Feasibility of Transvesical Prostate Resection and Its Effect on Postoperative Complications.

OBJECTIVE: To study the feasibility of transvesical prostate resection and its effect on urethral stricture. MATERIALS AND METHODS: We included 99 patients with symptomatic bladder outlet obstruction who underwent transvesical resection of prostate (TVRP; n = 48) and transurethral (TURP; n = 51) prostatectomy. We examined all the patients by means of digital rectal examination, transrectal ultrasound, and evaluated them by international prostate symptom score, quality of life score, uroflowmetric assessment and PSA level, and established definitive diagnosis. We followed up the patients in first month, third month, and the first year of the operation and monitored once a year in the following years. RESULTS: In this study, totally 99 symptomatic bladder outlet obstruction patients were included (TVRP = 48 and TURP = 51). Mean age of the patients were 66.5 ± 8.2vs 68 ± 9.8years for our patients with TVRP and TURP, respectively. Two groups displayed similar values in terms of improvements in the Qmax and PVR, and there were no statistically significant differences in between. We obtained similar values for resection time and weight of resected prostate tissue in both groups. Urethral stricture was not observed in TVRP group. In TURP group however, stricture was observed in 4 (7.8%) patients in bulbar urethra in sixth month at average. And there was also a concomitant urethral meatal stricture in one of these patients. When the 2 groups were compared, the rate of urethral stricture was statistically significantly higher in the TURP group (P = .001). CONCLUSION: Resection of prostate without using urethra significantly reduces the incidence of urethral stricture due to mucosal damage.

A new surgical technique: transvesical resection of prostate - case series

ABSTRACT Objective: To protect the urethra from instrumentation related urethra injures and stricture, we developed a new surgical technique which can be defined as transvesical resection of prostate without using urethra. Materials and Methods: Our study included 12 consecutive bladder outlet obstruction patients treated with transvesical prostate resection in our clinic between March 2016 and May 2016. Detailed anamnesis, results of physical examination, digital rectal examination, routine lab tests, international prostate symptoms score, transrectal ultrasound, measurement of prostate-specific antigen levels and uroflowmetry was performed in all patients prior to surgery. Results: Hospitalization period following surgery was 1 day. Foley catheter and suprapubic cystostomy catheters were removed in a median period of 3.6 days and 1 day. Median mass of resected adenomas was measured as 21.8 gr. Median maximum flow rate was measured as 6mL/s. Median postvoid residual urine volume was 70.6 cc and median international prostate symptoms score and quality of life scores were 9 and 1.4, respectively. Conclusion: In this study, we would like to show the possible practicality of transvesical resection of prostate technique in this patient group. However, we think that this technique is very useful in special patient groups such as patients with bladder stones, priapism and penile prosthesis.

The factors that affect the prediction of lymph node metastasis in prostate cancer.

OBJECTIVE: We aimed to demonstrate the effects of clinical evaluations as well as biopsy characteristics in terms of lymph node involvement (LNI) despite the small number of patients in our study. MATERIALS AND METHODS: A total of 221 patients who underwent radical prostatectomy (RP) and extended pelvic lymph node dissection (ePLND) in our clinic between 2010 and 2015 and who met the inclusion criteria were enrolled in our study group. All of the patients were evaluated in terms of age, prostate-specific antigen (PSA) value before transrectal ultrasound-guided prostate biopsy (TRUSPB), digital rectal examination, Gleason score (GS) on TRUSPB, percentage of positive cores on TRUSPB, total number of positive cores, highest percentage of cancer in positive cores, and number of lymph nodes removed at RP. Pathological examination of the data of RP specimens, PSA values in follow-up after surgery, and follow-up periods was recorded. The TNM 2009 classification was used for staging. RESULTS: In the evaluation of LNI risk, as regards the assessment of predictors and outcomes with respect to the univariate and multivariate analyses, LNI was found in the univariate analysis to be associated with GS, clinical stage, number of lymph nodes removed according to the D'Amico risk classification. In the multivariate analysis, however, the number of lymph nodes removed was found significant. CONCLUSION: Risk stratification should be considered in patients with prostate cancer while selecting the patients who would undergo pelvic lymphadenectomy. In addition, ePLND should be performed to patients undergoing lymphadenectomy.

