Efficacy of low-intensity shockwave therapy with different tadalafil regimens in patients with PDE5 inhibitor-resistant erectile dysfunction: a retrospective cohort study.

PURPOSE: Currently, there is a lack of research comparing tadalafil treatment protocols recommended during low-intensity shock wave therapy (LI-SWT) for patients with erectile dysfunction (ED) who are unresponsive to phosphodiesterase type 5 inhibitors (PDE5i). The objective of this study is to compare the efficacy of only LI-SWT versus LI-SWT plus 5 mg tadalafil daily versus LI-SWT plus 20 mg tadalafil alternate-day in PDE5i -resistant ED. MATERiALS AND METHODS: In this study, a cohort of 105 patients with PDE5i-resistant ED was recruited and divided into three groups labeled as A (only LI-SWT), B (LI-SWT plus 5 mg tadalafil daily), and C (LI-SWT plus 20 mg tadalafil alternate-day), comprising 27, 42, and 36 patients, respectively. The patients' International Index of Erectile Function-5 (IIEF-5) scores and the Erection Hardness Score (EHS) were evaluated at the baseline, three months and six months following the treatment. RESULTS: After three months post-treatment, the IIEF-5 scores in group A, B, and C increased by 4.1 ± 0.6, 7.3 ± 0.6, and 8.2 ± 0.6, respectively. These improvements were maintained at six months with IIEF-5 scores increasing by 3.7 ± 0.6, 7.3 ± 0.6, and 8.5 ± 0.7 in groups A, B, and C, respectively. At 3 and 6 months post-treatment, groups B and C showed significant improvement in IIEF-5 scores and EHS values compared to group A (p < 0.001). The rate of patients with EHS ≥ 3 and IIEF-5 ≥ 17 was significantly higher in groups B and C compared to group A, while there was no significantly different between groups B and C. CONCLUSiON: In patients with PDE5i-resistant ED, PDE5i combined with LI-SWT is superior to LI-SWT monotherapy. The statistical analysis failed to demonstrate any difference between two distinct tadalafil regimens when administered with LI-SWT treatment.

A Retrospective Analysis of 83 Patients with Testicular Mass Who Underwent Testis-Sparing Surgery: The Eurasian Uro-oncology Association Multicenter Study.

INTRODUCTION: Herein, we analyzed the histopathological, oncological and functional outcomes of testis-sparing surgery (TSS) in patients with distinct risk for testicular cancer. METHODS: This is a multicenter retrospective study on consecutive patients who underwent TSS. Patients were categorized in high- or low-risk testicular germ cell tumor (TGCT) according to the presence/absence of features compatible with testicular dysgenesis syndrome. Histology was categorized per size and risk groups. RESULTS: TSS was performed in 83 patients (86 tumors) of them, 27 in the high-risk group. Fifty-nine patients had a non-tumoral contralateral testis present. Sixty masses and 26 masses were benign and TGCTs, respectively. No statistical differences were observed in mean age (30.9 ± 10.32 years), pathological tumor size (14.67 ± 6.7 mm) between risk groups or between benign and malignant tumors (p = 0.608). When categorized per risk groups, 22 (73.3%) and 4 (7.1%) of the TSS specimens were malignant in the high- and low-risk patient groups, respectively. Univariate analysis showed that the only independent variable significantly related to malignant outcome was previous history of TGCT. During a mean follow-up of 25.5 ± 22.7 months, no patient developed systemic disease. Local recurrence was detected in 5 patients and received radical orchiectomy. Postoperative testosterone levels remained normal in 88% of those patients with normal preoperative level. No erectile dysfunction was reported in patients with benign lesions. CONCLUSION: TSS is a safe and feasible approach with adequate cancer control, and preservation of sexual function is possible in 2/3 of patients harboring malignancy. Incidence of TGCT varies extremely between patients at high and low risk for TGCT requiring a careful consideration and counseling.

Comparison of unilateral and bilateral microdissection testicular sperm extraction (MD-TESE) in patients with non-obstructive azoospermia: a prospective study.

