Effects of Novel Insulin Resistance Indices on Early Renal Functions in Donors.

OBJECTIVE: To investigate the relationship between quickly calculable new insulin resistance (IR) indices used to evaluate IR in early kidney functions after donor nephrectomy. STUDY DESIGN: Descriptive design. Place and Duration of the Study: Department of Urology, Ufuk University Faculty of Medicine, Ankara, Turkiye, between January 2016 and August 2021. METHODOLOGY: The preoperative biochemical analyses of patients undergoing open donor nephrectomies and estimated glomerular filtration rates (eGFR) were recorded in the preoperative and first postoperative month. The IR indices (triglyceride glucose [TyG] index, TyG-body mass index [TyG-BMI], triglyceride/HDL cholesterol ratio [TG/HDL-C], and metabolic score for IR [METS-IR]) were computed. Additionally, the patients were separated into two categories. Group 1 had a less than 30% decrease in eGFR values in the postoperative first-month period, and group 2 had a more than 30% decrease. The relationship between variables was analysed using the Spearman correlation, and comparisons between groups were analysed using the independent t-test or Mann-Whitney U-test. RESULTS: A total of 107 patients were included in the study. The mean eGFR reduction rate was 31.81 ± 8.87 %. In the correlation analyses, an increase in the rate of decrease in postoperative GFR was associated with higher IR indices, specifically TyG (r = 0.19, p = 0.04), TG/HDL-C (r = 0.21, p = 0.02), and METS-IR (r = 0.21, p = 0.02). No statistically significant difference was found between the groups regarding all the calculated IR indices (p < 0.05). CONCLUSION: The results suggest a possible link between increased IR and postoperative renal function decline. KEY WORDS: Insulin resistance, Glomerular filtration rate, Donor nephrectomy, Triglyceride-Glucose index, METS-IR.

Psychological review of hemodialysis patients and kidney transplant recipients during the COVID-19 pandemic.

BACKGROUND: Kidney transplantation (KT) and end-stage renal disease (ESRD) requiring hemodialysis (HD) increase the incidence of morbidity and mortality associated with coronavirus disease 2019 (COVID-19) infection. The COVID-19 pandemic has had a negative effect on the psychological well-being of COVID-19 patients, especially those with a high-risk of infectious complications. The prevalence of anxiety and depression is known to be higher in ESRD patients undergoing HD than in the general population. On the other hand, KT recipients have different treatment requirements compared to HD patients, including adherence to complex immunosuppressive regimens and compliance with follow-up appointments. We hypothesized that psychosocial difficulties and stressors would differ between ESRD patients undergoing HD and KT recipients during the COVID-19 pandemic. If so, each group may require different interventions to maintain their psychosocial well-being. AIM: To measure and compare the levels of stress, anxiety, depression, concerns related to the pandemic, and coping skills in ESRD patients undergoing HD and KT recipients during the COVID-19 pandemic. METHODS: This cross-sectional study was performed at a training and research hospital. The study included ESRD patients undergoing HD (HD group) and KT recipients (with stable graft function for ≥ 6 mo prior to the study) (KT group). Patients completed a demographics form, the impact of events scale, the hospital anxiety and depression scale, and the Connor-Davidson resilience scale. Laboratory findings at the last clinical follow-up were recorded. The χ2 test was used to assess the relationship between the HD and KT groups and the categorical variables. The relationships between the scale scores were analyzed using Pearson's correlation test, and differences between the groups were analyzed using the independent groups t-test. RESULTS: The study included 125 patients, of which 89 (71.2%) were in the HD group and 36 (28.8%) were in the KT group. The levels of anxiety and depression were higher in the HD group than in the KT group [9.36 ± 4.38 vs 6.89 ± 4.06 (P = 0.004) and 8.78 ± 4.05 vs 6.42 ± 4.26 (P = 0.004), respectively], whereas the post-traumatic stress score was higher in the KT group [46.75 ± 13.98 vs 37.66 ± 18.50 (P = 0.009)]. The concern with the highest intensity in the HD group was transmission of COVID-19 to family and friends (93.3%) and in the KT group was loss of caregiver and social support (77.8%). Concerns regarding financial hardship, stigmatization, loneliness, limited access to health care services, failure to find medical supplies, and transmission of COVID-19 to family and friends were more prevalent in the HD group. Connor-Davidson resilience scale tenacity and personal competence, tolerance, and negative affect scores were higher in the KT group than in the HD group [43.47 ± 11.39 vs 33.72 ± 12.58, 15.58 ± 4.95 vs 11.45 ± 5.05, and 68.75 ± 17.39 vs 55.39 ± 18.65 (P < 0.001), respectively]. Biochemical parameters, such as creatine, urea, phosphorus, parathyroid hormone, and calcium, were lower, and the albumin and hemoglobin values were higher in the KT group than in the HD group (P < 0.001). CONCLUSION: Psychosocial difficulties and the level of stress differ in ESRD patients undergoing HD and KT recipients; therefore, psychosocial interventions should be tailored for each patient group.

