A multi-institutional European comparative study of open versus robotic-assisted laparoscopic ureteral reimplantation in children with high grade (IV-V) vesicoureteral reflux.

INTRODUCTION: Traditionally, open ureteral reimplantation (OUR) has been the standard treatment for primary vesicoureteral reflux (VUR) requiring reimplantation. Robotic-assisted laparoscopic ureteral reimplantation (RALUR) is gaining popularity and high success rates have been reported. OBJECTIVE: In this multi-institutional study, we aimed to compare the perioperative and postoperative outcomes of OUR and RALUR for high-grade (IV + V) VUR in children. STUDY DESIGN: A retrospective evaluation was performed collecting data from 135 children (0-18 years) who underwent high grade VUR surgical correction at nine European institutions between 01/01/2009 and 01/12/2020, involving either open or robotic approaches. Institutional review board approval was obtained. Patients with lower grades of VUR (≤III), previous history of open or endoscopic ureteral surgery, neurogenic bladder, or refluxing megaureter in need of ureteral tapering were excluded. Pre-, peri- and post-operative data were statistically compared. RESULTS: Overall, 135 children who underwent either OUR (n = 68), or RALUR (n = 67) were included, and their clinic and demographic features were collected. The mean age of the open group was 11 months (interquartile range [IQR] 9.9-16.6 months), in the RALUR group it was 59 months (IQR 29-78mo) (p < 0.01); the open cohort had a weight of 11 kg (IQR 9.9-16.6 kg) while the RALUR group had 19 kg (IQR 13-25 kg) (p < 0.01). No significant differences were found for intraoperative (1.5 % vs 7.5 %, p = 0.09) or for postoperative complication rates (7.4 % vs 9 %, p = 0.15). Favorable outcomes were reported in the RALUR group: shorter time to stooling (1 vs 2 days), fewer indwelling urethral catheter days (1 vs 5 days), perioperative drain insertion time (1 vs 5 days) and a shorter length of hospital stay (2 vs 5 days) (p < 0.01). The success rate was 94.0 % and 98.5 % in the open and RALUR groups, respectively. The long-term clinical success rates from both groups was comparable:42 vs 23 months for open and RALUR, respectively. DISCUSSION: This study reported a large multicentric experience focusing on high grade VUR. Furthermore, this study compares favorably to OUR in a safety analysis. There was also a trend towards higher success rates with RALUR utilizing an extravesical approach which has not been previously reported. CONCLUSION: RALUR is an efficacious and safe platform to use during ureteral reimplantation for high grade VUR. The overall peri-operative and post-operative complication rates are at least equivalent to OUR, but it is associated with a faster functional recovery and time to discharge. Medium to long term success rates are also equivalent to OUR.

Robotic simple prostatectomy is a safe and effective technique for benign prostatic hyperplasia: Our single center initial short-term follow-up results for 42 patients.

OBJECTIVE: Benign prostatic hyperplasia is one of the biggest problems of aging men. Prostate surgery is now well defined in the case of failure of medical therapy. Robotic simple prostatectomy is a minimally invasive surgical method with an alternative to open simple prostatectomy in large prostate volumes. We present our simple prostatectomy technique with robot, perioperative, and short-term functional result in our clinic. MATERIAL AND METHODS: Between January 2017 and January 2021, 42 patients underwent simple robotic prostatectomy were retrospectively evaluated. Preoperative, perioperative, and post-operative clinical data were analyzed. Post-operative continence status, voiding, and erectile functions were evaluated using uroflowmetry and international prostate symptom score (IPSS) at sixth week and third month. RESULTS: The mean age of the patients was 71 (66-78) years. No major complications were observed in any of the patients. Urethral catheters were removed on the fourth post-operative day. Except for one case, all of the cases urinated spontaneously after the catheter was removed. One case could not urinate spontaneously, and urethral catheter was placed again. Three days later, the urethral catheter was removed, and patient urinated spontaneously. None of the patients reported stress urinary incontinence or erectile dysfunction. The mean operative time was 112minutes, the mean hospital stay was 1.6 days, the mean post-operative IPSS was 6, and the mean post-operative Q max was 24.4mL s 1. CONCLUSION: Robotic simple prostatectomy may be an effective and safe alternative minimally invasive technique in the treatment of large-volume benign prostatic hyperplasia.

Does biofeedback therapy improve quality of life in children with lower urinary tract dysfunction: parents' perspective.