OBJECTIVE: To compare sperm retrieval rates between unilateral and bilateral microdissection testicular sperm extraction (MD-TESE) procedures in patients with non-obstructive azoospermia and to contribute to the literature by comparing them with literature data. METHODS: This prospective study included 84 males with primary infertility who had azoospermic NOA, who had been married for at least one year, and whose female partners did not have a history of infertility. The study was conducted between January 2019 and January 2020. MD-TESE was applied bilaterally to 48% (n:41) (Group 1) and unilaterally to 52% (n:43) (Group 2) of the patients, and sperm retrieval rates were compared. RESULTS: There was no statistically significant difference between Group 1 patients and Group 2 patients in terms of sperm availability (61%, 56.5%, p=0.495, respectively). In addition, while no complications were observed in unilateral MD-TESEs, 3 complications were observed in bilateral MD-TESEs. CONCLUSIONS: In our study, it was determined that there was no significant difference between the groups in terms of sperm availability in patients with NOA. Considering the operative time and complication rates of bilateral MD-TESE in patients diagnosed with NOA and the possible MD-TESE procedures that may be performed later, we believe that unilateral MD TESE is a more preferable procedure for the patient and surgeon in this patient group.

Comparison of Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging in Patients with Prostate Biopsy Indications.

OBJECTIVE: This article aims to evaluate the efficacy of multiparametric magnetic resonance imaging before standard tru-cut biopsy in making prostate cancer diagnosis. MATERIALS AND METHODS: A total of 160 patients with prostate biopsy indications were prospectively evaluated between May 2017 and October 2018. Multiparametric magnetic resonance imaging was taken after obtaining a written informed consent from all patients. Cognitive transrectal ultrasound-guided biopsy was performed based on multiparametric magnetic resonance imaging results. Standard tru-cut biopsy was included to reduce false-negative rate. Statistical analysis was performed using the Statistical Package for Social Sciences version 20.0 software. RESULTS: The mean age of the patients was 65.94 ± 7.90 (48-84) years. Around 19.37% of the patients had a specificity in the digital rectal exam. The mean prostate-specific antigen value of the patients with adenocarcinoma was 42.1 ng/mL and it was 10.2 ng/mL in patients with benign prostate hyperplasia. It was observed that the prostate-specific antigen values in prostatic adenocarcinomas were significantly higher than those in benign prostate hyperplasia (P < .001). The results of multiparametric magnetic resonance imaging and the biopsy were 100% similar in terms of zones in patients with adenocarcinoma. All of the biopsy results of the patients who were evaluated to have normal prostate tissue in multiparametric magnetic resonance imaging were evaluated as benign prostate hyperplasia; on the other hand, 13.6% of PI-RADS 2 lesions, 14% of PI-RADS 3 lesions, 31.8% of PI-RADS 4 lesions, and 85.7% of PI-RADS 5 lesions were determined to be adenocarcinoma. It was observed that the prevalence of adenocarcinoma increased as the risk elevated in multiparametric magnetic resonance imaging (P < .001). CONCLUSION: Multiparametric magnetic resonance imaging evaluated by experienced radiologists may be instructive of urologists and reduce the need for unnecessary biopsies.

Management of patients with urinary tract endometriosis by gynecologists

Objective: The aim was to report the postoperative outcomes of urinary tract endometriosis (UTE), which is a form of deep, infiltrative endometriosis, and to contribute to the literature by presenting our experience. Material and Methods: In the present study, patients who underwent surgery for endometriosis at our clinic between 2005 and 2019 and had a final pathological diagnosis of UTE were examined in detail. Patient information was retrospectively retrieved from the medical records. Data obtained pre-, peri-, and postoperatively were analyzed. Results: Mean age of the 70 patients included, according to the study criteria, was 32.73±7.09 years. Ureteral involvement alone was observed in 49% (n=34) of the patients, bladder involvement alone was observed in 24% (n=17) of the patients, and both bladder and ureteral involvement were observed in 27% (n=19) of the patients. Microscopic hematuria was detected in 16% (n=11) of the patients, whereas preoperative urinary tract findings, such as recurrent urinary tract infections, were detected in 19% patients (n=13). Of the patients, 56% (n=39) were identified with dyspareunia, 56% (n=39) with dysmenorrhea, and 30% (n=21) with pelvic pain. Visual analog scale score was significantly lower after the procedure (p<0.0001). Conclusion: Although postoperative results were typically considered positive, surgical method performed in deep infiltrative endometriosis should aim to preserve fertility, improve quality of life, and reduce the complication rate to a minimum.

