin (DAPA) against acute kidney damage due to cyclosporine A (CsA). Thirty-two mice with an eight-week-old Balb\c albino strain were divided into four groups: control group, CsA group, DAPA group, and CsA + DAPA group. On day 9 of treatment, the animals were decapitated, and bilateral nephrectomy was performed. Oxidative stress and apoptosis were evaluated with caspase-3 activity, total oxidant status (TOS), total antioxidant status (TAS), malondialdehyde (MDA), myeloperoxidase (MPO), B-cell lymphoma-2 (Bcl-2), and Bcl-2-associated X protein (Bax) in the right kidney resection material. The left kidney resection material was evaluated histopathologically. CsA increased caspase-3 activity, Bax, TOS, MDA, TAS, and MPO levels, and the administration of DAPA with CsA significantly reduced this increase in levels (p < 0.001, p < 0.001, p < 0.001, p < 0.001, p < 0.001, and p < 0.001, respectively). CsA decreased Bcl-2 levels, and administration of CsA + DAPA significantly increased Bcl-2 levels compared with only CsA administration (p < 0.001). Additionally, administration of DAPA significantly reduced the histopathological findings (parenchymal inflammation, hyaline cast formation, vacuolization, and lysis of renal tubular cells) caused by CsA. DAPA reduces oxidative stress, apoptosis, and histopathological damage caused by CsA in renal tissue.

The effect of treatment of obstructive sleep apnea syndrome on overactive bladder symptoms.

OBJECTIVE: To evaluate the effect of the treatment of obstructive sleep apnea syndrome on overactive bladder symptoms. METHODS: All patients who applied to the outpatient clinic with complaints of snoring and apnea were evaluated by polysomnography between years 2017 and 2019. obstructive sleep apnea syndrome severity was evaluated according to the apnea-hypopnea-index. All patients were filled with questionnaire form as overactive bladder symptoms score, international quality of life, international consultation on incontinence questionnaire short-form, and 3-day bladder diary before polysomnography and three months after continuous positive airway pressure therapy and surgical treatment. RESULTS: A total of 125 patients, 34 (27.2%) patients with mild obstructive sleep apnea syndrome, 27 (21.6%) patients with moderate obstructive sleep apnea syndrome, and 64 (51.2) patients with severe obstructive sleep apnea syndrome were included in the study. The prevalence of overactive bladder symptoms in three obstructive sleep apnea syndrome groups were 67.6, 53.8, and 48.4%, respectively, and there was no statistical difference between the groups (p=0.190). obstructive sleep apnea syndrome treatment such as surgical treatment or continuous positive airway pressure therapy was applied to 45.5% (31 patients) patients with obstructive sleep apnea syndrome and overactive bladder. Three months after treatment, the overactive bladder symptoms score significantly decreased from 16.1±7.9-12.80±9.82, international quality of life was significantly increased from 105.0±23.2-110.4±22.2, and incontinence questionnaire short-form decreased from 11.9±4.0-10.4±5.6 (p=0.009, p=0.023, and p=0.248, respectively). There was a significant decrease between before and after treatment in terms of mean day-time frequency and mean urgency episodes of patients (p=0.007, p=0.002). CONCLUSIONS: Both surgery and continuous positive airway pressure treatment of obstructive sleep apnea syndrome improved overactive bladder symptoms, overactive bladder symptoms score, international quality of life, day-time frequency, and urgency episodes.

The impact of movement, physical activity and position on urine production: A pilot study.

BACKGROUND: Many different internal factors have been proven to influence urine production such as age, weight, and quality of sleep. External factors such as consumption of caffeine and fluid consumption have been shown to have an impact on urine production. AIM: To investigate the impact of movement, physical activity and position on urine production. METHODS: This prospective observational study was executed at Ghent University Hospital, Belgium. Study participation was open for anyone visiting the hospital. Participants collected one basic and two extended 24-hour urine collections and filled in questionnaires concerning their general health and physical activity. Urinary levels of osmolality, sodium and creatinine were determined. Data on movement, physical activity and position was described. RESULTS: An increase in body movement leads to a significant increase in diuresis during daytime, night-time, and 24 hours (P = .002, P < .001, and P < .001, respectively). An increase in body movement leads to a significant decrease in osmolality during night-time and 24 hours (P = .009, and P = .004, respectively). However, no significant influence of movement on osmolality was found during daytime (P = .12). An increase in body movement leads to a significant decrease in creatinine during daytime, night-time and 24 hours (P = .001, <0.001, and P < .001, respectively). An increase in body movement leads to a significant increase in sodium during daytime (P = .046) but this was statistically significant during night-time and 24 hours (P = .32, and P = .84 respectively). CONCLUSION: Our study demonstrates a statistically significant association of movement, physical activity, and position with urine production. It would therefore be interesting to explore this association further with the use of new technology to have more accurate data. Here, lays a potential role for conservative measurements and lifestyle adaptations in the management of patients with bothersome LUTS and more precisely nocturia.