A new surgical technique: transvesical resection of prostate - case series.

OBJECTIVE: To protect the urethra from instrumentation related urethra injures and stricture, we developed a new surgical technique which can be defined as transvesical resection of prostate without using urethra. MATERIALS AND METHODS: Our study included 12 consecutive bladder outlet obstruction patients treated with transvesical prostate resection in our clinic between March 2016 and May 2016. Detailed anamnesis, results of physical examination, digital rectal examination, routine lab tests, international prostate symptoms score, transrectal ultrasound, measurement of prostate-specific antigen levels and uroflowmetry was performed in all patients prior to surgery. RESULTS: Hospitalization period following surgery was 1 day. Foley catheter and suprapubic cystostomy catheters were removed in a median period of 3.6 days and 1 day. Median mass of resected adenomas was measured as 21.8 gr. Median maximum flow rate was measured as 6mL/s. Median postvoid residual urine volume was 70.6 cc and median international prostate symptoms score and quality of life scores were 9 and 1.4, respectively. CONCLUSION: In this study, we would like to show the possible practicality of transvesical resection of prostate technique in this patient group. However, we think that this technique is very useful in special patient groups such as patients with bladder stones, priapism and penile prosthesis.

Does preoperative neutrophil/lymphocyte rate have an effect on survival of the bladder cancer patients who received radical cystectomy?

INTRODUCTION: Radical cystectomy (RC) is the standard treatment model in invasive bladder cancer patients. Risk definitions before RC is mainly based on pathological results. Neutrophil/lymphocyte (N/L) rate is one of the inflammation markers. Some other studies reported negative prognostic results with increased N/L rates. In our study, we reviewed the relationship between preoperative N/L rate and clinicopathological results following RC. MATERIALS AND METHODS: Data gathered from 296 bladder cancer patients that received RC between 2002 and 2012 were retrospectively reviewed. All patients received preoperative routine hematological and biochemical tests and metastasis screening. All patients were treated with radical cystoprostatectomy and standard pelvic lymph node dissection. The cutoff value for N/L rate was calculated using a web-based "cutoff finder" software. RESULTS: Patient mean age was calculated as 65.7 years. Mean follow-up period was 24.5 (2-84) months. Cancer-related death was seen in 132 (44.6%) patients. Multivariate analysis showed age, lymph node metastasis, and low N/L rate as significant in cancer-specific survival. CONCLUSION: In our study, age, lymph node metastasis presence, and preoperative low N/L rates were detected as independent risk factors in RC cases. N/L rate, which is relatively easy to assess during preoperative period, could be beneficial in planning postoperative adjuvant treatments in those patients.

Does a previous prostate biopsy-related acute bacterial prostatitis affect the results of radical prostatectomy?

ABSTRACT Objective To The standard technique for obtaining a histologic diagnosis of prostatic carcinomas is transrectal ultrasound guided prostate biopsy. Acute prostatitis which might develop after prostate biopsy can cause periprostatic inflammation and fibrosis. In this study, we performed a retrospective review of our database to determine whether ABP history might affect the outcome of RP. Materials and Methods 441 RP patients who were operated in our clinic from 2002 to 2014 were included in our study group. All patients' demographic values, PSA levels, biopsy and radical prostatectomy specimen pathology results and their perioperative/ postoperative complications were evaluated. Results There were 41 patients in patients with acute prostatitis following biopsy and 397 patients that did not develop acute prostatitis. Mean blood loss, transfusion rate and operation period were found to be significantly higher in ABP patients. Hospitalization period and reoperation rates were similar in both groups. However, post-op complications were significantly higher in ABP group. Conclusion Even though it does not affect oncological outcomes, we would like to warn the surgeons for potential complaints during surgery in ABP patients.

Does a previous prostate biopsy-related acute bacterial prostatitis affect the results of radical prostatectomy?