Vesicovaginal fistula repair experiences in a single center high volume of 33 years and necessity of cystostomy.

OBJECTIVE: The aim of this study was to retrospectively examine the patients who underwent surgical treatment for vesicovaginal fistula (VVF) repair in our clinic, to evaluate our surgical preferences, success, and treatment results, to compare these with the literature, and firstly to reveal the necessity of cystostomy and its effect on treatment success. MATERIAL AND METHODS: Between 1985 and 2018, a retrospective evaluation was performed on the records of 102 patients who underwent surgical treatment for VVF repair. All cases underwent a detailed physical examination and had their routine laboratory tests and imaging methods. In obese patients, a Foley catheter was moved into the bladder through the fistula tract, then inflated in order to push the vagina and bladder wall upwards. A transurethral catheter was used in all cases, and cystostomy was used in 58 (56.9%). RESULTS: The most common cause was prior hysterectomy for benign diseases in 35 (34.31%) cases. Among a total of 102 cases with for VVF, 95 (93.1%) were primary, 5 (4.9%) secondary, and 2 (1.9%) tertiary. The transvesical and O'Connor approaches (transabdominal) were performed in 61 (59.8%) and 41 (40.2%) cases, respectively. Transvaginal approach was not used in any of the cases. Cystostomy was applied in 58 (56.9%) of cases and not applied in 44 (43.1%). CONCLUSION: Complete excision of the fistula tract and sealing of the layers separately using the water-tight technique are extremely crucial factors to increase the success rate of VVF repair. In cases where good transurethral drainage is ensured, cystostomy is unnecessary and may increase the risk of infection.

Erector spinae plane block vs non-steroidal anti-inflammatory drugs for severe renal colic pain: A pilot clinical feasibility study.

AIM: Ultrasound-guided plane blocks are increasingly used in the multi-modal analgesic concept for reducing opioid consumption. The present study was conducted to compare the analgesic effect of intravenous non-steroidal anti-inflammatory drugs (NSAIDs) and erector spinae plane (ESP) block in renal colic patients. METHODS: In this prospective randomised study, 40 patients with renal colic pain were randomly assigned into two groups: Group NSAID (n = 20) received an intravenous infusion of 50 mg of dexketoprofen trometamol and Group ESP (n = 20) received ultrasound-guided ESP block with 30 ml 0.25% bupivacaine at the T8 level. The pain severity of patients was assessed using the visual analogue scale (VAS) at baseline, 5, 15, 30, 45 and 60 minutes after intervention. Opioid consumption, patient satisfaction and side effects were recorded. RESULTS: In the ESP group, the VAS scores were significantly lower than the NSAID group at 5, 15, 30, 45 and 60 minutes after the procedure (P < .001). Opioid consumption was significantly higher in the NSAID group compared with the ESP group (10/20 vs 0/20, respectively; P < .001). Patient satisfaction was significantly higher in the ESP group (P < .001). CONCLUSIONS: ESP block can be an alternative, efficient and safe method for the relief of acute renal colic pain.

Ultra-mini flexible percutaneous nephrolithotomy in the treatment of moderate-size kidney stones: a new instrument, a preliminary prospective study.

