Systemic Inflammatory Index : A promising non-invasive marker for the prediction of response to neoadjuvant chemotherapy prior to cystectomy.

INTRODUCTION: The main challenge to the optimal use of neoadjuvant chemotherapy (NAC) is the difficulty in selecting patients who may or may not benefit from NAC. Our aim in this study is to investigate whether the Systemic Inflammation Index (SII) predicts response to chemotherapy in patients who receive NAC prior to cystectomy. METHODS: We retrospectively analysed the data of patients who underwent NAC followed by cystectomy at our institution between January 2010 and September 2015 and whose 5-year follow-up was completed. All patients who underwent diagnostic biopsy with complete transurethral resection of bladder tumour at our hospital and whose pathology result was muscle-invasive transitional cell carcinoma were included in the study. At least 3 courses of gemcitabine/cisplatin NAC were given to all patients. A pathological response was defined as a reduction in cystectomy to a lower pathological stage after NAC. RESULTS: The SII was 320.8 ± 51 in the responders and 388.28 ± 50 in the non-responders. SII Optimal cut-off of 350 was determined. The sensitivity and specificity of SII in predicting response were found to be 80 % and 83 % respectively. Low SII (< 350) was found to be a significant predictor of response compared with the other factors on multivariate analysis. The mean overall survival time was 55.4 months in patients with a low SII value and 40.3 months in the high SII group. CONCLUSION: SII, together with known clinicopathological factors and newer genetic and molecular markers, can be used to select patients for NAC.

High flow priapism following the insertion of an inflatable penile prosthesis mimicking autoinflation: a case report.

Penile prosthesis implantation is a surgical option for erectile dysfunction when other treatments fail or the patient prefers implantation. Although penile prosthesis is generally considered safe and effective, various complications have been reported in the literature. High-flow priapism, resulting from an arteriovenous fistula between the cavernosal artery and the corpora cavernosa, is a rare complication after penile prosthesis implantation. Managing the condition as autoinflation may lead to unfortunate complications. A 54-year-old male patient underwent a penile prosthesis implantation due to erectile dysfunction lasting for 5 years. Doppler ultrasound revealed arterial insufficiency that was refractory to oral and intracavernosal treatments. A 3-piece inflatable penile prosthesis (Coloplast - Titan) was implanted through a midline penoscrotal incision without any complications. The patient reported uncontrolled tumescence after activating the device, which led us to suspect autoinflation. The final diagnosis was high-flow priapism due to an arteriovenous fistula in the cavernosal artery. The patient was given an antiandrogenic medication and the prosthesis was deflated for 3 months. The fistula closed without any additional intervention. High-flow priapism is a rare but potential complication of penile prosthesis implantation. Careful evaluation and management of patients' symptoms are necessary for diagnosing and treating this condition. This case highlights the importance of considering high-flow priapism as a potential cause of uncontrolled tumescence after penile prosthesis implantation and the possibility of successful non-surgical management.

Systemic Inflammatory Index: A Novel Biomarker for Predicting the Progression in Active Surveillance in Patients with Prostate Cancer.

OBJECTIVE: To investigate active surveillance (AS) for patients with prostate cancer to show the systemic inflammatory index (SII) progression and to evaluate whether SII will be an AS criterion in PCa patients. STUDY DESIGN: Descriptive study. Place and Duration of the Study: Department of Urology, University of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital, from February 2015 to December 2021. METHODOLOGY: For active surveillance follow-up criteria, patients with prostate cancer who underwent AS with PSA <10 ng/ml, GS ≤6, clinical stage t1c-t2b, ≤2 core positive, and for each positive core had ≤50% tumour cells, were inducted and SII was determined. RESULTS: As a result of the univariate analysis, high SII values, number of cores involved, and length of the tumour in one core significantly affected progression (in order of p = 0.009, B = 1.830, Exp(B) = 6.233, CI [1.58-24.497]; p = 0.018, B = 0.682, Exp(B) = 1.978, CI [1.123-3.482]; p=0.006, B = 1.835, Exp(B) = 6.263 CI [1.692-23.181]). High SII values (>443.42) had better explanations for progression than the number of core involvement but were similar to the length of the tumour in one core. As a result of the multivariate analysis, high SII values (>443.42) and the tumour 's length in one core had similar effects on progression (in order of p = 0.011, B = 1.978, Exp(B) = 7.227, CI [1.570-33.269]; p = 0.009, B = 1.958, Exp(B) = 7.084, CI [1.642-30.555]). CONCLUSION: Th use of SII early in the course of treatment can help to identify which prostate cancer patients can be selected for active treatment instead of active surveillance, and to assess the probability of progression. KEY WORDS: Prostate cancer, Active surveillance, Systemic inflammatory index, Biomarker.

