Carotid artery intima media thickness can predict the response to phosphodiesterase 5 inhibitors in patients with moderate erectile dysfunction.

Background: Increased carotid artery intima-media thickness (CIMT) has been shown to be associated with erectile dysfunction (ED), but studies evaluating the efficacy of CIMT in predicting drug response are lacking in the literature. Aim: We aimed to evaluate the efficacy of CIMT in predicting the response to phosphodiesterase-5 inhibitors (PDE5-I). Methods: A total of 274 subjects were divided into two groups: ED patients (n = 150) and controls (n = 124). The patients in the ED group were further divided into the subgroups of severe, moderate, mild-moderate, and mild ED. Blood tests, carotid ultrasonography, and the International Index of Erectile Function-5 (IIEF-5) diagnostic tool were applied to all subjects. Tadalafil was administered to each patient. The patients were re-evaluated using the IIEF-5 questionnaire after 2 months of treatment. According to their response to medication, the patients were evaluated as responders or nonresponders. Outcomes: Increased CIMT was significantly associated with the failure of PDE5-I therapy, especially in patients with moderate/mild-moderate ED. Results: Fasting blood glucose, body mass index, and CIMT were significantly higher in the ED group compared to the control group (P = .021, P = .006, and P < .001, respectively). The IIEF-5 score was significantly lower in the ED group (P < .001). CIMT was significantly correlated with the IIEF-5 score. When the total patient group was evaluated, the CIMT value of the responders was significantly lower than that of the nonresponders (P = .001). CIMT was significantly higher among the nonresponders with moderate/mild-moderate ED compared to the responders (P = .004 and .008, respectively), while there was no significant difference in CIMT between the responders and nonresponders with severe or mild ED. A receiver operating characteristic (ROC) analysis of CIMT was performed for discrimination between nonresponders and responders with moderate/mild-moderate ED. The area under the ROC curve was 0.801 (0.682-0.921) (P = .001), and the cutoff value was determined to be 0.825 mm, at which CIMT predicted the response to treatment with 65% sensitivity and 89% specificity. Clinical Implications: Using a validated CIMT cutoff value can help the physician inform the patient about the possibility of drug failure and avoid attempting second-line therapy too soon. Strengths and Limitations: There are three main limitations to our study. First, the number of participants was low. Second, ultrasound is a relatively subjective method, and third, all measurements were made by the same radiologist. Conclusion: CIMT can be used as a predictor of response to PDE5-I therapies in patients with moderate/mild-moderate ED.

The effect of anesthesia type on the outcomes of percutaneous nephrolithotomy in elderly males.

Objective: To compare the anaesthesia methods in percutaneous nephrolithotomy in terms of safety and effectiveness in elderly men.Methods: Elderly male patients who had undergone percutaneous nephrolithotomy were screened retrospectively and divided into 2 groups: percutaneous nephrolithotomy under combined spino-epidural anaesthesia (Group CSEA, n = 70) and percutaneous nephrolithotomy under general anaesthesia (Group GA, n = 114). Preoperative, perioperative and postoperative outcome measures were examined.Results: Between the two groups, there was no statistically significant difference in terms of stone burden, stone location, presence of the previous operation in the same kidney, presence of staghorn stones, mean American Society of Anesthesiologists scores and presence of abnormal kidney (p > 0.05). The mean duration time in the operation room and post-anaesthesia care unit (PACU) was statistically shorter in the Group CSEA (p < 0.01). There was no significant difference between the two groups in terms of Clavien Grade 1 and above complications (p > 0.05). Stone-free rates and success rates were similar in both groups (p = 0.133 and p = 0.273, respectively).Conclusion: The type of anaesthesia does not affect the success rate and complication rate of percutaneous nephrolithotomy in elderly male patients. Patients who underwent percutaneous nephrolithotomy under CSEA needed less analgesic injection during the postoperative period. CSEA can shorten the time a patient spends in the operating room and PACU, which provides more effective use of operation room working hours.