Comparison of the Conventional PNL with Ecirs in the Treatment of Complete Staghorn Kidney Stones.

OBJECTIVE:  To analyse the results of conventional percutaneous nephrolithotomy (PNL) and endoscopic combined intrarenal surgery (ECIRS) in treating complete staghorn kidney calculi. STUDY DESIGN:  A comparative study. Place and Duration of the Study: Department of Urology, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey, between January 2007 and January 2022. METHODOLOGY:  Clinical data and surgical outcomes of the adult patients who underwent conventional PNL or ECIRS were retrospectively reviewed. Two patient groups were compared regarding the fluoroscopy time, the number of access, surgical time, duration of hospitalisation, haemoglobin (Hb) reduction, complication, and stone-free rates.  Results: There were 132 renal units in the conventional PNL (Group 1) and 45 renal units in the ECIRS group (Group 2). The comparative analysis revealed that fluoroscopy time, surgical time, duration of hospital stay, number of access, and the Hb drop were significantly lower in the ECIRS group compared to the conventional PNL group. Although stone-free rates were 48.5% in Group 1 and 64.4% in Group 2, p=0.064 and p>0.05 respectively). The median value of the complication grade was 1 (1-7) in Group 1 and 1 (1-5) in Group 2, (U=2446.5, p=0.026).  Conclusion: The ECIRS is a successful and more secure surgical method for treating complete staghorn stones than PNL. KEY WORDS:  PNL, ECIRS, Staghorn, Kidney, Stone.

Does Post-COVID-19 Erectile Dysfunction Improve over Time?

BACKGROUND: Some studies have shown that there may be an increase in the frequency of erectile dysfunction after COVID-19. However, no long-term study has investigated whether this is permanent or temporary. In this study, we aimed to examine whether there was an increase in the frequency of erectile dysfunction among individuals with a history of COVID-19, and, if there was, whether their condition improved over time. MATERIALS AND METHODS: In this study, a total of 125 healthy male healthcare workers, 95 with and 30 without a history of COVID-19, were evaluated in terms of erectile function. Four study groups were formed. The first three groups consisted of individuals with a history of COVID-19 confirmed by the polymerase chain reaction (PCR) test at different times, who recovered from the disease (time elapsed since COVID-19 positivity: <6 months for Group 1, 6 to 12 months for Group 2, and >12 months for Group 3). The individuals in Group 4 did not have a history of COVID-19 diagnosis. In order to evaluate the erectile function of the participants, they were asked to complete the five-item International Index of Erectile Function questionnaire (IIEF-5). Then, statistical analyses were performed to evaluate whether there was a difference between the groups in terms of the IIEF-5 scores. RESULTS: There was a statistically significant difference between the groups in terms of the IIEF-5 scores (p < 0.001), and this difference was determined to be caused by the significantly higher IIEF-5 scores of Groups 3 and 4 compared to Group 1 (p = 0.004 and p < 0.001, respectively). In addition, the IIEF-5 score of Group 4 was statistically significantly higher than that of Group 2 (p < 0.001). However, the IIEF-5 scores did not statistically significantly differ between Groups 1 and 2, Groups 2 and 3, and Groups 3 and 4 (p > 0.999, p = 0.204, and p = 0.592, respectively). CONCLUSION: There may be deterioration in erectile function after COVID-19; however, this tends to improve over time, especially from the first year after active infection. Given that vascular, hormonal, and/or psychogenic factors may lead to the development of erectile dysfunction after COVID-19, we consider that in order to easily manage this process, it is important to determine the underlying cause, initiate appropriate treatment, and inform couples that this situation can be temporary.