Management of Priapism: Results of a Nationwide Survey and Comparison with International Guidelines.

OBJECTIVE: The aim of this study is to evaluate current urologic practice regarding the management of priapism in Turkey and compare with international guidelines. METHODS: Urologists and urology residents were invited to an online survey consisting of 30 multiple-choice questions on priapism-related clinical practices that were consid- ered most important and relevant to practices by using Google Forms. RESULTS: Total number of responses was 340. Respondents reported that they recorded a detailed patient's medical history and physical examination findings (n = 340, 100%) and laboratory testing, which includes corporal blood gas analysis (n=323, 95%). Participants announced that they performed Doppler ultrasound for 1/4 cases (n = 106, 31%), but 22% of the participants (n=75) replied that they performed in >75% of cases. Participants (n=311, 91%) responded that the first-line treatment of ischemic priapism is decompression of the corpus cavernosum. Moreover, most respondents (n = 320, 94%) stated that sympathomimetic injection drugs should be applied as the second step. About three-quarters of respondents (n = 247, 73%) indicated adrenaline as their drug of choice. Phosphodiesterase type 5 inhibitors seems to be the most pre- ferred drug for stuttering priapism (n=141, 41%). Participants (n=284, 84%) replied that corpora-glanular shunts should be preferred as the first. A large number of par- ticipants (n = 239, 70%) declared that magnetic resonance imaging can be performed in cases with delayed (>24 hours) priapism to diagnose corporal necrosis. Most of the participants (84%) responded that penile prosthesis should be preferred to shunts in cases with delayed (>48 hours) priapism. CONCLUSION: It would be appropriate to improve the training offered by professional associations and to give more training time to the management of priapism during residency.

The effect of urinary tract infection on overall mortality in elderly male patients.

INTRODUCTION: Urinary tract infections are the most common bacterial infections in the older population.

The prevalence and topographic distribution of penile calcification in a large cohort: a retrospective cross-sectional study.

The prevalence of penile calcification in the population remains uncertain. This retrospective multicenter study aimed to determine the prevalence and characteristics of penile calcification in a large cohort of male patients undergoing non-contrast pelvic tomography. A total of 14 545 scans obtained from 19 participating centers between 2016 and 2022 were retrospectively analyzed within a 3-months period. Eligible scans (n = 12 709) were included in the analysis. Patient age, penile imaging status, presence of calcified plaque, and plaque measurements were recorded. Statistical analysis was performed to assess the relationships between calcified plaque, patient age, plaque characteristics, and plaque location. Among the analyzed scans, 767 (6.04%) patients were found to have at least one calcified plaque. Patients with calcified plaque had a significantly higher median age (64 years (IQR 56-72)) compared to those with normal penile evaluation (49 years (IQR 36-60) (p < 0.001). Of the patients with calcified plaque, 46.4% had only one plaque, while 53.6% had multiple plaques. There was a positive correlation between age and the number of plaques (r = 0.31, p < 0.001). The average dimensions of the calcified plaques were as follows: width: 3.9 ± 5 mm, length: 5.3 ± 5.2 mm, height: 3.5 ± 3.2 mm, with an average plaque area of 29 ± 165 mm² and mean plaque volume of 269 ± 3187 mm³. Plaques were predominantly located in the proximal and mid-penile regions (44.1% and 40.5%, respectively), with 77.7% located on the dorsal side of the penis. The hardness level of plaques, assessed by Hounsfield units, median of 362 (IQR 250-487) (range: 100-1400). Patients with multiple plaques had significantly higher Hounsfield unit values compared to those with a single plaque (p = 0.003). Our study revealed that patients with calcified plaques are older and have multiple plaques predominantly located on the dorsal and proximal side of the penis.