The Relationship Between Gensini Score and Erectile Dysfunction in Patients with Chronic Coronary Syndrome.

INTRODUCTION: In previous studies, the relationship between atherosclerosis and erectile dysfunction (ED) was examined, but the relationship and correlation between Gensini score which evaluates the extent and severity of chronic coronary syndrome (CCS), and ED severity were not investigated. AIM: To evaluate the relationship between Gensini score and ED in patients with CCS. METHODS: We included 142 consecutive male patients with the diagnosed CCS and underwent an elective coronary angiography between January 2019 and March 2020. MAIN OUTCOME MEASURE: Correlation analysis demonstrated that Gensini score significantly negatively correlated with the International Index Erectile Function - 5 (IIEF-5) score (r = -0.417, P < .001). RESULTS: Severe ED was present in 48 (33.8%) patients, moderate ED in 31 (21.8%) patients, and mild ED in 22 (15.5%) patients. 41(28.9%) patients did not have ED. Both the No ED and Mild ED groups were statistically significantly lower than the Severe ED group in terms of the Gensini score (P < .05). When the recommended optimal cut-off point and accuracy measurements were made for the Gensini score, the area under curve (AUC) value in predicting ED was 0.806 (95% CI: 0.732-0.880, P < .001). Multivariate logistic regression analysis demonstrated that independent predictors for ED were Gensini score and age (P < .001, and P = .026, respectively). Every 1 unit increase in Gensini score resulted in a 6% increase in the occurrence of ED (OR = 1.06, CI:1.03-1.10, P < .001). CONCLUSION: ED can be caused by endothelial dysfunction. Patients with severe CSS and high Gensini score should be evaluted for ED. ED may be a sign of severe CCS and a high Gensini score. It is also necessary to evaluate cardiological in patients with ED. Deger M, Ozmen C, Akdogan N, et al. The Relationship Between Gensini Score and Erectile Dysfunction in Patients with Chronic Coronary Syndrome. Sex Med 2021;9:100376.

Demonstration of advanced glycation end product (AGE) expression in bladder cancer tissue in type-2 diabetic and non-diabetic patients and the relationship between AGE accumulation and endoplasmic reticulum stress with bladder cancer.

PURPOSE: This study aimed to investigate the relationship between advanced glycation end product (AGE) expression and accumulation in transurethral resection (TUR-B) material taken from type-2 diabetes mellitus (DM) and non-DM bladder cancer patients and endoplasmic reticulum stress (ERS) with bladder cancer. METHOD: The patients who had TUR-B between May 2016 and September 2018 were included in the study. After the tissue samples had been taken and frozen at -80°C, they were homogenised to be used in enzyme-linked immunosorbent assay (ELISA) experiments. The patients were grouped as DM and non-DM. In both groups, mean AGE, IRE1, PERK and ATF6 expression amounts were evaluated through ELISA method in the pathological material. RESULTS: The expression amounts in tissue samples were AGE 0.59 ± 0.03 µg/mL, ATF6 1.08 ± 0.11 µg/mL, IRE1 30.71 ± 1.68 ng/mL, PERK 0.28 ± 0.02 ng. It was /mL. While there was no significant difference amongst AGE µg/mL (P = .146), ATF6 µg/mL (P = .175), IRE1 ng/mL (P = NA) and PERK ng/mL (P = .125) (P > .05) in the presence of DM, a positive correlation was observed between AGE values and PERK ng/mL values (r = .629; P < .05). CONCLUSION: Bladder cancer may develop as a result of accumulation of AGEs and ERS. Demonstration of the expression of proteins resulting from AGEs and ERS may be useful biomarkers for the diagnosis, prognosis, prevention and development of treatment alternatives for bladder cancer.