INTRODUCTION: Lower urinary tract dysfunction (LUTD) is a situation that often disrupts the quality of life (QoL) of both the child and the family with daytime and nighttime incontinence. Although the first-line treatment option for children with LUTD is standard urotherapy, biofeedback therapy can be performed in children in which standard urotherapy failed. OBJECTIVE: We studied the biofeedback success in children with LUTD according to parents' expressions. METHODS: We retrospectively analyzed our hospital records of children who were diagnosed with LUTD between 2005 and 2017. In total, 281 patients, refractory to standard urotherapy were included into the study and directed to biofeedback treatment. Their parents completed the dysfunctional voiding symptom scores (DVSS) before and after biofeedback therapy. RESULTS: At the end of the six-month follow-up period, all voiding disorders and voiding patterns were evaluated. According to DVSS, QoL tools before biofeedback treatment 48 (17%) parents appraised that LUTD caused no effect in their children's daily life, 104 (37.8%) expressed little effect, 89 (31%) moderate effect, and 40 (14.2%) serious effect. And, 120 (43%) parents expressed no effect, 95 (34%) little effect, 51 (18%) moderate effect, and 15 (5%) serious effect (P = 0.001) after biofeedback therapy. Biofeedback therapy affected positively the daily life of LUTD's family. The less serious the effect of LUTD on these children's family, the more success rate of biofeedback therapy. The effect of biofeedback therapy was less successful in moderated and serious affected families. CONCLUSIONS: Biofeedback treatment is a non-invasive and effective treatment modality for improving the QoL for LUTD families who were less suffered from LUTD.

Unusual intrascrotal lesions in adults in urological practice. / Lesiones intraescrotales inusuales en adultos en la práctica clínica urológica.

OBJECTIVE: Unusual intrascrotal lesions in adults generally have been described as case reports in the medical literature. We present two lesions observed in two clinics over more than 28 years, with their radiological, pathological and clinical characteristics. METHODS: Retrospective study preformed between 1989 and 2017 in 446 patients undergoing inguinal orchiectomy. Clinical data were obtained reviewing patient` s tables. All patients were evaluated with physical examination, medical history, serum tumor markers (alpha fetoprotein, beta human chorionic gonadotropin, LDH), and scrotal ultrasound in the perioperative period. RESULTS: In 396 cases (88,78%) the diagnosis was germ cell or non-germ cell tumor and the remainder 50 patients (11.2%) presented 15 different intrascrotal lesions. These lesions were rhabdomyosarcoma (1 patient), intrascrotal cavernous hemangioma (1 patient), dermoid cyst (2 cases), epidermoid cyst (4 patients), paratesticular mesothelioma (1 case), parietal testicular tunica vaginalis cyst (2 patients), spermatic granuloma (3 cases). The number of patients with tuberculosis orchitis was 6 and granulomatous orchitis 8. There were 8 patients with fibrous pseudotumor. 1 patient presented testicular plasmocytoma. Metastatic involvement secondary to lymphoma and leukemia appeared in 4 cases. Brucella epididymitis-orchitis 7 cases. 2 cases of adult pure yolk sac testicular tumors. Additional evaluations and treatments were performed depending on histologic diagnosis. CONCLUSIONS: The exact diagnosis of these lesions is difficult due to their rarity and they must always be considered for differential diagnosis.

OBJETIVO: Las lesiones intraescrotales adultas inusuales generalmente se han descrito como un informe de caso en la literatura. Estas lesiones que se observaron en dos clínicas durante más de 28 años se presentan aquí con características radiológicas, patológicas y clínicas.MÉTODOS: Este estudio retrospectivo se realizó entre 1989 y 2017 en 446 pacientes sometidos a orquiectomía inguinal. Los datos clínicos se obtuvieron mediante la revisión de tablas de pacientes. En el período preoperatorio, todos los pacientes evaluados con examen físico, historial de detalles, marcadores tumorales séricos (alfa-fetoproteína, beta-gonadotropina coriónica humana, lactato deshidrogenasa), ultrasonografía doppler escrotal. RESULTADOS: Se diagnosticaron tumores testiculares germinales y no germinales en 396 casos (88,78%) y los 50 pacientes restantes (11,22%) presentaron 15 lesiones intraescrotales diferentes. El tipo de estas diferentes lesiones intraescrotales fueron rabdomiosarcoma paratesticular (1 paciente), hemangioma cavernoso intraescrotal (1 caso), quiste dermoide (2 casos), quiste epidérmico (4 pacientes), mesotelioma paratesticular (1 caso), quiste de capa parietal de túnica testículo vaginal (2 pacientes), granuloma espermático (3 casos). El número de pacientes con orquitis tuberculosa y granulomatosa fue de 6 y 8 pacientes, respectivamente. Los pacientes con pseudotumor fibroso fueron 8 casos. Plasmacitoma del testículo se observó en 1 paciente. La afectación metastásica debida a linfoma y leucemia se observó en un total de 4 casos. Se observó epididimo- orquitis de Burucella en 7 casos. El número de tumores adultos en el testículo puro del saco vitelino fue de 2 casos. Se realizaron evaluaciones y tratamientos adicionales según el diagnóstico histológico. CONCLUSIONES: El diagnóstico exacto de estas lesiones es difícil debido a su rareza y siempre debe considerarse en el diagnóstico diferencial.