Combined spino-epidural anaesthesia (CSEA) can be safely administered in elderly men during PNL operation without affecting surgical success. CSEA patients less occupy the operating rooms. CSEA patients' postoperative period is more comfortable because of the less painful period.

Frequency of overactive bladder (OAB) and the factors affecting it in patients with obstructive sleep apnea syndrome (OSAS).

PURPOSE: To investigate the prevalence of overactive bladder (OAB) in patients with obstructive sleep apnea syndrome (OSAS) and the factors affecting it. MATERIALS AND METHODS: A total of 255 patients were included in this prospectively designed study. Among all patients, 166 were male, 89 were female; 213 patients were married and 42 were single. All patients underwent polysomnography. All patients completed the OAB-V8 form. OSAS was diagnosed via polysomnography. OAB was diagnosed via OABV8. The participants were evaluated as patients with and without OAB and those with and without OSAS. SPSS for Windows version 18.0 software was used for the statistical analysis and the level of significance was set at α = 0.05. RESULTS: The prevalence of OAB was high among the OSAS patients (66.3%, n = 136). Age, body mass index, waist circumference, marital status, oxygen desaturation index (ODI4) ⩾4%, apneahypopnea index (AHI), the number and duration of decreases in O2 saturation below 90%, wake after sleep onset (WASO) duration, and groups, and OSAS severity were different in the OAB group (p < 0.05). Duration and number of O2 saturation <90%, and ODI4 are higher in the OSAS group and OAB group (p < 0.05). In multivariate logistic regression analysis, AHI, WASO, age, and marital status were the factors influencing OAB. CONCLUSION: OAB is seen at a high rate in OSAS patients. Hypoxia is the main basis for both diseases and probably it is the common pathway. AHI, WASO, age, and marital status can provide valuable information to physicians for predicting OAB.

Evidence for the Association between Chronotype and Lifelong Premature Ejaculation.

PURPOSE: This study aimed to investigate the relationships between intravaginal ejaculatory latency time (IELT), severity of disease, and chronotype in lifelong premature ejaculation (PE). MATERIALS AND METHODS: Evaluation was made of 114 males with PE and 103 healthy individuals, and comparisons were made of self-estimated IELT, Arabic Index of Premature Ejaculation (AIPE), Pittsburg Sleep Quality Index (PSQI), and Morningness-Eveningness Questionnaire (MEQ). RESULTS: The frequency of morningness chronotype (78.1%) was significantly higher, and Morningness-Eveningness Questionnaire (MEQ) scores were negatively correlated with both IELT (r = -0.490, p < 0.001) and Arabic Index of Premature Ejaculation (AIPE) scores (r = -0.639, p < 0.001) in the PE group. MEQ scores significantly predicted IELT (t = -2.465, p = 0.015) and AIPE scores (t = -4.003, p = 0.000) in the PE group but not in the control group. CONCLUSION: It can be asserted that morningness chronotype is more common, and ejaculatory latency time and PE severity are associated with chronotype in males with PE.

Free prostate-specific antigen outperforms total prostate-specific antigen as a predictor of prostate volume in patients without prostate cancer.