Protective effect of naringin in rat model of renal ischemia reperfusion injury / Efecto protector de la naringina en modelo de rata con lesión por reperfusión de isquemia renal

ABSTRACT Objective: We aimed to research that naringin whether protects from renal ischemia/reperfusion induced renal damage in rats. Methods: Twenty-four Wistar albino female rats randomly were divided into three groups: 1) control group, in which the rats were only performed right nephrectomy; 2) a second group received right nephrectomy and left kidney ischemia (1 h) and reperfusion (24 h) group ischemia/reperfusion (I/R); 3) a third group received 50 mg/kg naringin orally once a day for two weeks before ischemia/reperfusion (I/R/N). Expression of cyclooxygenase-2 (COX-2), cytosolic phospholipase A2 (cPLA2), inducible nitric oxide synthase (iNOS), caspase-3, B-cell lymphoma-2 (Bcl-2), Bcl-2 associated x protein (Bax), serum creatinine (Cr), tumor necrosis factor α (TNF-α), interleukin 6 (IL-6) were measured by using enzyme-linked immunosorbent assay (ELISA). Results: Naringin-treated rats that performed renal ischemia/reperfusion demonstrated significant decrease in Cr, IL-6 and TNF-α levels when compared to the only renal ischemia/reperfusion performed rats. While renal ischemia/reperfusion caused a decrease of bcl-2 (1.72 ± 0.20 pg/ml) levels, while an increase of COX-2 (11882 ± 642 pg/ml), cPLA2 (2448 ± 139 pg/ml), iNOS (4331 ± 438 IU/ml), cleaved caspase-3 (7.33 ± 0.76 ng/ml) and Bax (2.33 ± 0.44 ng/ml) levels. The treatment of naringin reversed these kidney effects (7.47 ± 60.35 pg/ml; 9299 ± 327 pg/ml; 2001 ± 78 pg/ml; 3112 ± 220 IU/ml; 3.38 ± 0.54 ng/ml; 2.33 ± 0.44 ng/ml, respectively) (p <0.05). Conclusion: This study showed that naringin treatment attenuated renal damage induced by ischemia/reperfusion in rats.

RESUMEN Objetivo: Nuestro objetivo fue investigar si la naringina protege del daño en los riñones provocado por isquemia-reperfusión renal en ratas. Material y métodos: De forma aleatoria, dividimos 24 ratas albinas Wistar hembras en tres grupos: 1) grupo control, en el que solo se les realizó a las ratas una nefrectomía derecha; 2) un segundo grupo isquemia-reperfusión, con nefrectomía derecha e isquemia de riñón izquierdo (1 h) y reperfusión (24 h); 3) un tercer grupo al que se le administró 50 mg/kg de naringina por vía oral una vez al día durante dos semanas antes de la isquemia-reperfusión. Por medio de un ensayo inmunoabsorbente ligado a enzimas (ELISA), se midieron las siguientes expresiones: ciclooxigenasa-2 (COX-2), fosfolipasa citosólica A2 (cPLA2), óxido nítrico sintetasa inducible (ONSi), caspasa-3, linfoma de células B2 (Bcl-2), proteína X asociada a Bcl-2 (Bax), creatinina sérica (Cr), factor de necrosis tumoral alfa (FNT-α) e interleucina 6 (IL-6). Resultados: Las ratas tratadas con naringina por isquemia-reperfusión renal mostraron un descenso significativo en los niveles de Cr, IL-6 y FNT-α en comparación con las ratas a las que se les indujo isquemia-reperfusión renal pero que no se les suministró naringina. La isquemia-reperfusión renal provocó un descenso de los niveles de Bcl-2 (1,72 ± 0,20 pg/ml) y un ascenso en los niveles de COX-2 (11882 ± 642 pg/ml), cPLA2 (2448 ± 139 pg/ml), ONSi (4331 ± 438 UI/ml), caspasa-3 escindida (7,33 ± 0,76 ng/ml) y Bax (2,33 ± 0.,44 ng/ml). El tratamiento con naringina diminuyó estos efectos en el riñón (7,47 ± 60,35 pg/ml; 9299 ± 327 pg/ml; 2001 ± 78 pg/ml; 3112 ± 220 UI/ml; 3.38 ± 0.54 ng/ml; 2.33 ± 0,44 ng/ml, respectivamente) (p <0,05). Conclusión: En este estudio se demostró que el tratamiento con naringina atenuó el daño renal producido por isquemia-reperfusión en ratas.