Lesiones intraescrotales inusuales en adultos en la práctica clínica urológica / Unusual intrascrotal lesions in adults in urological practice

Objetivo: Las lesiones intraescrotales adultas inusuales generalmente se han descrito como un informe de caso en la literatura. Estas lesiones que se observaron en dos clínicas durante más de 28 años se presentan aquí con características radiológicas, patológicas y clínicas. Métodos: Este estudio retrospectivo se realizó entre 1989 y 2017 en 446 pacientes sometidos a orquiectomía inguinal. Los datos clínicos se obtuvieron mediante la revisión de tablas de pacientes. En el período preoperatorio, todos los pacientes evaluados con examen físico, historial de detalles, marcadores tumorales séricos (alfa-fetoproteína, beta-gonadotropina coriónica humana, lactato deshidrogenasa), ultrasonografía doppler escrotal. Resultados: Se diagnosticaron tumores testiculares germinales y no germinales en 396 casos (88,78%) y los 50 pacientes restantes (11,22%) presentaron 15 lesiones intraescrotales diferentes. El tipo de estas diferentes lesiones intraescrotales fueron rabdomiosarcoma paratesticular (1 paciente), hemangioma cavernoso intraescrotal (1 caso), quiste dermoide (2 casos), quiste epidérmico (4 pacientes), mesotelioma paratesticular (1 caso), quiste de capa parietal de túnica testículo vaginal (2 pacientes), granuloma espermático (3 casos). El número de pacientes con orquitis tuberculosa y granulomatosa fue de 6 y 8 pacientes, respectivamente. Los pacientes con pseudotumor fibroso fueron 8 casos. Plasmacitoma del testículo se observó en 1 paciente. La afectación metastásica debida a linfoma y leucemia se observó en un total de 4 casos. Se observó epididimo- orquitis de Burucella en 7 casos. El número de tumores adultos en el testículo puro del saco vitelino fue de 2 casos. Se realizaron evaluaciones y tratamientos adicionales según el diagnóstico histológico. Conclusiones: El diagnóstico exacto de estas lesiones es difícil debido a su rareza y siempre debe considerarse en el diagnóstico diferencial

Objective: Unusual intrascrotal lesions in adults generally have been described as case reports in the medical literature. We present two lesions observed in two clinics over more than 28 years, with their radiological, pathological and clinical characteristics. Methods: Retrospective study preformed between 1989 and 2017 in 446 patients undergoing inguinal orchiectomy. Clinical data were obtained reviewing patient's tables. All patients were evaluated with physical examination, medical history, serum tumor markers (alpha fetoprotein, beta human chorionic gonadotropin, LDH), and scrotal ultrasound in the perioperative period. Results: In 396 cases (88,78%) the diagnosis was germ cell or non-germ cell tumor and the remainder 50 patients (11.2%) presented 15 different intrascrotal lesions. These lesions were rhabdomyosarcoma (1 patient), intrascrotal cavernous hemangioma (1 patient), dermoid cyst (2 cases), epidermoid cyst (4 patients), paratesticular mesothelioma (1 case), parietal testicular tunica vaginalis cyst (2 patients), spermatic granuloma (3 cases). The number of patients with tuberculosis orchitis was 6 and granulomatous orchitis 8. There were 8 patients with fibrous pseudotumor. 1 patient presented testicular plasmocytoma. Metastatic involvement secondary to lymphoma and leukemia appeared in 4 cases. Brucella epididymitis-orchitis 7 cases. 2 cases of adult pure yolk sac testicular tumors. Additional evaluations and treatments were performed depending on histologic diagnosis. Conclusions: The exact diagnosis of these lesions is difficult due to their rarity and they must always be considered for differential diagnosis

Is fluoroscopy necessary during flexible ureteroscopy for the treatment of renal stones?