Ultra-mini PNL is increasingly preferred in the treatment of kidney stones. Unlike routine applications of the ultra-mini PNL technique, we aimed to perform kidney stones treatment with an epiduroscopic device that can pass through 11-13-Fr ureteral access sheaths with a flexible structure and which is routine in neurosurgical practice. The study was planned prospectively. The study included 52 patients with mid-sized kidney stones who had presented to our clinic between July 2017 and January 2019. The ultra-mini percutaneous nephrolithotomy was carried out with epiduroscopy routinely used in neurosurgery practice, which can pass through 11-13-Fr ureteral access and has a flexible structure. The perioperative and postoperative parameters were analyzed. The mean operation time was 45.6 ± 4.8 min and entry was provided through a single entry (from the calyx appropriate to the lower pole) in all patients; a second entry tract was not required. No DJ catheter or nephrostomy tube was installed in any patient and the procedures were completed totally without a tube. The mean reduction in hemoglobin values was determined as 0.33 (0.1-1.1) g/dL. None of the patients needed transfusion and no patient developed acute kidney injury. Clinically significant (≥ 3 mm) residual stone was observed in 2 (4%) of the 52 patients, while clinically insignificant (≤ 3 mm) stones were observed in 50 patients (96%). The mean length of hospital stay was 2.5 ± 0.9 days. Ultra-mini flexible percutaneous nephrolithotomy is an effective and safe method in the treatment of medium-sized kidney stones.

The incidence of epididymal anomalies in the bilateral and unilateral cryptorchidism cases: A comparative study.

OBJECTIVE: Our study was planned based on the hypothesis that epididymal anomalies may be more incidental and more severe in cases with bilateral undescended testicles compared to unilateral undescended cases. We also aimed to review the classifications of epididymal anomalies in the literature and to establish a simpler and clinically applicable classification in the present study. MATERIALS AND METHODS: In this study, we retrospectively reviewed 197 pediatric patients who had been operated for undescended testis between January 2014 and January 2018. In the collective analysis of bilateral undescended testes cases, if the present anomaly were present in any testis, the anomaly was considered to be present for these cases and subjected to statistical analysis. RESULTS: The study included a total of 241 testicles of 197 patients. The incidence of epididymal anomalies was found to be significantly higher in cases with bilateral undescended testicles compared to unilateral cases (68.2%, 43.1%, respectively; p = 0.003). It was observed that the incidence of epididymal anomaly and the severity of the anomaly statistically significantly decreased as the localization of the undescended testicle changed between the intraabdominal position and the external inguinal ring (p = 0.0001). DISCUSSION: The effects of the undescended testicles on fertilization have been subject to evaluation in a limited number of studies and it has been reported that the rate of fertility is lower in patients with bilateral undescended testicles, whereas the fertility rate is close to that of healthy males in patients with unilateral undescended testicles. The incidence of epididymal anomalies was found to be higher in cases with bilateral undescended testicle, as shown in our study. However, based on these data, it is not possible to make a comment about whether this condition leads to infertility or not. Furthermore, accurate documentation of epididymal anomalies and standardization of the classifications of epididymal anomalies may be guiding in the prevention of complications for the surgeons in the treatment of patients who will undergo orchiopexy. CONCLUSIONS: We concluded that the incidence of epididymal anomalies was significantly higher in cases with bilateral undescended testicles compared to unilateral cases. In our study, based on a comprehensive high-quality surgical image archive, we believe that the differentiation of epididymal anomalies according to the classification we have proposed will make it possible to create a database that is easier to use clinically in a more objective way.

Acute effect of microdissection testicular sperm extraction on blood total testosterone and luteinising hormone levels.

Testicular sperm extraction is a common surgical procedure to retrieve spermatozoa from men with azoospermia which may affect the tissue and cause hypogonadism (Human Reproduction Update, 24, 2018, 442). We aimed to evaluate the acute effect of micro-TESE on blood total testosterone (TT) and luteinising hormone (LH) levels. Between April 2018 and September 2019, 60 selected NOA (i.e. with normal TT and LH) patients were included in the study. After procedure, blood samples were collected to evaluate the levels of TT and LH at 1st and 24th hour and first week. Values were compared. In addition, patients were divided into two groups according to their body mass index. Mean age of patients was 27.37 ± 4.52 years, and mean of body mass index was 24.49 ± 3.78 kg/m2 . Mean TT levels at the 1st hour, 24th hour and the 1st week were 3.81, 3.50 and 3.05 ng/ml respectively. Mean LH levels at the 1st hour, 24th hour and the 1st week were 5.03, 5.15 and 5.46 IU/L respectively. Statistically significant differences between pre- and post-operative 24th hour and 1st week values were detected (p = .001, p < .001 respectively). No statistical differences were found between two BMI's groups. TT decreased in acute period after the procedure, whereas the increase of LH levels was observed after 24th hour.