Clinical practice in vesicoureteral reflux with respect to EAU guidelines: A multicenter study.

PURPOSE: We designed a multicenter, retrospective study to investigate the current trends in initial management of reflux with respect to European Association of Urology (EAU) Guidelines in Urology clinics of our country. MATERIALS AND METHODS: The study group consisted of 1988 renal units (RU) of 1345 patients treated surgically due to vesicoureteral reflux (VUR) (between years 2003 and 2017) in nine different institutions. Patients were divided into two groups according to time of initial treatment and also grouped according to risk factors by "EAU guidelines on VUR." RESULTS: In this series, 1426 RUs were treated initially conservatively and 562 RUs were initially treated with surgery. In initially surgically treated group, success rates of surgery decreased significantly in low and moderate risk groups after 2013 (P = .046, P = .0001, respectively), while success rates were not significantly different in high risk group (P = .46). While 26.6% of patients in low risk group were initially surgically treated before 2013, this rate has increased to 34.6% after 2013, but the difference was not statistically significant (P = .096). However, performing surgery as the initial treatment approach increased significantly in both moderate and high risk groups (P = .000 and P = .0001, respectively) after 2013. Overall success rates of endoscopic treatments and ureteroneocystostomy (UNC) operations were 65% and 92.9% before 2013 and 60% and 78.5% after 2013, respectively. Thus, the overall success rate for surgery was 72.6%. There was significant difference between success rates of UNC operations before and after 2013 (P = .000), while the difference was not significant in the injection group (P = .076). CONCLUSION: Current trends in management of reflux in our country do not yet follow the EAU guidelines on VUR in low and moderate risk groups despite these reliable and accepted guidelines were expected to influence our daily approach.

Comparison of erectile function in patients with end-stage renal disease receiving haemodialysis and kidney transplantation.

To investigate the frequency and risk factors of ED in haemodialysis patients (HDps) and kidney transplantation (KTx) recipients (KTxRs). HDps and KTxRs between the ages of 18-65 were compared in terms of ED. IEFF-15 (International Index of Erectile Function) score was used to evaluation of ED. Fifty-seven male HDps and 52 male KTxRs with a mean age of 45.6 ± 10.4 years were included in our study. DM, CAD, hyperlipidaemia, smoking and beta blocker use were higher HDps (p = 0.037, p < 0.001, p = 0.001, p = 0.001 and p = 0.031 respectively). There was no ED in five (8.8%) HDps and 27(51.9%) KTxRx. Severity of ED was significantly higher in HDps (p < 0.001). In multiple logistic regression analysis, KTx was found the most relevant associated factor with ED. KTxRs had decreased risk for ED (OR = 0.09, 95% CI 0.02-0.30, p < 0.001). ED is significantly more common in HDps than KTxRs. Known risk factors for ED, HT, DM, CAD, HL, smoking, obesity and beta-blocker use were not related to ED in the HDps and KTxRs, and the KTx was positively effective for ED in patients undergoing renal replacement therapy.

How did the COVID-19 pandemic affect audience's attitudes in webinars?

INTRODUCTION: Following the COVID-19 pandemic, the face-to-face meetings are delayed to a future date, which is still not clear. However, seminars, meetings and conferences are necessary for updating our knowledge and skills. Web-based seminars (webinars) are the solutions to this issue. This study aimed to show the participant behaviour when webinars present at the COVID-19 pandemic era. METHODS: From December 2017 to July 2020, 58 webinars were broadcasted via the Uropedia, electronic library of SUST. Data of all webinars were collected with the YouTube analytics and application of the Uropedia. Data of streaming webinars included participant behaviours such as content views, engagement time, total unique attendees, average engagement time and the number of audience to leads. Data were split into two groups; group-1 is webinars before COVID-19 (before March 2020) and group-2 is the webinars during COVID-19. RESULTS: Total broadcast time and total page view number were found to be 112.6 hours (6761 minutes) and 15 919, respectively. The median participant age was 40.1 y. Median content view and median engagement time were found to be 261.0 and 12.2 minutes, respectively. Comparison of two groups revealed a significant increment in the content views (group-1; 134.0 range = 86.0-87.0 and group-2; 414.0 range = 296.0-602.0, P < .001) and the number of the unique attendees (group 1; 18.0 range = 10.0-26.0 and group-2; 57.0 range = 27.0-100.0, P < .001) following COVID-19. However, the median engagement time of the audience did not seem to change with the COVID-19 pandemic (group-1; 11.5 range = 10.0-13.3 minutes and group-2; 13.2 range = 9.4-18.1 minutes, P = .12). CONCLUSION: The webinars are effective ways to share information and have many advantages, including low cost, reaching a high number of audiences. Audience number and page visits seemed to increase following the COVID-19 pandemic. However, this era did not seem to affect the critical attitude of the audience, which is engagement time.