OBJECTIVE: To investigate the feasibility and effectiveness of flexible ureteroscopy (fURS) without fluoroscopy during the treatment of renal stones. PATIENTS AND METHODS: Between April 2013 and August 2018, 744 patients' data were evaluated retrospectively. Of these, 576 patients were included in the study. All fURS were performed by experienced surgeons. All procedures were planned with zero-dose fluoroscopy. But, if fluoroscopy was necessary for any reasons, these patients were excluded from the study. Demographic data, perioperative parameters, stone-free rate (SFR), and complication rates were recorded. RESULTS: Of the patients planned for fluoroless fURS (ffURS), the procedure was successfully achieved in 96.7% (557/576 patients), as 19 patients required fluoroscopy during the procedure for various reasons. In the patients included in the study, the mean (SD) stone size was 11.6 (5.2) mm and the mean (SD) operating time was 39.4 (8.2) min. After the first session of ffURS, the SFR was 83.3% (achieved in 464 patients). Second and third sessions of ffURS were performed in 32 (5.7%) and seven (1.2%) patients, respectively. Overall, the complication rate was 11.8% and all complications were minor (Clavien-Dindo Grade I or II). CONCLUSIONS: The ffURS technique seems to be a safe and effective treatment compared to conventional fURS in patients with renal stones. This procedure should be performed in experienced centers, where fluoroscopy can be considered not to be mandatory during fURS. ABBREVIATIONS CIRF: clinically insignificant residual fragment; CT: computed tomography; EAU: European Association of Urology; (f)fURS: (fluoroless) flexible ureteroscopy; FT: fluoroscopy time; KUB: plain abdominal radiograph of the kidneys, ureters and bladder; mSv: millisievert; PCNL: percutaneous nephrolithotomy; pps: pulse-per-second; rem: roentgen equivalent man; PUJ: pelvi-ureteric junction; SFR: stone-free rate.

Our experience with ureterocystoplasty in bilateral functional kidneys.

OBJECTIVE: We have reviewed the data of the patients in order to evaluate the effectiveness of our ureterocystoplasty technique in augmentation cystoplasty operation. MATERIAL AND METHODS: Data of a total of 16 patients with bilateral functional kidneys who had undergone augmentation ureterocystoplasty between January 1995 and June 2018 which were retrieved during the retrospective archive scanning were included in the study. Ultrasonography (USG), serum blood urea nitrogen and creatinine values and Technetium-99 DTPA (Tc-99 DTPA) scan were used to evaluate the renal function of the patients. Intravenous pyelography (IVP) and USG were used to evaluate the ureters before surgery. Magnetic resonance (MR) urographies were performed in our center. RESULTS: Of the total 16 patients, 10 were male and 6 were female, while ages ranged from 1 to 24 years. Among 16 patients, the most common cause of neurogenic bladder etiology was meningomyelocele. In the urodynamic studies performed before the operation, it was determined that the bladder capacities of the patients were between 40-180 mL and the bladder compliances were 1.0-4.0 cc/cmH2O. At postoperative 3rd months, it was determined that the bladder capacities of the patients were between 180-330 mL and the bladder compliances were between 6.0-24.0 cc/cmH2O. CONCLUSION: Augmentation ureterocystoplasty seems to be an appropriate technique in which successful results are obtained with appropriate patient selection. Besides, complications that may occur due to use of ileal segment are avoided.

Three Distraction Methods for Pain Reduction During Cystoscopy: A Randomized Controlled Trial Evaluating the Effects on Pain, Anxiety, and Satisfaction.

BACKGROUND: Cystoscopy is a safe diagnostic procedure commonly used to evaluate lower urinary tract symptoms. This can cause pain, anxiety, and dissatisfaction in patients undergoing cystoscopy. OBJECTIVES: The aim of this study was to compare the effects on pain, anxiety, and satisfaction of distraction methods used during cystoscopy. DESIGN: Single-center, open-label, randomized, parallel-group trial. SETTING: Cystoscopy unit of a training and research hospital in Turkey. PARTICIPANTS: Male patients ≥18 years of age who underwent rigid cystoscopy for the first time. METHODS: A total of 120 male patients were recruited and randomized into four groups as music, stress ball, video, and control group. Data were collected using visual analog scale for pain and satisfaction, State-Trait Anxiety Inventory for anxiety, and hemodynamic parameters. The primary outcome was the difference with respect to pain scores among intervention groups. Other outcome measures were anxiety and satisfaction scores. RESULTS: Pain severity during cystoscopy was found to be significantly lower in the intervention groups than the control group. In the video group, the severity of pain during cystoscopy was also found to be significantly lower than music and stress ball groups (p = 0.006, p < 0.001). After cystoscopy, anxiety levels were significantly lower and satisfaction levels were significantly higher in the intervention groups than in the control group. Anxiety levels were significantly lower in the video group than music and stress ball groups (p < 0.001, p < 0.001). Satisfaction levels were also significantly higher after cystoscopy in the video group than in the music and stress ball groups (p = 0.018, p = 0.018). CONCLUSIONS: According to this study, distraction methods used during rigid cystoscopy were found to have a reducing effect on pain, anxiety, and dissatisfaction. As the results of the study are evaluated, video should be recommended to be the first preferred distraction method during rigid cystoscopy.