Burned-out germ cell tumor presenting with acute abdomen.

Acute abdomen is a serious condition frequently encountered in the emergency departments (ED). There are various etiologies causing acute abdomen, most common being acute appendicitis; however, there are rare causes of acute abdomen as well and one should keep them in mind while handling a patient with unusual clinical features. We herein present a 26-year-old male, with no past medical or surgical history, presenting with acute abdominal pain and distension to the ED. He was found to have a large vascular retroperitoneal mass on computed tomography which had invaded and perforated the duodenum thus causing the acute presentation. Repair of the duodenal perforation and sampling of the mass were performed in terms of surgical management. Pathology results revealed the mass originating from a burned out testis yolk sac tumor with embryonal carcinoma component. Although the original tumor had regressed at the testis, its metastasis at the retroperitoneal area had caused the clinical condition. This entity is described as the retroperitoneal metastasis of a burned-out testicular tumor. Few cases presenting with gastrointestinal bleeding secondary to invasion of the retroperitoneal metastasis have been reported. However, this is the first case in the literature presenting with duodenal perforation and acute abdomen. Sampling of the retroperitoneal tumor for histopathological diagnosis during the immediate surgical intervention facilitates the diagnostic management in these cases. Although scrotal examination combined with testis tumor marker assessments is essential for optimal patient management, the possibility of a burned-out testicular tumor with normal scrotal examination should always be kept in mind.

An isolated traumatic renal artery pseudoaneurysm treated by renal artery stent insertion: a case report presenting a nephron-sparing approach.

Penetrating or blunt traumas can rarely lead to renal artery pseudoaneurysms (RAPs). Renal parenchymal lacerations usually accompany them, and nephrectomy is performed in these cases. Although angioembolization of the renal artery can negate the need for nephrectomy while treating the RAP, it is not a nephron-sparing procedure. Herein, we present a case of isolated (i.e. without accompanying renal laceration) left RAP. During conservative follow-up, the RAP enlarged, and subsequently, it was treated by renal artery stent insertion. An expandable covered stent was used during this procedure. The renal function was preserved without experiencing any complications.

Effect of the COVID-19 Pandemic on Radical Prostatectomy: A Turkish Multicenter Study.

OBJECTIVE: The present study examines the effects of the coronavirus disease 2019 pandemic on radical prostatectomy performed as part of localized prostate cancer treatment in Turkey. MATERIAL AND METHODS: A retrospective analysis was made of the data of 176 patients from 8 centers in Turkey who underwent radical prostatectomy due to localized prostate cancer over the 2 years spanning March 1, 2019, to February 28, 2021. Within this timeframe, March 1, 2019, to February 28, 2020, was denoted the 1-year pre-coronavirus disease 2019 period, while March 1, 2020, to February 28, 2021, was denoted the 1-year coronavirus disease 2019 period. An analysis was made of whether there was a difference in the number of radical prostatectomies performed for prostate cancer, the time from biopsy to operation, and the biopsy and radical prostatectomy pathology between the 2 periods. RESULTS: It was found that the number of radical prostatectomies performed for localized prostate cancer during the coronavirus disease 2019 pandemic was statistically and highly significantly fewer than in the pre-coronavirus disease 2019 period (P <.001). The patients diagnosed with Gleason 3+3 (low risk) prostate cancer were statistically significantly fewer in number in the coronavirus disease 2019 period (P <.001). The pathological Gleason score was upgrading than the biopsy Gleason score in all patients who underwent in both periods (P <.001). When the periods were compared, the pathological involvement determined by lymph node dissection performed during radical prostatectomy was found to be decreased in the coronavirus disease 2019 period, although the difference was not statistically significant (P =.051). CONCLUSION: As with many diseases, the diagnosis and treatment of prostate cancer have been adversely affected by the coronavirus disease 2019 pandemic.

Utilization of Internet Resources by Surgeons for Continuous Professional Development in the Era of Prevailing COVID-19 Pandemic: Trends and Obstacles.