Determination of the etiology of pediatric urinary stone disease by multigene panel and metabolic screening evaluation.

INTRODUCTION: Urinary tract stone disease (UTSD) is seen with increasing frequency in children, and genetic, metabolic and environmental factors are known to play a role in its etiology. Since it is a genetically heterogeneous disease, we investigated the multigene panel and metabolic evaluation together. MATERIAL AND METHOD: Forty-eight pediatric patients that underwent surgery for UTSD and were followed up in the Department of Urology of Çukurova University Faculty of Medicine between March 2016 and July 2019 were included in the study. Children with known metabolic diseases were excluded.A detailed history was taken from each patient, and presence of a positive family history was questioned. Blood and urine samples were obtained, and metabolic evaluation was performed. In addition, 2 cc peripheral blood samples were collected from selected patients to perform DNA isolation at Çukurova University Adana Genetic Diseases Diagnosis and Treatment Center. The analysis of the obtained sequence data was performed. RESULTS: Of the 48 children included in the study, 29 (60.4%) were male and 19 (39.6%) were female. The mean age was 60 ± 50 (12-192) months. It was observed that 28 (58.3%) of the patients included in the study had a positive family history.As a result of the next-generation sequencing studies conducted with the multigene panel, a total of 21 clinically significant variants in eight different genes were identified with the bioinformatics analysis on the data on which quality control was performed. The weighted distribution of the 21 variants according to the genes was as follows: five variants (23.8%) in the SLC3A1 gene, four (19%) in SLC6A20, and three (14.3%) in SLC7A9 and SLC26A1. The clinical reporting of the disease etiology and/or variants with prognostic significance determined as a result of the performed analyses was completed by field experts in accordance with international standards. The visuals of the detected variants are presented in Summary figure. CONCLUSION: In pediatric cases with UTSD, it is important to determine the underlying metabolic and genetic risk factors in order to prevent recurrence and apply the most effective treatment.

The Effect of Diagnostic Ureterorenoscopy on Intravesical Recurrence in Patients Undergoing Nephroureterectomy for Primary Upper Tract Urinary Carcinoma.

OBJECTIVE: The objective of this study is to evaluate the effect of diagnostic ureterorenoscopy (URS) prior to radical nephroureterectomy (RNU) on intravesical recurrence (IVR), in patients with primary upper urinary tract urothelial carcinoma (UTUC). MATERIALS AND METHODS: Retrospective analysis of 354 patients, who underwent RNU for UTUC from 10 urology centers between 2005 and 2019, was performed. The primary endpoint was the occurrence of IVR after RNU. Patients were divided into URS prior to RNU (Group 1) and no URS prior to RNU (Group 2). Rates of IVR after RNU were compared, and a Cox proportional hazards model was used to evaluate potential predictors of IVR. RESULTS: After exclusion, a total of 194 patients were analyzed: Group 1 n = 95 (49.0%) and Group 2 n = 99 (51.0%). In Group 1, a tumor biopsy and histopathological confirmation during URS were performed in 58 (61.1%). The mean follow-up was 39.17 ± 39.3 (range 12-250) months. In 54 (27.8%) patients, IVR was recorded after RNU, and the median recurrence time within the bladder was 10.0 (3-144) months. IVR rate was 38.9% in Group 1 versus 17.2% in Group 2 (p = 0.001). In Group 1, IVR rate was 43.1% in those undergoing intraoperative biopsy versus 32.4% of patients without biopsy during diagnostic URS (p =0.29). Intravesical recurrence-free survival (IRFS) was longer in Group 2 compared to Group 1 (median IRFS was 111 vs. 60 months in Groups 2 and 1, respectively (p< 0.001)). Univariate analysis revealed that IRFS was significantly associated with URS prior to RNU (HR: 2.9, 95% CI 1.65-5.41; p < 0.001). In multivariate analysis, URS prior to RNU (HR: 3.5, 95% CI 1.74-7.16; p < 0.001) was found to be an independent prognostic factor for IRFS. CONCLUSION: Diagnostic URS was associated with the poor IRFS following RNU for primary UTUC. The decision for a diagnostic URS with or without tumor biopsy should be reserved for cases where this information might influence further treatment decisions.