In Vivo Comparison of "V-Loc 90 Wound Closure Device" With "Vicryl" and "Monocryl" in Regard to Tissue Reaction in a Rabbit Bladder Model.

OBJECTIVE: To compare the barbed polyglyconate suture (BPS) with 2 commonly used conventional sutures, this prospective randomized trial was designed. The sutures applied in the urinary collecting system, in terms of long-term histopathologic and macroscopic suture material features. MATERIALS AND METHODS: Eight female and 6 male New Zealand rabbits were included in the study. Each animal served as its own control and was subjected to cystotomy. Watertight running cystorrhaphies were performed using 3 different sutures in a randomized fashion, namely Monocryl, Vicryl, and V-Loc 90. Seven animals were sacrificed after the third and 7 after the sixth week. Macroscopic and histopathologic examinations were performed. Tissue reaction, like inflammation and fibrosis, around the sutures were evaluated. Friedman and Wilcoxon signed ranks test was used for the statistical analysis. RESULTS: The BPS demonstrated no adhesion. However, in the six-week group, stone formation was recorded on 4 BPS and 1 Vicryl thread, a difference being statistically significant (P = .039). Additionally, in the third- and in the sixth-week group, 1 (P = .368) and 3 (P = .050) BPS threads migrated, respectively. The histopathologic analysis revealed less inflammation and fibrosis associated with the BPS thread in both the third and the sixth-week groups (P = .010 and P = .002, respectively). CONCLUSION: The BPS appears to be superior to conventional sutures in terms of local inflammation and fibrosis. However, suture migration and stone formation following collecting system closure could be potential predicaments.

Shock wave lithotripsy or retrograde intrarenal surgery: which one is more effective for 10-20-mm renal stones in children.

OBJECTIVES: To compare shock wave lithotripsy and flexible ureteroscopy in children with renal stone's diameter of 10 to 20 mm. MATERIALS AND METHODS: This is a retrospective study including 79 children, who had renal stone and underwent either shock wave lithotripsy or flexible ureteroscopy between January 2007 and June 2017. Of those, 38 patients underwent shock wave lithotripsy assigned as group 1 and 41 patients underwent flexible ureteroscopy assigned as group 2. Stone-free rate, fluoroscopy time, procedure time, complication rates, hospitalization time, and cost-effectiveness were monitored and included in the analyses. RESULTS: The mean patient age was 4.4 ± 3.5 in group 1 and 4.9 ± 4.1 in group 2. Stone-free rate was not different in both groups in the first and third months of follow-up. The mean fluoroscopy time was statistically significantly longer in group 1 compared to group 2. Procedure and hospitalization times were longer in group 2 compared to group 1. No complications were seen in either groups. The expenditure was calculated as 135.23 and 869.41 Euro per patient for groups 1 and 2, respectively, which shows significant higher cost in group 2. CONCLUSIONS: In this present study, we have shown that shock wave lithotripsy is cheaper, has short hospitalization time and long fluoroscopy time and similar stone-free rate, and has the same efficiency compared to flexible ureteroscopy regarding pediatric renal stones with the diameter between 10 and 20 mm.

The Efficacy of Ureteroscopy Without Fluoroscopy for Ureteral and Renal Stones in Pediatric Patients.

OBJECTIVES: In the pediatric population, there have been significant improvements in the treatment of stones in recent years. Conventionally, ureteroscopy (URS) and/or retrograde intrarenal surgery are techniques performed with fluoroscopy. When using fluoroscopy, problems, including malignancy, may arise because of radiation exposure in the patient, physician, and operation room staff. The aim of this study is to evaluate the possibility of ureteroscopic treatment without fluoroscopy in children with ureteral and renal stones. MATERIALS AND METHODS: Between December 2010 and April 2017, pediatric patients were enrolled in this study. Data were retrospectively evaluated. URS was performed by the experienced surgeons in our center. Fluoroscopy was not routinely used during the operations. Demographic data, perioperative parameters, and success and complication rates were evaluated. RESULTS: Sixty-seven renal units from 61 patients were operated on. URS without fluoroscopy was achieved in 95.0% of 61 patients (95.5% of 67 renal units). Three patients needed fluoroscopy during the operation. The mean stone size was 12.4 ± 5.3 mm, and the mean operation time was 41.9 ± 15.1 minutes. The success rates in the postoperative first and third mounts were 82.1% (55 renal units) and 88.0% (59 renal units), respectively. For 10 patients, second-session URS without fluoroscopy was needed. Clinically insignificant residual fragments were detected in three patients. There were no major complications. CONCLUSION: URS without fluoroscopy for ureteral and renal stones in pediatric patients can be safely and effectively performed in experienced centers.