OBJECTIVE: In the management of benign prostatic hyperplasia (BPH), urology guide- lines recommend medical or surgical treatments according to different prostate volumes (PV). The aim of this study was to analyze the relationships between PV and age, total and free prostate specific antigen (tPSA, fPSA) and fPSA/tPSA ratio in patients without histologically proven prostate cancer. MATERIALS AND METHODS: A retrospective analysis was made of the data of 1334 patients who underwent transrectal ultra- sound (TRUS)-guided prostate biopsy between January 2016 and October 2018. A total of 438 patients with available data for age, tPSA and fPSA levels and PV calculated by TRUS were enrolled in the study. Patients with chronic prostatitis pathology in addition to BPH were also noted and evaluated as a separate group. RESULTS: There were significant correlations between PV and age, tPSA, fPSA, fPSA/tPSA ratio (r = 0.210, r = 0.338, r = 0.548, r = 0.363 respectively). In multivariate linear regression analysis, fPSA was found to be the only predictor for PV (p < 0.001) when compared to age (p = 0.097), tPSA (p = 0.979) and fPSA/tPSA ratio (p = 0.425). In patients with chronic prostatitis pathology there were significant correla- tions between PV and age, tPSA, fPSA, fPSA/tPSA ratio (r = 0.279, r = 0.379, r = 0.592, r = 0.359, respectively). The multivariate linear regression analysis showed a signifi- cant correlation only between PV and tPSA and fPSA/tPSA ratio but not with fPSA and age (p = 0.008, p = 0.015, p = 0.430, p = 0.484, respectively). In men with only BPH pathology there were significant correlations between PV and age, tPSA, fPSA, fPSA/tPSA ratio (r = 0.223, r = 0.385, r = 0.520, r = 0.287, respectively) In multivariate linear regression model the significant correlation was shown only between PV and fPSA (p < 0.001). CONCLUSIONS: Although tPSA was significantly correlated with PV in patients without prostate cancer, the correlation between fPSA and PV was much stronger. However, it should be kept in mind that the efficacy of fPSA may be limited in patients with clinically unknown prostatic inflammation.

Percutaneous Nephrolithotomy via a Middle Calyx Access Is Effective in the Treatment of Lower Pole Kidney Stones: A Single-Center Study.

PURPOSE: To compare the efficacy of the middle calyx access (MCA) and lower calyx access (LCA) in the treatment of lower pole kidney stones. MATERIALS AND METHODS: The data of patients with isolated lower pole kidney stones who underwent percutaneous nephrolithotomy via MCA or LCA between 2009 and 2019 were evaluated retrospectively. Pre-, peri-, and postoperative parameters of the groups (LCA group and MCA group) were compared. A value of p < 0.05 was considered significant. RESULTS: A total of 601 patients with lower pole kidney stones were included in the study. LCA was performed for the initial tract in 400 patients, and MCA was performed in 201 patients. There were no significant differences in terms of age, gender, laterality, body mass index, previous operation history, stone burden, duration of fluoroscopy, and stone-free rate between the groups. Operation time was significantly longer in the LCA group (p = 0.041). In the LCA group, additional access was required in 50 cases, which was significantly higher than in the MCA group (p = 0.013). Clinically insignificant residual fragments (CIRF) were present in 28 patients (7%) in the first group (significantly higher vs. MCA: p = 0.044). There were no statistically significant differences in terms of overall complication and transfusion rates. CONCLUSIONS: MCA had superior outcomes in terms of operation time, CIRF rate, hemoglobin drop, and requirement of an additional tract compared to LCA. Further studies evaluating the efficacy of MCA in lower pole kidney stones should be performed to verify our results.

Comparison of Guy's Stone Score and clinical research of the endourological society nomogram for predicting surgical outcomes after pediatric percutaneous nephrolithotomy: a single center study.

BACKGROUND: The aim of this study was to compare the efficacy of Guy's Stone Score (GSS) and Clinical Research of the Endourological Society (CROES) Nomogram in predicting PCNL outcomes in the pediatric patients with kidney stone. METHODS: A retrospective review of the clinical data of 120 pediatric patients who underwent PCNL between August 2004 and February 2016 was performed. Patients were grouped according to stone-free (SF) status and complication status. The patients whose history, preoperative physical examination records, biochemical analysis, imaging records were available and who did not neglect the follow-up, were included in the study. The stone size measurement and the scoring system calculation were always performed by the same surgeon. Multivariate logistic regression analysis were performed to identify the factors associated with SF status and complication status. RESULTS: CROES score was significantly higher in SF patients compared to the patients with residual stones (P=0.009), while stone burden and GSS were significantly lower (P=0.023 and P=0.025). Median hospitalization day of patients with complications was significantly higher compared to the patients without complication (P=0.005). To have stones located in multiple calyces was the only statistically significant condition when two groups were compared (P=0.014). In multivariate analysis, CROES score was the independent factor associated with SF status (OR:0.984 95% CI: 0.959-1.010 P=0.017) and to have stones located in multiple calyces was the independent factor associated with complication status (OR:0.265 95% CI:0.087-0.808 P=0.02). CONCLUSIONS: CROES nomogram is associated with the SFR while GSS is not. Both scoring systems do not have predictive accuracy on complication status. Further studies are required to make modifications in the scoring systems in the pediatric population.