The effect of acute urinary retention on the results of transurethral resection of the prostate.

INTRODUCTION: Acute urinary retention (AUR) is one of the most severe symptoms of Benign Prostatic Hyperplasia (BPH). There are some studies in the literature describing the risk factors for the development of AUR in BPH patients. However, the studies that summarize the effect of AUR on Transurethral resection of Prostate (TUR-P) surgery results are limited. The aim of this study is to assess the effect of AUR on TUR-P results. METHODS: Between 2018 and 2020, patients who underwent TUR-P for AUR or lower urinary tract symptoms (LUTS) were included in the study. The inclusion criteria were, men over 50 years old with a BPH diagnosis and who underwent monopolar TUR-P by a single surgeon. The exclusion criteria were; patients who had prostate cancer, multiple sclerosis, or neurogenic bladder were diagnosed or had previous lower urinary tract surgeries such as TUR-P, TUR-Bladder, Urethrotomy, had a chronic indwelling catheter, and patients who did not accept immediate TUR-P and preferred trial without catheter (TWOC) protocol. The age, PSA, prostate volume, pre- and post-operative flow rates, duration of hospitalization, and complications were recorded. Two groups were constituted for comparison such as AUR and Elective Group and p values <0.05 were considered significant. RESULTS: There were 14 and 46 patients for AUR and Elective Groups respectively. The age, pre-operative prostate volume, free and total PSA values, postoperative complication rate, and re-hospitalization rate were significantly higher in the AUR-Group. However, there were no differences between groups in terms of pre-operative medication, duration of hospitalization, and post-operative uroflow maximum flow rate. DISCUSSION: Patients who underwent TUR-P after AUR have a higher risk for complications and re-hospitalization. Care should be taken in these patients and patients should be warned about the risks.

Antimicrobial susceptibility of bacteria isolated from urine cultures in Southern Turkey.

Background: Pathogen spectrum and antibiotic susceptibility patterns vary in different regions and should consider the empirical treatment of urinary tract infections (UTIs). Information on susceptibility is the basis for providing reliable treatment. This study aimed to determine the antibiotic susceptibility of bacteria isolated from urine cultures at Çukurova State Hospital, which is located south of Turkey and east of the Mediterranean region. Materials and methods: Urine culture results were retrospectively evaluated between April 2018 and January 2021. Variables, such as age, sex, and medical department, were also recorded. Inclusion criteria were patients aged at least 18 years with pathogenic bacterial growth in their urine cultures. Antibiotic susceptibility testing and bacterial identification were performed using the VITEK 2 automated system. Results: Of 12,288 urine samples, 2033 (16.5%) had pathogenic growth. The rates of bacterial and yeast growth were 93.3% and 6.7%, respectively. Gram-negative pathogens constituted 91.6% of the cohort. The most prevalent bacteria were Escherichia coli with a 66% rate, followed by Klebsiella (14.2%). According to our results, ciprofloxacin, trimethoprim-sulfamethoxazole, and ampicillin are not suitable for empirical treatment of UTIs, whereas nitrofurantoin and fosfomycin are rational options. Conclusions: Uropathogens exhibit an increased resistance rate against ampicillin, trimethoprim-sulfamethoxazole, and ciprofloxacin. Nitrofurantoin, fosfomycin, and ceftazidime have better efficacy than other investigated antibiotics in urine culture against common uropathogens and are suitable for empirical treatment of UTI.

Is there a relationship between mean platelet volume and response to treatment with daily tadalafil in patients with erectile dysfunction?