OBJECTIVE: To The standard technique for obtaining a histologic diagnosis of prostatic carcinomas is transrectal ultrasound guided prostate biopsy. Acute prostatitis which might develop after prostate biopsy can cause periprostatic inflammation and fibrosis. In this study, we performed a retrospective review of our database to determine whether ABP history might affect the outcome of RP. MATERIALS AND METHODS: 441 RP patients who were operated in our clinic from 2002 to 2014 were included in our study group. All patients' demographic values, PSA levels, biopsy and radical prostatectomy specimen pathology results and their perioperative/postoperative complications were evaluated. RESULTS: There were 41 patients in patients with acute prostatitis following biopsy and 397 patients that did not develop acute prostatitis. Mean blood loss, transfusion rate and operation period were found to be significantly higher in ABP patients. Hospitalization period and reoperation rates were similar in both groups. However, post-op complications were significantly higher in ABP group. CONCLUSION: Even though it does not affect oncological outcomes, we would like to warn the surgeons for potential complaints during surgery in ABP patients.

Effect of delayed radical cystectomy for invasive bladder tumors on lymph node positivity, cancer-specific survival and total survival.

INTRODUCTION: Radical cystectomy (RC) is the main treatment option for patients with muscle-invasive bladder cancer (MIBC) and non-muscle-invasive bladder cancer (NMIBC), which carry the highest risk of progression. In this study, we investigated the effect of time from transurethral resection of the bladder (TUR-B) to cystectomy on lymph node positivity, cancer-specific survival and overall survival in patients with MIBC. METHODS: The records were reviewed of 530 consecutive patients who had RC and pelvic lymphadenectomy procedures with curative intent performed by selected surgeons between May 2005 and April 2016. Our analysis included only patients with transitional cell carcinoma of the bladder; we excluded 23 patients with other types of tumor histology. RESULTS: Patients who underwent delayed RC were compared with patients who were treated with early RC; both groups were similar in terms of age, gender, T stage, tumor grade, tumor differentiation, lymph node status and metastasis status. However, when both groups were compared for disease-free survival and overall survival, patients of the early-RC group had a greater advantage. CONCLUSIONS: The optimal time between the last TUR-B and RC is still controversial. A reasonable time for preoperative preparation can be allowed, but long delays, especially those exceeding 3 months, can lead to unfavorable outcomes in cancer control.

Effects of previous unsuccessful extracorporeal shockwave lithotripsy treatment on the performance and outcome of percutaneous nephrolithotomy.

OBJECTIVE: To evaluate the effects of previous unsuccessful extracorporeal shockwave lithotripsy (ESWL) treatment on the performance and outcome of percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS: Of 1625 PCNL procedures performed in our clinic, 393 renal units with similar stone burden and number of accesses was included in the present study. We categorised the study patients into two groups according to whether they underwent ESWL within 1 year prior to PCNL or not. Accordingly, Group 1 comprised 143 (36.3%) ESWL-treated patients and Group 2 comprised 250 (63.7%) non-ESWL-treated patients. RESULTS: Residual stones were detected in 36 (25.1%) of the ESWL-treated patients (Group 1) and in 60 (24%) of non-ESWL-treated patients (Group 2). There were no statistically significant differences between the groups for length of hospital stay (LOS), nephrostomy tube removal time, and the presence of residual stones. When we evaluated the groups for both the preoperative and postoperative haemoglobin (Hb) drop and blood transfusion rate, manifest Hb declines and more transfusions were required in the ESWL-treated patients (both P = 0.01). CONCLUSIONS: In our study, previous ESWL treatment had no influence on the PCNL stone-free rate, operation time, incidence of postoperative complications, and LOS, in patients with similar stone burdens. However, bleeding during PCNL was more prevalent in the ESWL-treated patients, so close attention should be paid to bleeding in patients who have been pretreated with ESWL.

Is Prostate Biopsy Recommended in Turkish Men with a Prostate-Specific Antigen Level between 2.5 and 4 ng/mL?