Effect of Reconstructive Techniques on Continence in Robot-Assisted Laparoscopic Prostatectomy: Novel Combination of Long Urethral Stump and Anterior Suspension Suture.

OBJECTIVE: To investigate the effects of the novel combination of a long urethral stump and anterior suspension suture in patients who underwent Robot-Assisted Laparoscopic Prostatectomy (RALP) for localized prostate cancer. MATERIALS AND METHODS: Of the 40 participating patients, 20 did not undergo any reconstructive technique, whereas the remaining 20 patients underwent reconstructive technique that included the combination of long urethral stump and anterior suspension suture. Body mass index (BMI) (kg/m2), age, preoperative prostate-specific antigen (PSA) levels, prostate volume, Gleason score, D'Amico risk class, clinical stage, operation type and the application of either perioperative or postoperative reconstructive techniques, and the duration of catheterization were the parameters investigated. Continence rate was measured in the 3rd, 6th, and 12th month after the removal of the catheter. Both techniques were compared statistically. RESULTS: The control and reconstructive groups each comprised 20 patients. Between the groups, no statistically significant differences were observed in age, BMI, American Society of Anesthesiologists class, risk group, prostate weight, perioperative PSA, duration of surgery, duration of hospitalization, surgical margins, and the total amount of bleeding (p>0.05). Continence rate was significantly higher in the reconstructive group in the 3rd and 6th months compared with the control group (p<0.05). CONCLUSION: The combination of anterior suspension suture and long urethral stump contributed to early improvement in the continence rates.

Expression of androgen receptor and estrogen receptor-beta in foreskin tissue of hypospadiac and healthy boys. / Expresión de receptores androgénicos y estrogénicos beta en la piel prepucial de hipospadias y niños sanos.

OBJECTIVES: This prospective study aimed to investigate the expression of the androgen receptor(AR) and the estrogen receptor-ß (ER-ß) in foreskint issues in boys with and without distal hypospadias. METHODS: Thirty boys with distal hypospadias were evaluated. Fifteen boys who under went elective circumcision over a period of 18 months served as the control group. The presence of AR and ER-ß in foresk in tissues was investigated immunohistochemically. RESULTS: The percentages of AR in epithelial cells were18.9 ± 27.3% in the hypospadias group and 3.3 ±5.3% in the circumcision group, and the difference betweent he groups was significant (p=0.034). Of the stromal cells, 19.5 ± 26.8% in the hypospadias group and2.6 ± 4.4% in the circumcision group were positive lystained for AR (p=0.004). In the hypospadias group,significantly higher stromal cell percentage of ER-ß was found compared to that in the control group (24± 24.5% and 1.3 ± 1.1%, respectively, p<0.001). Moreover, epithelial cell percentage of ER-ß was higher in the hypospadias group than that in the control group,and the respective values were 6.8 ± 10.1% and 0.9± 1.3% (p<0.0001)CONCLUSION: The percent of AR and ER-ß expression were higher in hypospadias-affected foresk in than in the normal foreskin. Whether the normal function of these receptors reveals, there is a need for more detailed studies.

OBJETIVO: Este estudio prospectivo que pretende investigar la expresión del receptor androgénicoy estrogénico en la piel prepucial en niños con y sin hipospadias distal.MÉTODOS: Treinta niños con hipospadias distal fueron evaluados. 15 niños recibieron una circuncisión electiva en un periodo de 18 meses y sirvieron de grupo control.La presencia de RA y RE-ß en la piel prepucial se investigo por immunohistoquimica. RESULTADOS: El porcentaje de expresión del receptor androgenico en células epiteliales fue de 18,9+/-27,3% en el grupo hipospadias y 3,3+/- 5,3% en el grupo de circuncisión. La diferencia entre ambos grupos fue significativo (p=0,034). En las células estromales,19,5+/- 26,8% en el grupo hipospadias y 2,6+/-4,4% en el grupo circuncisión fueron positivos para el RA (p=0,004). En el grupo de hipospadias, un porcentaje mas elevdo de expresión de RE-b ß se evidencio en comparación al grupo control (24+/-24,5%y 1,3+/-1,1, respectivamente, pel porcentaje de células epiteliales con RE-ß fue superior en el grupo hipospadias que en el grupo control; los valores respectivos fueron 6,8+/-10,1% y 0,9+/-1,3%(p<0,0001).CONCLUSIÓN: En este estudio se sugiere que la expresiónde RA y RE fueron superiores en el grupo conhipospadias que en piel prepucial normal. Se requierenmas estudios para determinar el significado de esta expresión.