The histopathological effects of intracavernosal mitomycin-C injection in a rat Peyronie's disease model.

INTRODUCTION: We aimed to evaluate whether or not mitomycin-C (MMC) has an antifibrotic effect on transforming growth factor-beta (TGF-ß)-induced Peyronie's disease (PD) in a rat model. METHODS: Eighteen 12-week-old male Sprague-Dawley rats were divided into three groups: Group 1=TGF-ß1 (n=7); Group 2=TGF-ß1+MMC (n=7); and Group 3=Sham group (0.25 ml bovine serum albumin injected) (n=4). All groups were sacrificed on the sixth week of the procedure and their penises were excised. All penis specimens were evaluated semi-quantitatively and quantitatively with histochemical, immunohistochemistry, and image analysis. RESULTS: Both Group 1 and Group 2 had significantly higher fibrosis scores and lower elastic fibers in both outer surface of tunica albuginea (TA) and subsinusoidal area compared with Group 3. When compared with Group 1, the amount of collagen was significantly decreased in Group 2. Intracavernosal MMC injection (Group 2) ended up with lower elastic fibers when compared with Group 1. According to the quantitative analyses, when compared with Groups 1 and 3, lower dorsal, ventral, and trabecular thickening values were seen in Group 2. These parameters were only statistically significant when compared with Group 1, suggesting the antifibrotic effect of TGF-ß1-induced fibrosis. Both Groups 1 and 2 showed lower decorin staining levels in subsinusoidal areas of tunica albuginea (SATA) and subsinusoidal areas of trabecular wall (SATW) when compared with Group 3. The statistically significant difference was only detected between Group 1 and Group 3. CONCLUSIONS: Our study demonstrates the antifibrotic effects of MMC on PD. Further clinical studies are necessary to make inferences regarding its clinical use.

Our experiences with robot- assisted laparoscopic surgery in pediatric patients: the first case series from Turkey.

OBJECTIVE: Robotic surgery is a leading treatment option for minimally invasive surgery and has an increasing popularity in pediatric population, as well. In this article, we reported our case series of robot-assisted laparoscopic surgery in pediatric population. MATERIAL AND METHODS: We retrospectively reviewed 29 consecutive pediatric patients who underwent robot- assisted procedures between May 2014 and October 2016. Patient demographics, hospitalization time, estimated blood loss, robotic time and total operative and peri-, and post-operative complications were evaluated. RESULTS: A total of 24 ureter units (18 patients) with grade 1-5 vesicoureteral reflux in 13 female and 5 male, 1 male patient with vesicoureteral stenosis were underwent robot- assisted laparoscopic ureteral reimplantation (RALUR). All patients had complete resolution after surgery. Robot-assisted laparoscopic pyeloplasty (RALP) was performed in 6 patients with ureteropelvic junction obstruction. All patients had complete resolution after surgery. Completely intracorporeal robotic assisted laparoscopic augmentation ileocystoplasty (RLAIC) was applied to two patients with neurogenic bladder. The symptoms and preoperative hydronephrosis were regressed on the first month of follow-up. Robot-assisted laparoscopic reduction cystoplasty (RALRC) was performed in 14-year-old boy with a bladder diverticula and recurrent urinary tract infection. The last case was eleven- year-old female patient with non-functioning kidney. She had recurrent urinary tract infections and was treated with robotic assisted laparoscopic nephrectomy (RALN). CONCLUSION: Robot-assisted laparoscopic surgery is safe and efficient in pediatric population. Although open surgery is still the gold standard for many pediatric diseases, inherent reconstructive advantages of robotic assisted laparoscopy have a chance to change this view.

Is testis-sparing surgery safe in small testicular masses? Results of a multicentre study.