BACKGROUND: Prostate cancer is the most common solid tumor. The incidence of prostate cancer shows regional and racial differences. The ideal PSA threshold for prostate biopsy is still being debated. OBJECTIVE: We aimed to investigate cancer detection rates in Turkish men who underwent transrectal ultrasound-guided prostate biopsy (TRUSPB) who had prostate-specific antigen (PSA) levels in the range of 2.5 to 4.0 ng/mL and compare them with the rates of cancer in patients with PSA levels in the range of 4.0 to 10.0 ng/mL. METHODS: All Turkish men who underwent TRUSPB in our clinic between January 2012 and May 2014 were included; that is, 101 patients (Group 1) with PSA level in the range of 2.5 to 4.0 ng/mL and 522 patients (Group 2) with PSA level in the range of 4.0 to 10.0 ng/mL. Mean PSA level, age, prostate volume, and cancer detection rates were evaluated. RESULTS: The mean age was 60.5 and 64 years in Group 1 and Group 2, respectively (P = 0.06). The mean PSA level was determined as 3.1 and 6.8 ng/mL in Group 1 and Group 2, respectively (P = 0.03). The cancer detection rate was 12.7% in Group 1 (n = 13) and 30.8% in Group 2 (n = 161), which revealed a statistically significant difference between the 2 groups (P = 0.001). In Group 1, 9 of 13 patients (69%) had Gleason score of 6, 3 (23%) had Gleason score of 7, and 1 (8%) had a Gleason score of 8. CONCLUSIONS: The cancer detection rate is lower in Turkish men with PSA level in the range of 2.5 to 4.0 ng/mL when compared with men with PSA level in the range of 4.0 to 10.0 ng/mL. Furthermore, most patients in whom cancer was detected who have a PSA level in the range of 2.5 to 4.0 ng/mL are low risk. Therefore, the benefit of TRUSBP in Turkish men with PSA level between 2.5 and 4 ng/mL is low.

Correlation between lower urinary tract symptoms and objective measures of uroflowmetry.

Indroduction: Benign prostate hyperplasia (BPH) is the most commonly diagnosed benign adenoma which causes serious clinical symptoms by bladder outlet obstruction. BPH patients suffer from negative changes in their quality of life and restriction of their daily activities due to the disease symptoms. Our main objective in this study is to evaluate the relationship between BPH and LUTS as described by International Prostate Symptoms Score and objective non-invasive parameters related to BPH. MATERIALS AND METHODS: 238 Patients over 40 years with clinical BPH, LUTS and/or prostate volumes greater than 25 ml who presented to urology department were included in the study. All patients included in the study were subjected to a standardized diagnostic panel which included patient history, physical examination, biochemistry panels and urinalysis. RESULTS: Results showed an increase in symptom scores with age. As symptom scores go from mild to severe; Qmax values showed a decrease meanwhile prostate volume, PSA and postvoid residue increased. Again, in terms of erectile dysfunction, erectile dysfunction complaints increased with increased IIEF symptom scores. When all these results were evaluated, a positive correlation was seen between uroflowmetry parameters with patient symptoms, PSA and IIEF scores. CONCLUSION: From our study results, we can conclude that uroflowmetry is a very useful tool in monitoring lower urinary system complaints.

Predictive factors for stone disease in patients with renal colic.

INTRODUCTION: Many patients present to urology and emergency departments for acute renal colic complaints. There are many different imaging studies that can be used in patients with a pre-diagnosis of acute renal colic. In this study, we would like to assess the efficacy of using clinical and laboratory results in patients with flank pain complaint as a predictive factor of urinary system stone disease. MATERIALS AND METHODS: All patients were assessed using spinal non-contrast complete abdominal computerized tomography and urine analysis. Presence of stones and their number and size were recorded. RESULTS: 516 patients who were included in the study were divided into 2 groups according to urinary stone presence. Group 1 (n = 388) consisted of patients with stones meanwhile patients in Group 2 (n = 128) were stone-free. According to these results, male sex, presence of microscopic hematuria, stone history in the family, nausea and emesis in addition to pain and accompanying urinary symptoms were detected as predictive factors in diagnosing urinary stone disease by multivariate analysis. CONCLUSION: From our study results, we can conclude that uroflowmetry is a very useful tool in monitoring lower urinary system complaints.

Is a second look necessary in multiple and/or large Ta tumors?