Use of the prostate health index in the detection of prostate cancer at all PSA levels (use of prostate health index in prostate cancer).

OBJECTIVES: To determine the efficiency of prostate health index (PHI) calculated simultaneously during an ultrasound-guided fine-needle prostate biopsy in prostate cancer diagnosis. METHODS: The present study included 258 subsequent patients who underwent a TRUS-guided biopsy in our clinic between August 2015 and March 2016 due to elevated blood levels of PSA and suspicion of prostate cancer. The total PSA, free PSA and pro-PSA were analysed in all patients before the procedure. RESULTS: The average age of 258 patients was 63.5 (36-91) years, and the mean PSA level and mean PHI values were 40.1 (0.12-2170) and 118 (0.41-1308), respectively. According to the PSA data, the patients were divided into two groups: the low PSA (<4 ng/mL) group containing ten patients with adenocancer (31.2%) and 22 patients with BPH (68.8%) and the high PSA (>4 ng/mL) group consisting of 86 patients with adenocancer (42.2%) and 118 (57.8%) with BPH. The sensitivity and specificity of PSA in detecting prostate adenocancer were calculated as 89.6% and 15.7%, respectively. Similarly, when a PHI level below 55 was accepted as low, and a PHI level at or above 55 was accepted as high, PHI's sensitivity and specificity were determined as 71.9% and 67.9%, respectively. CONCLUSIONS: The overall findings indicate that the specificity of PHI is higher than PSA in terms of prostate cancer detection.

Risk factors associated with nocturia in patients with obstructive sleep apnea syndrome.

AIM: To evaluate the risk factors associated with nocturia in patients with obstructive sleep apnea syndrome (OSAS). MATERIALS AND METHODS: Patients aged over 18 years who had been diagnosed with OSAS using polysomnography (PSG) from January to December 2019 were evaluated. The number of nocturia episodes had been assessed in a 3-day bladder diary. We analysed the age, sex, body mass index (BMI) score, apnea-hypopn ea index (AHI) score and severity, hypertension, diabetes mellitus, smoking and heart diseases in all patients. RESULTS: A total of 124 patients with a mean age of 49.9 ± 11.6 years (range: 25-81 years) were included in the study. Ninety-two (75.8%) patients had nocturia. The mean number of nocturia episodes of patients with nocturia was 2.4 ± 1.3. To determine factors affecting the risk of nocturia, the logistic regression analysis was performed. Patient age and BMI scores were found as the most effective risk factors determining nocturia (P < .05). The odds of patient age were 1.06 (odds ratio: 1.12; 95% confidence interval: 1.01-1.11; P = .010) times higher for patients with nocturia. Every 1-unit increase in the BMI score increased the risk of nocturia 1.12 times. In the study period, 48 patients with nocturia had undergone the continuous positive airway pressure (CPAP) therapy or surgical treatment. The mean number of nocturia episodes of these patients was 2.3 ± 1.4 before treatment and 1.7 ± 2.2 after treatment, showing a significant decrease (P = .032). Although the total daily urine volume increased significantly with the treatment, the total night-time urine volume decreased significantly at night (P = .016 and P = .024, respectively). CONCLUSION: The age and BMI score were the risk factors associated with nocturia in patients with OSAS.

Percutaneous Nephrolithotomy in Young-Old, Old-Old, and Oldest-Old Patients: A Multicenter Study.