Expression of androgen receptor and estrogen receptor-beta in foreskin tissue of hypospadiac and healthy boys / Expresión de receptores androgénicos y estrogénicos beta en la piel prepucial de hipospadias y niños sanos

OBJECTIVES: This prospective study aimed to investigate the expression of the androgen receptor(AR) and the estrogen receptor-β (ER-β) in foreskint issues in boys with and without distal hypospadias. METHODS: Thirty boys with distal hypospadias were evaluated. Fifteen boys who under went elective circumcision over a period of 18 months served as the control group. The presence of AR and ER-Beta in foresk in tissues was investigated immunohistochemically. RESULTS: The percentages of AR in epithelial cells were18.9 ± 27.3% in the hypospadias group and 3.3 ±5.3% in the circumcision group, and the difference betweent he groups was significant (p = 0.034). Of the stromal cells, 19.5 ± 26.8% in the hypospadias group and2.6 ± 4.4% in the circumcision group were positive lystained for AR (p = 0.004). In the hypospadias group,significantly higher stromal cell percentage of ER-β was found compared to that in the control group (24 ± 24.5% and 1.3 ± 1.1%, respectively, p < 0.001). Moreover, epithelial cell percentage of ER-β was higher in the hypospadias group than that in the control group,and the respective values were 6.8 ± 10.1% and 0.9 ± 1.3% (p < 0.0001). CONCLUSION: The percent of AR and ER-Beta expression were higher in hypospadias-affected foresk in than in the normal foreskin. Whether the normal function of these receptors reveals, there is a need for more detailed studies

OBJETIVO: Este estudio prospectivo que pretende investigar la expresión del receptor androgénicoy estrogénico en la piel prepucial en niños con y sin hipospadias distal. MÉTODOS: Treinta niños con hipospadias distal fueron evaluados. 15 niños recibieron una circuncisión electiva en un periodo de 18 meses y sirvieron de grupo control.La presencia de RA y RE-Beta en la piel prepucial se investigó por immunohistoquimica. RESULTADOS: El porcentaje de expresión del receptor androgenico en células epiteliales fue de 18,9 +/- 27,3% en el grupo hipospadias y 3,3 +/- 5,3% en el grupo de circuncisión. La diferencia entre ambos grupos fue significativo (p = 0,034). En las células estromales,19,5 +/- 26,8% en el grupo hipospadias y 2,6+/-4,4% en el grupo circuncisión fueron positivos para el RA (p = 0,004). En el grupo de hipospadias, un porcentaje más elevdo de expresión de RE-b β se evidencio en comparación al grupo control (24 +/- 24,5%y 1,3 +/- 1,1, respectivamente, pel porcentaje de células epiteliales con RE-Beta fue superior en el grupo hipospadias que en el grupo control; los valores respectivos fueron 6,8 +/- 10,1% y 0,9 +/- 1,3%(p < 0,0001). CONCLUSIÓN: En este estudio se sugiere que la expresiónde RA y RE fueron superiores en el grupo conhipospadias que en piel prepucial normal. Se requierenmas estudios para determinar el significado de esta expresión

A new method in robotic-assisted laparoscopic radical prostatectomy: personalised neuroprotective surgery with neuromonitoring system-randomised controlled study.