Lymphocyte-to-monocyte ratio is a valuable marker to predict prostate cancer in patients with prostate specific antigen between 4 and 10 ng/dl.

OBJECTIVE: To evaluate the diagnostic value of serum inflammation markers derived from complete blood count in diagnosis of prostate cancer (PCa). METHODS: We retrospectively analyzed the data of 621 patients who underwent prostate biopsy between March 2013 and April 2018. Age, prostate specific antigen (PSA), free PSA, platelet count, neutrophil count, lymphocyte count, monocyte count, prostate volume (PV) and pathology result of the patients were recorded. Patients were grouped as benign prostatic hyperplasia (BPH), prostatitis and PCa. Patients were also grouped according to PSA values, as PSA < 4 , PSA 4-10 and PSA > 10 ng/dl. RESULTS: The mean lymphocyte-to-monocyte ratio (LMR) value of the patients with PCa was significantly lower in the entire cohort (p = 0.047). In the PSA 4-10 ng/dl range, LMR value wassignificantly lower in patients with PCa than those with BPH or prostatitis (p = 0.012). In this PSA range, free/total PSA ratio and LMR were significant factors to predict PCa. The cut-off values of LMR, free/total PSA were 3.05 and 0.15 respectively. The sensitivities, spesificities, positive predictive values (PPV) and negative predictive values using LMR cut-off, free/total PSA cut-off and their combination were assessed. Specificity and PPV of the combination group were higher (97.2%, 83.3% respectively) compared to free/total PSA cut-off group (91.6%, 76.6%) and LMR cut-off group (67.8%, 43.7%). CONCLUSIONS: LMR is a useful tool at detecting PCa especially in patients with PSA value between 4 and 10 ng/dl. The combination of free/total PSA ratio and LMR improves the diagnostic accuracy more than the use of free/total PSA ratio alone.

Neuronal Nitric Oxide Synthase Expression in the Anterior Vaginal Wall of Patients with Stress Urinary Incontinence.

PURPOSE: Stress urinary incontinence (SUI) and pelvic organ prolapse (POP) are common medical problems, particularlyamong older women. In this study, we aim to explore the relationship between the neurotransmitter nNOS in the vaginal epithelium, and the occurrence of SUI and changes of nNOS levels according to menopausal status.Matherials and Methods: Fourty women were enrolled. The patients were divided into four groups according to menstruaiton status and SUI. The vagina specimens were taken during transobturator tape application. The specimens were examined pathologically in terms of n-NOS expression. nNOS expression was compared between SUI and control groups. The results were evaluated statistically. RESULT: Epithelial total nNOS score in group 1 and group 3 were 2.4 ± 0.5 and 1.4 ± 0.5 respectively (P = .003). Stromal total nNOS score was found 2.2 ± 0.4 in group 1 and 1.3 ± 0.5 in group 3 (P = .001). Epithelial total nNOS score in group 2 and group 4 were 4.4 ± 0.5 and 3.5 ± 0.5 respectively (P = .003). Stromal total nNOS score was found 4.4 ± 0.5 in group 2 and 3.6 ± 0.5 in group 4 ( P = .006). CONCLUSION: Our results show that expression of nNOs in the anterior vaginal epithelium decreased significantly in the SUI group. Altough our findings indicate important results, well designed further studies are needed to comprehend the role of NOS pathways better in SUI pathophysiology.

Percutaneous nephrolithotomy in solitary kidneys: effective, safe and improves renal functions.