INTRODUCTION: Most of the bladder cancers are tumors without muscle invasion at the time of diagnosis. Transurethral resection is the standard treatment in bladder tumors without muscle invasion. Proper review of transurethral resection is important for correct risk classification. In this study, our main objective was to show that a "second look" in patients with multiple and/or > 3 cm tumors regardless of T stage during the early term can be helpful in detection of possible residues and determining risk classification. MATERIALS AND METHODS: 156 patients with primary, multiple and/or > 3 cm tumors were included in the study. Patients were divided into 3 groups as Group 1 (Ta), Group 2 (T1 without second TUR) and Group 3 (T1 with second TUR). Macroscopic tumor occurrence rates were compared in their 3rd month control cystoscopy. RESULTS: Macroscopic tumor detection rates in patients' 3rd month control cystoscopy were 21 (46.7%) in Group 1, 18 (30%) in Group 2 and 4 (7.8%) in Group 3. When compared with Group 3 patients, Group 1 and Group 2 had higher statistically significant macroscopic tumor detection rates (p = 0.001) CONCLUSION: A second look in patients with multiple and/or > 3 cm tumors during early term will enable the surgeons to detect possible tumors and do a better job in risk classification.

The factors predicting biochemical recurrence in patients with radical prostatectomy.

OBJECTIVE: The main objective of this study was to evaluate the factors predicting recurrence in patients who underwent radical prostatectomy (RP) for localized prostate cancer. MATERIALS AND METHODS: A total of 275 patients who underwent RP between 2000 and 2012 years in our clinic were evaluated retrospectively and 238 patients who met our criteria were included in the study. The effect of PSA values at diagnosis in addition the histopathological variables on the risk of recurrence was evaluated. Biochemical recurrence (BCR) is defined as "an increase of > 0.2 ng/ml or more in the serum total PSA count". The statistical analysis of this study was done using SPSS for Windows Version 15.0 package program. Values below p < 0.05 are accepted as statistically significant. RESULTS: The mean follow up, age and PSA of patients were 37,2 months, 66,01 ± 6,85 years and 11,12 ng/ml, respectively. BCR rate was 28% (68/238). Univariate analysis revealed that PSA levels during initial diagnosis (p < 0.0001), Gleason score (GS) (p < 0.0001), prostatic capsule involvement (p < 0.005), extracapsular extension (p = 0.0001), seminal vesicle involvement (p < 0.003) and surgical margin positivity (p < 0.014) were significant factors in predicting recurrence, while multivariate analysis showed that PSA at initial diagnosis (p = 0.002) and GS (p = 0.003) were independent prognostic factors. PSA > 10 ng/ml and Gleason score > 7 are considered as the risk factors for BCR. CONCLUSION: Our study results showed that PSA value during initial diagnosis as well as Gleason score were independent factors in predicting BCR following radical prostatectomy.

Toilet training age and influencing factors: a multicenter study.

To determine toilet training age and the factors influencing this in our country, 1500 children who had completed toilet training were evaluated in a multicenter study. The mean age of toilet training was 22.32 ± 6.57 months. The duration it took to complete toilet training was 6.60 ± 2.20 months on the average. In univariant analysis, toilet training age increased as the parental education level, specifically that of the mother, increased. The training age of children whose mothers had over 12 years of education differed significantly from that of children of mothers with less education. There was no significant difference in toilet training age with regard to the education level of the father, or the employment status of the mother. We also found significant differences with respect to family income level, toilet type and training method. In multivariant analysis, family income >5000 TL and use of a potty chair were determined to be factors affecting toilet training age. In conclusion, toilet training age in Turkey, a developing country, was found to be lower than that in developed countries.

Risk factors for hemorrhage requiring embolization after percutaneous nephrolithotomy.

INTRODUCTION: Percutaneous nephrolithotomy (PCNL) is the primary surgical intervention in kidney stone management. Even though it is performed quite often, the complication rates are also high. Arteriovenous fistulas following extended hemorrhages after PCNL are one of the most serious complications of this operation. Our main objective was to review the data of patients who required angiography and embolization. METHODS: In total, we included 1405 patients who underwent PCNL between 2007 and 2014. All patient data were retrospectively reviewed. All patients went under PCNL using fluoroscopy. Following informed consent, all hemorrhagic patients underwent angiography in the interventional radiology department and embolization was performed in patients with a hemorrhage focus point. RESULTS: A total of 147 patients (10.4%) required transfusion for post-PCNL hemorrhages. Of them, 14 (0.99%) underwent angiography and embolization (9 [64.2%] were male and 5 [35.8%] were female, with a mean age of 39.4 ± 10.2). The remaining 133 patients were conservatively managed (81 [60.9%] males and 52 [39.1%] females, with a mean age of 42.3 ± 12.4). When the predicting factors for angiography and embolization were reviewed, renal abnormalities and the mean size of stones were significant in both univariate and multivariate analysis (p < 0.001). CONCLUSION: Patients with extended and intermittent hematuria should be monitored closely for hemodynamics; if there is an ongoing necessity for transfusion, angiography should be considered.