PURPOSE: Erectile dysfunction is one of the important morbidities following the radical prostatectomy (RP) surgeries. The goal of this research is to investigate the contribution of intraoperative neuromonitorisation method (IONM) on postoperative erectile function in patients who underwent robotic-assisted laparoscopic radical prostatectomy (RALP) with the localise prostate cancer (LPCa). MATERIALS AND METHODS: In this randomised controlled study contains 88 patients with LPCa were classified based on D'Amico Risk Classification. 61 patients who met the necessary criteria were divided into two groups as neuromonitorisation group (n = 30) and control group (n = 31). All patients were operated under general anaesthesia. All patients included in the study underwent RALP by robotic-assisted system. For the neuromonitorisation, IONM electromyography electrodes were placed to the right and left cavernous bodies in neuromonitorisation group. Impulses in the corpora cavernosa were considered significant. Postoperative erectile functions were determined according to the 3th and 6th month IIEF-5 scores. Demographic data, operative procedures, Gleason scores, final pathology, surgery border, PSA, and IIEF-5 score of patients were recorded. RESULTS: No statistically difference was found between the groups in terms of demographic data, operative procedures, Gleason scores, final pathology, surgery border, and third-month PSA levels (p > 0.05). There was statistically difference between the postoperative third and 6-month IIEF-5 score in neuromonitorisation group (p < 0.05). CONCLUSION: In the IONM technique, high rate of improvement in erectile function was observed in the early period thanks to personalised neuroprotective surgery applied to patients.

Jaboulay's technique contrasted with a novel hydrocelectomy technique using a vessel sealer in the treatment of adult hydrocele: a prospective randomized study.

PURPOSE: The study aims to compare the clinical efficacy, complications, and patient satisfaction rates of two open hydrocelectomy techniques, Jaboulay's technique, and sac excision hydrocelectomy using a LigaSure™ device, in a prospective and randomized fashion. METHODS: Eighty-two (82) patients were randomized, one-to-one into two groups. All surgeries were carried out by a single surgeon. Jaboulay's technique and hydrocelectomy with excision of the sac were carried out in the first and the second groups, respectively. The patients' data were collected prospectively on the first day, the first week, the first month, and the sixth month after surgery. Patient demographics, length of hospital stay, postoperative complications, and sixth-month cosmetic satisfaction rates were compared between the groups. RESULTS: We observed better patient satisfaction [73.2% confer (cf.) 92.9%], shorter hospital stay (1.66 cf. 1.29 days), and less incidence of postoperative edemas (31.7% cf. 6%) in the sac excision hydrocelectomy group (p = 0.017, p = 0.011, and p = 0.029, respectively). CONCLUSION: We can report that hydrocelectomy with an excision of the sac using a vessel-sealing device, namely LigaSure™, provides less incidences of postoperative edemas and better patient satisfaction rates respective to the Jaboulay's technique in the treatment of adult hydrocele. The statistical difference between hospital stay times is mostly affected by social factors in our study. Clinically, all patients were amenable to discharge in the first day.

Silodosin Has Nocebo Effect on Sexual Adverse Effects: A Randomized Controlled Trial.

OBJECTIVE: Nocebo effect is known in patients refered to side effects of drugs that cause more side effects than expected. Side effects on sexual function have been reported in about 60% of patients using silodosin. To investigate whether there was nocebo effect of silodosin in the side effects on sexual function. MATERIALS AND METHODS: Between May 2014 and March 2017, 129 moderate-to-severe LUTS patients were included in the study. For the patients, PSA (ng/mL), prostate volume (cc), uroflowmetry test IIEF-15 and IPSS questionnaires were filled at the time of before and after treatment. Patients were divided into two groups, referred to as side effects that was mentioned and not mentioned. After 3 months control, all patients were asked whether they had sexual side effects. It was analyzed whether there was significantly differences between two groups. RESULTS: The groups were compared in terms of the frequency of androgenic side effects, low semen volume was 40.9% in Group 1 and 22.2% in Group 2 (p=0.04). Anejaculation rates were 6% and 4%, respectively (p=0.12); loss of libido and erectile dysfunction were observed in one patient in both groups (p=0.42). There was no statistically significant difference between the groups for anejaculation, decreased libido and erectile dysfunction. 9 patients (7%) who left medication due to side effects were excluded from the study. CONCLUSION: In patients, mentioned about the sexual side effects, low semen volume was seen more frequantly, but anejaculation, decreased libido and erectile dysfunction were same. Therefore, be informed about the side effects before treatment is a matter of debate.