BACKGROUND: To evaluate success and complication rates of endourological stone treatments and to evaluate effects of percutaneous nephrolithotomy (PCNL) on renal functions, in patients with solitary kidneys. METHODS: In our center, 3150 patients underwent PCNL between 2003 and 2017 and 142 patients underwent retrograd intrarenal surgery (RIRS) between 2013 and 2017. We retrospectively analysed the data of 82 patients with solitary kidney who underwent PCNL and of 8 patients with solitary kidney who underwent RIRS. Complications were classified according to Clavien-Dindo Classification system. Serum creatinin was measured before the procedure, on the early postoperative period and at sixth month follow-up in PCNL group. The estimated glomerular filtration rate (eGFR) was calculated using Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula. The 5-stage classification of chronic kidney disease (CKD) was used according to the National Kidney Foundation guideline. RESULTS: In the PCNL group, the initial stone-free and success rates were 82.9% and 95.1%, respectively. Complications occured in 18 (22%) patients. Transfusion was the most common complication (15.5%). One patient required JJ stenting. The stone-free rates of the patients who required multiple accesses were statistically lower than the patients who required single access (P=0.01). Transfusion rates were statistically higher in patients who required multiple accesses and who had complex stones (P=0.01 and P=0.02, respectively). GFRs calculated preoperatively, in the early and in the late period were 65.03, 62.85 (P=0.224) and 70.63 mL/min/1.73 m2 (P<0.001), respectively. At the postoperative 6th month, GFR was stable in CKD stage 1 patients and improved in CKD stage 2-4 patients (P<0.001, P<0.001 and P=0.012 respectively). In the RIRS group, 5 patients (62.5%) were stone free and the success rate was 75% (6 patients) after single procedure. Any complication did not occur in the RIRS group. CONCLUSIONS: PCNL in solitary kidney is a safe method with acceptable complication rates. Renal functions are preserved in patients with normal functioning kidney and improved in patients with renal insufficiency. RIRS may be an alternative method in selected patients with solitary kidney.

Upper pole access is safe and effective for pediatric percutaneous nephrolithotomy.

INTRODUCTION: Upper pole access in percutaneous nephrolithotomy (PCNL) provides a straight tract to the ureter, resulting in easier placement of a guidewire to the ureter, good exposure of the pelvis, calices, and upper ureter, and comfortable manipulations. However, despite these benefits, upper pole access is usually avoided because of the risk of chest complications in both pediatric and adult patients. OBJECTIVE: We aimed to evaluate the safety and morbidity of single upper pole access in pediatric patients undergoing PCNL. STUDY DESIGN: We retrospectively reviewed patients aged ≤17 years with renal stones who underwent PCNL with a single access between August 2004 and February 2016. The patients were separated into two groups: the single upper pole access group (SUPAG) and the single other pole access group (SOPAG). We compared the SUPAG and SOPAG in terms of the demographic features of the patients, stone burden and location, operative data, and postoperative outcomes. Complications were classified according to the modified Clavien system. RESULTS: During the study period, 101 PCNL procedures were performed, 77 of which were managed with only one access. The median age of the 77 patients managed with a single access was 12 years (range 3-17 years). The number of cases in the SUPAG and SOPAG was 10 and 67, respectively. There were no statistically significant differences between the SUPAG and SOPAG in terms of age, sex, stone location, hydronephrosis status, stone area, side of kidney, and previous stone treatment or renal surgery. Furthermoret, there were no significant differences between the groups in terms of the operative parameters. Although the difference was insignificant, the median operation times in the SUPAG and SOPAG were 37 and 45 min, respectively. There was no chest complication or bleeding that required transfusion in the SUPAG. Two cases required transfusion, and one case was managed with a double pigtail catheter (double-J) placement because of prolonged extravasation in the SOPAG. The stone-free ratios were 100% and 82.1% in the SUPAG and SOPAG, respectively. CONCLUSION: Upper pole access provides similar outcomes to other (middle and lower) pole accesses, and may be performed without serious complications. These results indicate that this is a safe and effective approach of PCNL, and it presents a good alternative for removal of renal stones in pediatric patients.