Introduction: To compare percutaneous nephrolithotomy (PCNL) outcomes between the elderly and young age groups and examined differences between young-old, old-old, and oldest-old patients. Methods: A retrospective analysis was conducted on 8191 renal units that underwent PCNL between September 1997 and March 2020 at three Turkish academic institutions. Patients were classified into young (18-64 years) and elderly (65+ years) age groups. The elderly age group was classified into young-old (65-69 years), old-old (70-79 years), and oldest-old (80+ years). Demographics, stone features, and perioperative and postoperative outcomes were compared between groups. The factors affecting stone-free rates and complications were determined in the elderly age group. Results: The patients' median age was 47 years (18-100) and the female to male ratio was 1:1.72. The stone-free and complication rates were 78.9% and 16.4%, respectively. General complications, blood transfusion, postoperative urinary tract infections, and major complications rate were similar between the young and elderly age groups (P = .902, P = .740, P = .659, P = .219, respectively). The stone-free rate was higher in the elderly age group (P = .002). Presence of partial or complete staghorn stones and number of stones were independently associated with stone-free rates for elderly age group patients (P = .006, P < .001, respectively). Stone burden (≥400 mm2) and presence of partial or complete staghorn stones were significantly associated with complications for the elderly age group patients (P = .038, P = .014, respectively). Conclusions: In the young-old, old-old, and oldest-old age group, PCNL appears like the preferred treatment with high stone-free rates but similar complication rates compared to their younger counterpart.

The effect of body mass index on oncological and surgical outcomes in patients undergoing radical cystectomy for bladder cancer: A multicentre study of the association of urooncology, Turkey.

OBJECTIVE: We aimed to evaluate the effect of body mass index (BMI) on oncological and surgical outcomes in patients who underwent radical cystectomy (RC) for bladder cancer (BC). MATERIALS AND METHODS: We retrospectively assessed data from patients who underwent RC with pelvic lymphadenectomy and urinary diversion for BC recorded in the bladder cancer database of the Urooncology Association, Turkey, between 2007 and 2019. Patients were stratified into three groups according to the BMI cut-off values recommended by the WHO; Group 1 (normal weight, <25 kg/m2 ), Group 2 (overweight, 25.0-29.9 kg/m2 ) and Group 3 (obese, ≥30 kg/m2 ). RESULTS: In all, 494 patients were included, of them 429 (86.8%) were men and 65 (13.2%) were women. The median follow-up was 24 months (12-132 months). At the time of surgery, the number of patients in groups 1, 2 and 3 were 202 (40.9%), 215 (43.5%) and 77 (15.6%), respectively. The mean operation time and time to postoperative oral feeding were longer and major complications were statistically higher in Group 3 compared to Groups 1 and 2 (P = .019, P < .001 and P = .025, respectively). Although the mean overall survival (OS), cancer-specific survival (CSS), recurrence-free survival (RFS) and metastasis-free survival (MFS) was shorter in cases with BMI ≥ 30 kg/m2 compared with other BMI groups, differences were not statistically significant (P = .532, P = .309, P = .751 and P = .213, respectively). CONCLUSION: Our study showed that although major complications are more common in obese patients, the increase in BMI does not reveal a significant negative effect on OS, CSS, RFS and MFS.

The Effect of Percutaneous Nephrolithotomy on the Estimated Glomerular Filtration Rate in Patients with Chronic Kidney Disease.

Objective: We evaluated the influence of percutaneous nephrolithotomy (PCNL) on the estimated glomerular filtration rate (eGFR) in patients with chronic kidney disease (CKD). Materials and Methods: Between September 2007 and April 2019, 280 patients with a preoperative eGFR level <90 mL/min/1.73 m2 and who underwent PCNL were retrospectively examined. The primary endpoint of this study was the effect of PCNL on eGFR levels in the 1st and 12th month after surgery in patients with CKD according to CKD stages. The secondary endpoint of this study was the identification of potential risk factors for deteriorated eGFRs. Results: The mean eGFR of patients was 48.7 ± 17 mL/min/1.73 m2 in the preoperative period, 54.7 ± 21 mL/min/1.73 m2 in the postoperative 1st month, and 59.1 ± 23.2 mL/min/1.73 m2 in the postoperative 12th month. It was determined that the increases in eGFRs in the postoperative 1st and 12th months were significant in all CKD stages (p < 0.005). Compared with preoperative values, the eGFR value was reduced in 61 (21.8%) patients in the 1st month and 49 (17.5%) patients in the 12th month. When these patients were compared with those in the stable eGFR and recovery group, multiaccess PCNL was an independent risk factor for renal function deterioration at the postoperative 1st and 12th month on multivariate analysis (odds ratios were 6.94 and 9.46, respectively). Conclusion: PCNL was found to have a positive effect on short- and long-term eGFRs in patients with CKD. However, multiaccess PCNL may have adversely affected eGFRs in both the short and long term.