A comparison between the efficacy and safety of microscopic inguinal and subinguinal varicocelectomy.

OBJECTIVE: To compare microscopic inguinal (MIV) and subinguinal varicocelectomy (MSV) surgeries with respect to efficacy and safety. MATERIAL AND METHODS: Patients who underwent varicocelectomy between January 2002 and January 2018 were evaluated retrospectively and prospectively. The patients who underwent varicocelectomy until December 2015 were analyzed retrospectively and the cases after January 2016 were analyzed prospectively. In our study, the married infertile male cases were compared on the basis of operation duration, number of ligated veins, number of preserved veins, postoperative pain score (visual analogue scale: VAS), patient satisfaction, surgeon satisfaction, changes in sperm parameters, testicular consistency, pregnancy rates, and complications, such as hydrocele, testicular atrophy, and recurrence of varicocele. Surgical success rates were compared by semen analysis between unmarried infertile male cases because pregnancy rates cannot be tested. The patients were recalled for control examinations every 3 months for 1 year and tested the above-mentioned parameters. Statistical Package for the Social Sciences Version 20 Windows Software was used for data analysis and comparison between the two groups. RESULTS: The study included a total of 136 adult patients. Mean age of the patients was 28.14 (20-41) years. MSV and MIV were performed in 62 (45.6%) and 74 (54.4%) patients, respectively. No statistically significant difference was detected between the two groups in terms of admission duration, semen parameters within the 1-year follow-up process, hormonal changes, and complication rates. Operation duration was significantly longer in the MSV group. It was determined that a fewer number of veins were ligated, and a fewer number of veins needed to be ligated in the MIV group. The analysis of all the patients revealed that pain scores at 4 and 24 hours postoperatively were significantly statistically lower in the MSV group. CONCLUSION: MIV and MSV are distinct, efficient, and safe surgical techniques with specific advantages and disadvantages. Their efficacy and safety rates are similar.

The effect of using ureteral access sheath for treatment of impacted ureteral stones at mid-upper part with flexible ureterorenoscopy: a randomized prospective study.

BACKGROUND: The number of the studies made on the efficacy of flexible ureteroscopy (FURS) with ureteral access sheath (UAS) for impacted ureteral stones is limited. The aim of our study was to compare the efficacy and reliability of FURS in treatment of mid-upper impacted ureteral stones in cases where access is used or not. METHODS: Between January 2017 and June 2018, 131 adult patients who applied to our clinic with complaints of mid-upper impacted ureteral stones. Patients were randomized as group 1 (without UAS) and group 2 (with UAS) by means of a draw and assessed in terms of demographic features, stone size, stone localization, hydronephrosis grade, operation time, scope time, the need for additional surgery, hospitalization time and complications. RESULTS: The mean age of the patients in group 1 was 45.01 years (19-76) and was 37.01 years (16-80) in group 2. Mean stone size was 9.04 mm2 and 9.77 mm2 in group 1 and 2, respectively. Additional treatment was required for 26 (42.6%) patients in group 1 and 8 (11.4%) in group 2. No major intraoperative and postoperative complications developed in both groups. Although bleeding as a postoperative complication rate was similar, fever (>38° C) and urinary tract infection were higher in group 1 than in group 2. CONCLUSIONS: In the treatment of mid-upper impacted ureteral stones, using UAS during the application of FURS is an advantageous procedure due to shorter operation time, fever intraoperative stone migrations and the need for additional surgery, less postoperative infection.

Relief of refractory renal colic in emergency department: A novel indication for ultrasound guided erector spinae plane block.

Plane blocks have become very popular in recent years with the introduction of ultrasonography into the regional anesthesia and algology practice. Erector spinae plane (ESP) block involves injection of local anesthetics between erector spinae muscles and transverse process of vertebrae and can block the dorsal and ventral rami of thoracolumbar spinal nerves. The primary factor in the great popularity of this block is easy sonographic identification of landmarks and lower complication rate compared to paravertebral or central neuroaxial blocks. These characteristics mean that it will in all probability be widely used in the future, not just for anesthetists, but also for emergency physicians. Here we first report a novel indication for ESP block in emergency department; renal colic.