Relationship between erectile dysfunction and the neutrophil to lymphocyte and platelet to lymphocyte ratios.

The most important cause of erectile dysfunction (ED) among aging men is organic disease due to vascular disturbance that is often caused by atherosclerosis. Recently, studies have shown that atherosclerosis can manifest as an active inflammatory process rather than as passive vascular injury caused by lipid infiltration. Our study aimed to examine the association of ED with the neutrophil/lymphocyte ratio (NLR) and the platelet/lymphocyte ratio (PLR), both of which are markers of inflammation. Between December 2014 and May 2015, 101 male patients aged 40-70 years who were seen at our institute due to ED were included in this study. Thirty-one sexually active men with similar clinical and demographic characteristics without ED were included in our study as a control group. The control and patient groups were compared with respect to their NLR and PLR values as well as other hormonal, biochemical, hematological parameters. The median ages of the patient and control groups were 49 (40-69) and 48 (43-65) years old, respectively. Comorbidities such as hypertension, diabetes, chronic obstructive pulmonary disease (COPD), and coronary artery disease were not significantly different between the groups (p > 0.05). The neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios were significantly higher in the patient group than in the control group (p < 0.05). Furthermore, the detected CRP levels were also significantly higher in the patient group than in the control group (p < 0.001). In the correlation analysis, the NLR, PLR, and CRP levels were negatively correlated with the IIEF-5 scores. A multivariate analysis was performed to determine the independent predictors of ED. PLR was identified as an independent predictor for ED. The neutrophil-to-lymphocyte and especially platelet-to-lymphocyte ratios are correlated with a diagnosis of ED, and these ratios could serve as practical parameters that will not elicit additional costs.

Effects of Tadalafil 5 mg Dosed Once Daily in Men with Premature Ejaculation.

PURPOSE: In this study, we evaluated the effect of 5 mg tadalafil once daily in men with premature ejaculation (PE). METHODS: Thirty married men with lifelong PE and 30 healthy men as control group were included in this study. All the patients received 5 mg tadalafil once a day for a month. The international index of erectile function questionnaire and intravaginal ejaculatory latency times (IELTs) and PE profile were recorded before and after treatment. Plasma samples were collected before and after treatment. RESULTS: The mean baseline IELTs was 40.8 ± 8.1 s in the PE group and 196.5 ± 26.2 s in the control group. After treatment in the PE group, the mean IELTs values showed a statistically significant improvement from the baseline values. At the end of 4 weeks, in the PE group, the mean IELT values showed a statistically significant improvement from the baseline values. Baseline serum nitric oxide (NO) levels were 27.3 ± 1.7 in the PE group and in the 31.1 ± 1.4 healthy control groups. After treatment, NO levels were increased from baseline. CONCLUSION: We consider that 5 mg tadalafil once daily is safety and effective for the treatment of PE.

Factors Influencing Complications of Percutaneous Nephrolithotomy: A Single-Center Study.

PURPOSE: Percutaneous nephrolithotomy (PNL) is a minimally invasive procedure used for successful treatment of renal calculi. However, it is associated with various complications. We assessed the complications and their potential influencing factors in patients who had undergone PNL. MATERIALS AND METHODS: In total, 1750 patients who had undergone PNL from November 2003 to June 2011 were evaluated retrospectively. PNL complications and possible contributing risk factors (age, sex, serum creatinine level, previous operations, hydronephrosis, calculi size, localization, opacity, surgeon's experience, accessed calyxes, number of accesses, and costal entries) were determined. Receiver operating characteristic (ROC) analysis was used to investigate the cutoff values of the data. Ideal cutoff value was determined by Youden's J statistic. All the demographic and clinical variables were examined using backward stepwise logistical regression analysis. Continuous variables were categorized with logistic regression analysis according to the cutoff values. RESULTS: Complications occurred in 396 (24.4%) patients who had undergone PNL. Hemorrhage requiring blood transfusion occurred in 221 (12.6%) patients, hemorrhage requiring arterial embolization occurred in 7 (0.4%) patients, perirenal hematoma occurred in 17 (0.97%) patients, hemo-pneumothorax occurred in 32 (1.8%) patients, and colon perforation occurred in 4 (0.22%) patients. Three patients (0.06%) died of severe urosepsis, and one patient (0.02%) died of severe bleeding. The calculus size, localization, access site, number of accesses, presence of staghorn stones, surgeon's experience, and duration of the operation significantly affected the complication risk. CONCLUSION: Our retrospective evaluation of this large patient series reveals that, PNL is a very effective treatment modality for kidney stones. However, although rare, serious complications including death can occur.