Factors determining biochemical recurrence in low-risk prostate cancer patients who underwent radical prostatectomy.

OBJECTIVE: This study was conducted to research the factors determining biochemical recurrence (BCR) in low-risk localized prostate cancer patients who underwent radical prostatectomy (RP). MATERIALS AND METHODS: We retrospectively analyzed the data of 504 patients who had undergone RP between 2003 and 2013 at our clinic. One hundred and fifty-two patients who underwent RP for low-risk prostate cancer were included in the study. RESULTS: The mean follow-up period for patients was 58.7 (21-229) months. The mean age of the patients was 63.7±7.2 years (49-79). The mean prostate specific antigen (PSA) value was 5.25±4.22 ng/mL (3.58-9.45). The BCR rate after the operation was 25% (38/152). In the univariate analysis, recurrence determining factors were shown to include extracapsular involvement (ECI) (p=0.004), capsular invasion (CI) (p=0.001), age (p=0.014), and tumor size (p=0.006). However, only CI was found to be significant in multivariate analysis (p=0.001). CONCLUSION: Capsular invasion is an independent risk factor in low-risk prostate cancer patients who underwent RP for BCR.

Colon perforation during percutaneous nephrolithotomy and fistula closure with Spongostan following conservative therapy.

Percutaneous nephrolithotomy (PCNL) is the first-line treatment for kidney stones. Colon perforation is a rare, but dangerous, complication. Colonic perforation might be very serious if it is not found early. After an unsuccessful extracorporeal shockwave lithotripsy, a 45-year-old female underwent a left-sided PCNL for two 1-cm kidney stones in the left kidney upper pole calyx. During dilatation, a colon perforation was suspected. The procedure was finished by inserting a 14Fr re-entry catheter into the colon. On postoperative day 5, a fluoroscopy was performed by injecting contrast dye through the re-entry catheter, which showed a fistula formation between skin and colon. The catheter was removed completely. A 16Fr external drainage catheter was inserted over the guide-wire through the fistula tract. The fistula was closed by introducing prepared absorbable hemostatic gelatin powder (Spongostan) particles into the fistula tract through the catheter. Fistula tracks can be closed early by injecting absorbable Spongostan particles into the colonic fistula tract, thereby reducing inpatient time and increasing patient comfort.

[Investigation of prevalance and risk factors for hospital-acquired urinary tract infections in patients with severe burn injury]. / Ciddi yanik travmasi olan hastalarda hastane kaynakli idrar yolu enfeksiyonu sikligi ve risk faktörlerinin arastirilmasi.

BACKGROUND: This study aimed to investigate the prevalence and risk factors for hospital-acquired urinary tract infections in patients with severe burn injuries. METHODS: In this study, patients treated due to their burn injuries of greater than 20% between August 2009 and April 2012 in Bozyaka Training and Research Hospital Burn Center were assessed retrospectively. Sixty nine patients (30 [43.5%] males, 39 [56.5%] females; mean age 40.1±16.7 years) were included into the study. RESULTS: DM, duration of the catheter and catheter care showed a statistically significant correlation with hospital-acquired urinary tract infections (p<0.005). DISCUSSION: A large number of hospital-acquired urinary tract infections are associated with urinary catheterization. In addition, removing urinary catheter within the shortest time possible is another issue to be considered for the prevention of these infections. If the catheter has to remain for a longer time, regular catheter care is recommended.

Castleman's disease imitating adrenal mass in the retroperitoneal area.

Castleman's disease (CD) is a non-clonal lymph node hyperplasia, mostly seen in the mediastinum. It has various clinical and pathological outcomes. There are different treatments because of its rare occurance and heterogenity. We present 2 cases which were referred to our clinic as retroperitoneal mass and diagnosed as CD after surgical resection.