INTRODUCTION: Our goal was to evaluate benign and malignant lesions and testicular intraepithelial neoplasia (TIN) in the neighbouring normal-appearing testis tissue in men who underwent radical orchiectomy for testicular mass with a pathologic tumour size of ≤3cm. METHODS: In this retrospective, multicentre study, data of 252 patients from 11 different institutions were included. Patients were divided into three groups based on tumour size: Group 1 (0-1 cm; n=35), Group 2 (1.1-2cm; n=99), and Group 3 (2.1-3 cm; n=118). Benign lesions and TIN were sought in the neighbouring testicular tissue and compared between groups. RESULTS: Mean patient age was 32.3 years. Benign lesions were reported in 54.3%, 33.3%, and 14.4% of Groups 1, 2, and 3, respectively (p<0.05 between groups). TIN was detected in 20%, 42.4%, and 41.5% of Groups 1, 2, and 3, respectively (p<0.05 for Group 1 vs. Groups 2 and 3; p>0.05 for Groups 2 vs. 3). Multifocality was detected in 8.6%, 4%, and 0% of Groups 1, 2, and 3, respectively (p<0.05 for both Group 1 vs. Group 3 and for Group 2 vs. Group 3; p>0.05 for Group 1 vs. Group 2). A tumour cutoff size of 1.5 cm was found to be significant for detecting benign tumour. TIN and multifocality rates were similar in patients with a tumour size of ≤1.5 vs. >1.5 cm (p>0.05). CONCLUSIONS: Benign lesions and TIN in the neighbouring testis were significantly decreased and multifocality was increased in patients with a tumour mass size of ≤1 cm. Testis-sparing surgery should be performed with caution and a safety rim of normal tissue should also be excised.

The histopathological and pharmacodynamic effects of intradetrusor decorin injected in a rabbit partial bladder outlet obstruction model.

PURPOSE: To evaluate whether or not the bladder function can be protected by supporting the detrusor with decorin levels during the fibrotic process. METHODS: Forty-two male rabbits were divided into three main groups, partial bladder outlet obstruction (pBOO) group, pBOO + intradetrusor decorin-injected (IDI) group and control group. Both pBOO and pBOO + IDI groups were divided into three subgroups according to the killing schedule. Histopathological, immunohistochemical and pharmacodynamics studies were performed for the evaluation of fibrotic process and tissue characteristics. RESULTS: Histopathological evaluation revealed statistically significant high fibrosis levels for both pBOO and pBOO + IDI groups when compared with control. Strikingly the antifibrotic effect of decorin was significant on 2nd, 4th and 8th week and increased as time passed. Immunohistochemical analysis was revealed high expressions of anti-TGF-ß1 and decorin levels in all pBOO + IDI groups. Pharmacodynamical results were also revealed better contraction responses in favor of 2nd, 4th and 8th week groups of pBOO + IDI groups, when compared with pBOO groups. In addition, the contraction responses against the depolarizer agent KCl were increased in the three decorin-administrated groups. CONCLUSION: Our study demonstrates the antifibrotic effects of decorin on bladder fibrosis. Strikingly, this antifibrotic effect is shown in histopathological, immunohistochemical and pharmacodynamics studies. Although further studies are warranted to make more decisive inferences regarding its clinical use, our study has the proper pride to be the first step of this time course.

Effect of Voided Volume on Voiding Patterns and Reliability of Uroflowmetry-Electromyography Results in Children with Lower Urinary Tract Dysfunction.

OBJECTIVE: To examine whether voided volume (VV) could change the uroflow patterns and result in children with lower urinary tract dysfunction (LUTD). METHODS: Between January 2009 and May 2010, the children with LUTD were enrolled in this study. Uroflowmetry (UF) combined with electromyography (EMG) was performed two times and was reviewed independently by two urologists. UF-EMG curves were classified as bell, staccato, intermittent, plateau, and tower. Patients' expected bladder capacity (EBC) and VV were recorded. Patients were divided into four groups according to their VV and EBC. Group 1, VV <50% of EBC; group 2, VV between 50 and 100% of EBC; group 3, VV between 100 and 125% of EBC; group 4, VV >125% of EBC. RESULTS: A total of 143 patients underwent UF-EMG at least two times and 382 results were obtained. Groups 1, 2, 3 and 4 consisted of 27, 60, 27 and 29 children, respectively. The percentages of normal, intermittent, plateau voiding patterns were 58.5, 12.8, 7.1% in group 1; 79.8, 5.4, 1.8% in group 2; 59.2, 8.5, 2.8% in group 3; and 37.2, 5.1, 2.6% in group 4, respectively. The percentages of staccato and tower pattern were 1.4, 20% in group 1; 9.1, 3.6% in group 2; 30, 0% in group 3; and 55.1, 0% in group 4, respectively. The rate of tower shape curve decreased as voided volume increased, but the rate of staccato curve increased as voided volume increased. CONCLUSIONS: In case of exceeding the EBC, the test should be repeated with normal VV when UF results are being evaluated.