Background: To investigate the use of internet resources by surgeons for continuing professional development (CPD). Results: This cross-sectional study was carried out between July 1, 2021, to October 31, 2021, at the Department of Medicine, Health Sciences University Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey, with participants from nine surgical specialties: General surgery, neurosurgery, orthopedics, urology, plastic surgery, ear-nose-throat surgery, cardiovascular surgery, ophthalmology, and anesthesiology. All study participants were asked to complete a questionnaire comprising 23 questions regarding their age, duration of work experience, appointment status, venue, and time spent on internet resources and preferred online resources for CPD purposes. In addition, participants were divided into two groups according to their appointment status: academic faculty and staff surgeons. Data analysis was performed using IBM SPSS Statistics version 17.0. The target population consisted of 216 specialists. The survey was completed by 204 (94.4%) surgical specialists. The majority of the specialists (n = 137, 67.2%) reported using the internet for work-related purposes every day. Daily time spent on internet resources was reported to be 30-60 min by 39.2% (n = 80) participants, whereas 52 (25.5%) reported spending less than 30 min. The participants wished to spend more time on internet resources. The majority of surgeons found the hospital and home equally effective in using the internet and preferred to engage alone. The mean age, English language level, usage of online resources, and the attitude score toward the perceived credibility and usefulness of e-resources were significantly higher in the academic faculty group than staff surgeons (p < 0.005). On the other hand, the use of Google/Google scholar was similar between the two groups (p = 0.192). Technical difficulties such as slow internet, need for website registration, and article fees were considered drawbacks for internet resources among all the participants. Conclusions: This study showed that most surgeons use internet resources daily for CPD and stated they would like to engage longer despite technical difficulties. Institutions should address these technical difficulties.

Parastomal skin metastasis in a patient with history of urinary bladder cancer.

Transitional cell cancer of the urinary bladder very rarely metastasize to the skin. Herein, we present a patient with urinary bladder cancer who underwent radical cystoprostatectomy and ileal conduit surgery. During follow-up, he developed lung and skin metastases. However, the latter presented as a solitary sessile polypoid lesion at the parastomal area.

The efficacy of Tadalafil 5mg in the treatment of lower urinary tract symptoms in patients where alpha blocker treatments have failed in terms of lower urinary tract symptoms. / Eficacia de Tadalafilo 5 mg en el tratamiento de los síntomas del tracto urinario inferior en pacientes tras fallo de los alfabloqueantes.

OBJECTIVES: To investigate the efficacy of tadalafil 5mg in patients with lower urinary tract symptoms who failed alpha blocker treatment. PATIENTS AND METHODS: Twenty-three patients were included. Patient consent was obtained after explaining the efficacy of tadalafil 5mg in lower urinary tract symptoms. Before initiating tadalafil 5mg treatment, prostate cancer and urinary tract infection in the patients were eliminated. IPSS, IIEF-5 and Qmax values were assessed before and one month after tadalafil 5mg treatment. Difference between two assessments was evaluated by the Wilcoxon method. RESULTS: After 1 month of Tadalafil 5mg treatment, IPSS decreased and IIEF-5 and Qmax increased. The difference between two assessments were statistically significant. CONCLUSION: Tadalafil 5mg once daily in the treatment of BPH/LUTS is found to be successful in patients who failed previous alpha blocker treatment.

OBJETIVOS: Investigar la eficacia de tadalafilo 5 mg en pacientes con síntomas del tracto urinario inferior (STUI) tras fallo de los alfabloqueantes. PACIENTES Y MÉTODOS: Treinta y tres pacientes fueron incluidos. Se obtuvo consentimiento informado en todos los casos tras explicarles la eficacia del tadalafilo 5 mg en el tratamiento de los STUI. Antes de iniciar el tratamiento se descartaron cáncer de próstata e infección urinaria. Se evaluaron los valores de los cuestionarios IPSS, IIEF-5 y el Q max antes del tratamiento y al mes del tratamiento. Las diferencias entre los grupos se evaluaron utilizando el método de Wilcoxon.    RESULTADOS: Después de un mes con tadalafilo 5 mg, el IPSS disminuyó, y el IIEF-5 y el Q max aumentaron. Las diferencias fueron estadísticamente significativas. CONCLUSIONES: Se ha visto que el tadalafilo 5 mg una vez al día es eficaz en el tratamiento de los STUI/HBP en pacientes con fallo previo del tratamiento con alfabloqueantes.