Comparison between Retroperitoneal and Transperitoneal Approaches in the Laparoscopic Treatment of Bosniak Type I Renal Cysts: A Retrospective Study.

PURPOSE: We retrospectively compared laparoscopic transperitoneal and retroperitoneal approaches for the decor­tication of simple renal cysts with respect to safety, postoperative pain, and clinical results. MATERIALS AND METHODS: The study included 40 patients (28 males and 12 females) with symptomatic simple renal cysts and who underwent laparoscopic cyst decortication, and they were evaluated retrospectively. Patients' age, gender, disease-specific history, comorbid disease and family history, in general and urological and phys­ical examination findings were recorded. Patients prior to surgery were evaluated by urinalysis, serum creati­nine level, blood count, urinary tract ultrasonography, and unenhanced and contrast-enhanced abdominal com­puted tomography. Patients were informed about laparoscopic surgery and their written informed consent was taken. For those who preferred the laparoscopic approach, the placement of the cyst, history of prior surgery and obesity were evaluated. All patients filled out the visual analog scale (VAS) to evaluate postoperative pain. RESULTS: The mean age of the patients were 54.65 ± 5.26 years in the retroperitoneal group and 56.0 ± 4.66 years in the transperitoneal group. For all patients the indication for surgery included right or left flank pain. The mean operative time for the transperitoneal approach was 51.5 min., and that for the retroperitoneal approach was 44.75 min. This difference was statistically significant between the two groups (P < .05). According to VAS scale, the retroperitoneal scoring method was found to be lower than the transperitoneal scoring method. All patients were discharged on the first postoperative day, and the drains were taken out. None of the patients had complications. At the end of six months, no clinical and radiological recurrence was detected in any patient. CONCLUSION: We consider the retroperitoneal approach to be the first-choice because of its shorter operation time and particularly low level of postoperative pain.

Internal urethrotomy versus plasmakinetic energy for surgical treatment of urethral stricture.

PURPOSE: we aimed to compare the longterm outcome of surgical treatment of urethral stricture with the internal urethrotomy and plasmakinetic energy. MATERIAL AND METHODS: 60 patients, who have been operated due to urethral stricture were enrolled in our clinic. None of the patients had a medical history of urethral stricture. The urethral strictures were diagnosed by clinical history, uroflowmetry, ultrasonography and urethrography. The patients were divided two groups. Group 1 consisted of 30 patients treated with plasmakinetic urethrotomy and group 2 comprised 30 men treated with cold knife urethrotomy. RESULTS: There were no statistically significant differences between two groups in terms of patient age, maximum flow rate (Qmax) and quality of life score (Qol) value. A statistical difference between the two groups was observed when we compared the 3rd-month uroflowmetry results. Group 1 patients had a mean postoperative Qmax value of 16,1 ± 2,3 ml/s, whereas group 2 had a mean postoperative Qmax value of 15,1 ± 2,2 ml/s (p < 0.05). In the cold knife group, 3 of 11 (27,7%) recurrences appeared within the first 3 months, whereas in the plasmakinetic group zero recurrences appeared within the first 3 months in our study. The urethral stricture recurrence rate up to the 12 month period was statistically significant for group 1 (n = 7, 23%) compared with group 2 (n = 11, 37%) (p < 0.05). CONCLUSION: We believe that plasmakinetic surgery is better method than the cold knife technique for the treatment of urethral stricture.