Mean platelet volume (MPV) has been related to erectile dysfunction (ED). However, its value in predicting therapeutic response to phosphodiesterase-5 inhibitors is not evaluated. This study aimed to investigate the value of MPV as a marker for the prediction of the response of the tadalafil treatment of ED. A retrospective analysis of patients who were admitted to the andrology outpatient clinic between 2020-2022 were performed. The inclusion criteria were, ≥40 years old male, International Index of Erectile Function-Erectile Function domain score < 26, not received any ED treatment before, have a stable heterosexual relationship, and prescribed 5 mg daily tadalafil for primary treatment of ED. A total of 116 patients were included in the study. The mean age of the patients was 53.7 ± 8.7 years. The response rate to 5 mg tadalafil treatment was 52.6% (Group-1; N = 61). An MPV value 3 10.05 fL was associated with 66% sensitivity and 75,4% specificity for no response to 5 mg daily tadalafil treatment (Area under curve = 76.9% [95% CI 68.2%-85.6%; p < 0.001]). Initial IIEF-EF score, fasting blood glucose, and MPV level was independently associated with the response to the tadalafil treatment. This is the only study to evaluate the value of MPV level on the therapeutic response of ED to tadalafil. Strict inclusion criteria were applied to the cohort. However, the diagnose of vascular ED has been made by clinical evaluation and retrospective design of the study were the limitations of the study. The results of our study suggest that MPV might be used to predict the result of 5 mg daily tadalafil treatment in selected ED patients as a fast and cost-effective test.

Youtube videos as an information source about urinary incontinence.

AIM: Youtube is one of the most popular video-sharing websites, and people use Youtube as a source of information. Patients with urinary incontinence may seek information about their condition on Youtube. This study aims to assess the videos on Youtube about urinary incontinence and evaluate the information regarding whether patients can understand and/or act accordingly. METHODS: We performed a Youtube search with the keywords of "incontinence," "urinary incontinence," and "overactive bladder" in the English language with the incognito mode on the browser. All links were extracted and recorded in an excel file. Duplicated links were removed, and metadata of the videos were collected. A custom python language script was used to perform this operation. We selected the most viewed 150 videos for the assessment. After removing the non-related videos, 112 of them were included in the study. Two researchers separately evaluated all the videos with the Patients Education Material Assessment Tool (PEMAT, audiovisual version). RESULTS: The total duration of all included (n:112) videos was 12.6 hours, and these videos had been watched 37,332,178 times until the query date. The vast majority of the videos were about information, management, and treatment options (Kegel exercises, surgery modalities) of incontinence, individual experiences of patients with incontinence, commercials about the diapers, and healthcare professionals who wanted to introduce themselves or their services. Mean understandability and actionability scores of the videos were 57.9% and, 44.7% respectively. Our analysis showed that only 12.5% of the videos on Youtube related to incontinence were understandable, as well as actionable, in terms of PEMAT scores. CONCLUSION: According to our study, 87.5% of the videos about incontinence on Youtube.com in the English language were not understandable and actionable for users. Development of high-quality content about incontinence is needed.

Vasectomy with vessel sealing device: comparison of different diameters.

OBJECTIVES: Vasectomy is a popular and effective male surgical contraceptive method. Different techniques have been proposed to reduce failure rates and complications. In this study, we sought to compare vas deferens occlusion rates using both standard occlusion techniques and LigaSure (LSVS) for vasectomy. MATERIAL AND METHODS: A total of nine patients underwent open radical retropubic prostatectomy at our institution. During the procedure, a total of 125 fresh vas deferens samples were obtained and divided into four groups as follows: Group 1: ligation (n = 22), Group 2; ligation and electrocauterization (n = 18), Group 3; 5 mm LSVS (n = 44), Group 4; 10 mm LSVS (n = 41). All specimens were harvested during surgery and subsequent histopathological assessments were performed to assess the luminal status of the vas deferens. RESULTS: Histopathological evaluation revealed that the majority of vas lumens with LSVS (79.5% of Group 3 and 89.4% of Group 4) were totally occluded. With standard techniques, however, the majority of vas lumens (86.4 and 77.8% of Groups 1 and 2, respectively) maintained a tiny patency. CONCLUSIONS: On histopathological review, the application of LSVS resulted in better occlusion rates, compared to standard ligation methods. These findings suggest a higher occlusive role for LSVS for vasectomy. Further clinical studies are needed to confirm the clinical efficacy and safety of this technique.