Concised Form for Lower Urinary Tract Dysfunction Symptom Scale in Children.

INTRODUCTION: Symptom Scales (SS) are questionnaires for evaluating and following up of special illnesses. SS used for the diagnosis and follow-up of Lower Urinary Tract Dysfunction (LUTD) in children is called LUTD Symptom Scale (LUTDSS). AIM: Aim of the present study was to identify the questions which are more important for the diagnosis of LUTD in children and create a simpler SS. MATERIALS AND METHODS: From January 2005 to March 2015, 631 children between the age 5 and 15 were enrolled in this study. Eleven children with active urinary tract infections were excluded from the study. Two hundred sixty three children from the nursery and secondary school saying that they have no urinary complaints and having LUTDSS <9 were designed as control group. Three hundred fifty seven children with LUTDSS score ≥9 were thought as having LUTD and diagnoses were verified with 3-day bladder diaries and 2-time Uroflow-EMG-PVR tests. The answered questions of LUTDSS in patient and control group were compared. RESULTS: Children with daytime incontinence (first question of questionnaire) were 47.7 (4.8-510) times (p=0.01), children with enuresis (third question) were 59.53 (6.2-961) times (p=0.001), children with pause while urinating (eighth question) were 28.7 (4.4-2090) times (p=0.001), children with urgency (tenth question) were 54.7 (29.3-604) times (p=0.039) more likely to have LUTD than the children not having these complaints. The area under ROC curve created by using 1,3,8, and 10 questions was calculated 86.4%. CONCLUSION: The diagnosis and control of LUTD can be made by using only 1., 3., 8. and 10. questions, and these 4 questions could form simpler SS for LUTD in children.

Robot-Assisted Laparoscopic Repair of Spontaneous Appendicovesical Fistula.

BACKGROUND: To report the first case of the spontaneous appendicovesical fistulas' (AVF) repair with robot assisted laparoscopy. CASE PRESENTATION: A 29-year-old male patient with urgent persistant bacteriuria and dysuria was referred to our clinic. Physical examination and blood tests were normal. He had used various antibiotics due to recurrent UTI for about 20 years. Computed tomography revealed the fistula tract between the distal end of the appendix and right lateral wall of the bladder dome. He was successfully treated with robot-assisted laparoscopic repair. Following this surgery, the patient's complaints were resolved completely. CONCLUSION: AVF is the rare condition. Robot-assisted laparoscopy repair of AVF is safe and effective treatment option.

The effect of physical activity on varicocele pain and resolution of this pain by different varicocelectomy techniques.

INTRODUCTION: To evaluate the effect of physical activity on varicocele pain and how different varicocelectomy techniques relieve this pain. MATERIALS AND METHODS: Between November 2012 and January 2015, a total of 64 patients with left groin pain and clinical varicocele were enrolled in this study. A visual analogue scale (VAS) classifying the pain in ten scores was used to assess the severity of pain before and after beginning continuous physical activity, and after operations. Patients were randomly divided into three groups. Group 1 had open sub-inguinal varicocelectomy, Group 2 had loupe-assisted sub-inguinal varicocelectomy and Group 3 had microscope-assisted sub-inguinal varicocelectomy. RESULTS: The mean VAS score of patients before and after beginning continuous physical activity was 3.10 +/- 0.9, and 7.65 +/- 0.93, respectively (p = 0.001). These values were 3.36 +/- 0.9, and 7.45 +/- 0.82 in Group 1 (p = 0.001), 2.90 +/- 0.83, and 7.54 +/- 1.29 in Group 2 and 3.06 +/- 1.06, and 7.87 +/- 0.71 in Group 3 (p = 0.001). After the operations, the mean VAS score decreased to 1.90 +/- 1.13 in Group 1 (p = 0.002), 1.63 +/- 1.32 in Group 2 (p = 0.003), and 0.81 +/- 0.71 in Group 3 (p = 0.001). Comparing the postoperative results among the groups, there was no statistical significance between Groups 1 and 2 (p = 0.190), and Groups 2 and 3 (p = 0.378), but a statistically significant difference was determined between Groups 1 and 3 (p = 0.011). CONCLUSIONS: Physical activity has a significant worsening effect on varicocele pain. Microscopic sub-inguinal varicocelectomy offers the best results for pain resolution.