Use of three types of synthetic mesh material in sling surgery: a prospective randomized clinical trial evaluating effectiveness and complications.

OBJECTIVE: The aim of this study was to determine the surgical success and complication rates of mixed type of mesh materials compared with Prolene mesh in sling surgery over a 4-year follow-up period. MATERIAL AND METHODS: Between 2005 and 2007, broad-based double-forced sling operations were performed in 144 women with stress incontinence using three different types of mesh material. Group I consisted of 48 patients in whom Vypro® mesh (Ethicon, USA) was used; group II of 48 patients in whom Ultrapro® mesh (Ethicon) and group III of 48 patients in whom Prolene® light mesh (Ethicon) was used. The patients' data and the success of the operation were evaluated based on the 24 h pad test, International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) scoring and Korman questionnaire analysis. RESULTS: The ICIQ-SF score, the number of pads used and the results of 24 h pad test were statistically lower in group II at postoperative month 48 (p < 0.05). The rate of postoperative complications was lower in Group II than in the other groups (p < 0.05). The continence rates of groups I, II and III were 84.7%, 91.6% and 85.1%, respectively, in the 48th postoperative month. CONCLUSIONS: Ultrapro mesh can be used in sling surgery owing to its higher success rates, and lower vaginal and urethral extrusion and de novo urgency rates, which have also been shown in clinical studies.

Penile revascularization in vasculogenic erectile dysfunction (ED): long-term follow-up.

OBJECTIVE: To determine the overall long-term success of penile revascularization surgery in the treatment of vasculogenic erectile dysfunction (ED) and also to investigate the effect of risk factors on the results of a modified Furlow-Fisher technique. PATIENTS AND METHODS: Between 1999 and 2010, 125 men with a mean (sd, range) age of 43.2 (11.3, 23-69) years underwent penile revascularization surgery. In all, 110 men completed the long-term follow-up with a mean follow-up of 73.2 months. Diagnostic evaluations, penile colour Doppler ultrasonography, corpus cavernosum electromyography, and cavernosometry, were performed in all the men before surgery. The efficacy of the surgery was assessed as improvement or failure according to the change in the five-item version of the International Index of Erectile Function (IIEF-5). A ≥5 point increase in the IIEF-5 score during the latest patient visit after surgery compared with that before surgery was regarded as improvement (surgical success). RESULTS: The mean (SD) IIEF-5 score was 7.3 (3.2) before surgery and at the end of the follow-up period it was 16.8 (3.1). The success rates were 81.8% at 3 months, 77.2% at 1 year, 70% at 2 years, 66.3% at 3 years and 63.6% at 5 years after surgery in the men who achieved a no-ED threshold score of >26 in the IIEF-15. The success rate was the highest in the men with no risk factors (92.8%). Seven patients (6.36%) showed signs of glans hypervascularization as a major complication. CONCLUSIONS: Penile revascularization surgery has not been widely used by urologists probably due to the technical difficulties and the use of phosphodiesterase type 5 inhibitors. However, with reported high rates of noncompliance or failure of oral pharmacotherapy it seems likely that this surgery will become more popular in the near future.

Multiple giant prostatic urethral stones with an ureteral stone in a young patient.

Giant prostatic urethral stones have been reported as a very rare entity, and the etiology of these stones is not clear. We report a case of a 40-year-old man with giant multiple prostatic urethral stones whereby the entire gland was replaced, and a big ureteral stone presented with voiding difficulty and recurrent urinary tract infections. In the literature, to our knowledge, this is the youngest case wherein giant prostatic urethral stones coexisted with a big ureteral stone. Many different-sized stones were observed endoscopically, some protruding into the urethra, and some filling different cavities on the prostate. Following cystoscopy, multiple giant prostatic stones weighing a total of 151 g were removed by the open retropubic route. We treated the big ureteral stone endoscopically.