A comparative evaluation of semen parameters in pre- and post-Hurricane Katrina human population.

A natural disaster leading to accumulation of environmental contaminants may have substantial effects on the male reproductive system. Our aim was to compare and assess semen parameters in a normospermic population residing in the Southern Louisiana, USA area pre- and post-Hurricane Katrina. We retrospectively evaluated semen analyses data (n = 3452) of 1855 patients who attended the Tulane University Andrology/Fertility Clinic between 1999 and 2013. The study inclusion criteria were men whose semen analyses showed ≥ 1.5 ml volume; ≥15 million ml -1 sperm concentration; ≥39 million total sperm count; ≥40% motility; >30% morphology, with an abstinence interval of 2-7 days. After the inclusion criteria applied to the population, 367 normospermic patients were included in the study. Descriptive statistics and group-based analyses were performed to interpret the differences between the pre-Katrina (Group 1, 1999-2005) and the post-Katrina (Group 2, 2006-2013) populations. There were significant differences in motility, morphology, number of white blood cell, immature germ cell count, pH and presence of sperm agglutination, but surprisingly there were no significant differences in sperm count between the two populations. This long-term comparative analysis further documents that a major natural disaster with its accompanied environmental issues can influence certain semen parameters (e.g., motility and morphology) and, by extension, fertility potential of the population of such areas.

Cycling-Related Sexual Dysfunction in Men and Women: A Review.

INTRODUCTION: The risk of sexual dysfunction due to bicycling has been addressed in the literature for both men and women. New studies have provided information about the prevalence, pathophysiology, and strategies for prevention of sexual dysfunction as it relates to cycling. AIM: The aim of this article is to review the current literature about bicycle-related sexual dysfunction in both genders, exclusive of that caused by cycling-related genitourinary trauma. METHODS: A systematic comprehensive review of the English-language literature was performed in March 2014 using PubMed.gov, and search terms including (but not limited to) "cycling, bicycle, sexual dysfunction, and erectile dysfunction." RESULTS: Several studies have documented a relationship between bicycling and sexual dysfunction. Of the symptoms described, perineal numbness (prevalence of 22-91%) and erectile dysfunction (prevalence of 1.8-50%) are the most commonly reported in the male population. The primary mechanisms leading to these symptoms in both genders appear to be perineal compression of the pudendal nerve within Alcock's canal and possible trauma. Communications have also postulated that potential cycling-related disruption of the hypothalamic-pituitary-gonadal axis, specifically in testosterone signaling, may indirectly lead to sexual dysfunction. Studies have provided evidence that the rider's position on the bicycle, as well as different types of bicycle seats, affect the degree of pudendal compression, and consequently the degree of resultant sexual dysfunction. CONCLUSIONS: Although a number of studies have described mechanisms for cycling-related sexual dysfunction, further validated studies are needed to both better describe the dysfunction, as well as to develop strategies for prevention and treatment. Our best evidence indicates that the type of saddle used, as well as the position of the rider, has more effect on resultant sexual dysfunction than simply participation in cycling. Baran C, Mitchell GC, and Hellstrom WJG. Cycling-related sexual dysfunction in men and women: A review. Sex Med Rev 2014;2:93-101.

Importance of the number of retreived lymph nodes during cystectomy.

PURPOSE: To evaluate the effect of the number of dissected lymph nodes (LNs) during radical cystectomy on survival outcomes. MATERIALS AND METHODS: Medical files of 211 patients who underwent cystectomy between 1996 and 2009 were retrospectively evaluated. Seventy-four patients were included in the study and divided into two groups regarding the median number of retrieved LNs (median number = 13); 36 patients in the 1st and 38 in the 2nd group. Radical cystectomy, urinary diversion, and pelvic LN dissection were done in all the patients. When necessary, adjuvant chemotherapy was applied. Kaplan-Meier survival analysis was performed to compare survival outcomes of the groups. RESULTS: Of 74 patients, 67 (90.5%) were men and 7 (9.5%) were women, with the mean age of 61.7 years (range, 39 to 83 years). Age distribution, pathologic stages, carcinoma in situ occurrence, adjuvant chemotherapy rates, LN involvement, and median follow-up period were similar in both groups. Mean dissected LNs number in the 1st and 2nd groups was 6.17 (range, 1 to 12) and 21.6 (range, 13 to 41), respectively. Five-year estimated overall survival rates were 24.5% and 60.5% (P = .002) while five-year estimated disease-specific survival rates were 43.7% and 74.4% (P = .049), respectively. CONCLUSION: Although exact guidelines are not described, it seems that dissection of high number of LNs during radical cystectomy is crucial.

Superficial dorsal vein rupture imitating penile fracture.

Dorsal vein rupture of the penis is a rare condition, and few cases have been reported in the literature. Herein we report a 41-year-old man who presented with mildly painful and acute swollen penis, which initially imitated a penile fracture but was surgically explored and shown to be a superficial dorsal vein rupture.

[Investigation of Panton-Valentine leukocidin gene, SCCmec gene cassette types and genotypes of methicillin-resistant Staphylococcus aureus strains isolated from outpatients]. / Ayaktan saglik hizmeti alan hastalardan izole edilen metisiline dirençli Staphylococcus aureus izolatlarinda Panton-Valentin lökosidin geni ve SCCmec gen kaseti tiplerinin arastirilmasi ve izolatlarin genotiplendirilmesi.

The identification of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) is becoming a hard task since colonization with MRSA is lasting for years and the number of the health care facilities other than hospitals is continuously increasing. In this study we aimed to investigate the genetic properties and health-care association of MRSA strains isolated from skin and soft tissue infections of outpatients admitted to Akdeniz University Hospital. Thirty strains were phenotypically identified as MRSA and after assessing the risk factors, 28 (93.3%) of them were classified as health-care associated (HCA) and 2 (6.7%) of them as community-acquired (CA). All of the isolates were positive for nuc and mecA genes by polymerase chain reaction. Antimicrobial resistance rates of HCA-MRSA and CA-MRSA isolates were found as follows, respectively; 89.3% and 0% for rifampin, 89.3% and 50% for ciprofloxacin, 89.3% and 0% for gentamicin, 50% and 50% for erythromycin, 28.6% and 0% for clindamycin, whereas all of the isolates were susceptible to vancomycin, linezolid and trimethoprim-sulfamethoxazole. SCCmec type III was detected in 24 (85.7%) of HCA-MRSA strains. SCCmec type IV was detected in 1 (3.6%) of HCA-MRSA and in 2 (100%) of CA-MRSA strains. Panton-Valentin leucocidin (PVL) gene positivity was detected in only CA-MRSA isolates (2/2; 100%). MRSA isolates were grouped into 17 different genotypes (from A to R) of which pulsotype A was predominant among HCA isolates and CA-MRSA isolates were found to be clonally related with each other. This is the first study which investigated the genetic properties of MRSA strains in Antalya (a province located at Mediterranean Region, Turkey). In this study HCA risk factors were investigated and CA-MRSA rate was only 6.7% among all MRSA strains isolated from outpatients. As a result of detailed investigation of HCA risk factors, it was possible to detect the exact rate of CA-MRSA among outpatients. Thus it is of clinical and epidemiological importance to know the origin of MRSA isolates since this will affect the empirical treatment choice. Genetic studies supplied by appropriate demographic data will help to clarify the evolution and epidemiology of MRSA in the community and in the hospital setting.

Giant desmoid tumor in a case of ileal neobladder.

Aggressive fibromatosis or desmoid tumor, is a histologically benign entity with unknown etiology that may present a serious clinical course. Due to its high tendency to recur and local aggressive behavior and as there is no established effective medical treatment, complete surgical excision remains the sole management. To our knowledge, we describe the first case of giant desmoid tumor which arised from ileal neobladder mesenterium in a bladder cancer patient with orthotopic substitution.