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.

Multiple Endoclip Retraction Technique (MERT) in Laparoscopic Burch.

Background and Objectives: The multiple endoclip retraction technique (MERT) was developed based on our experience with suturing renal parenchyma in laparoscopic partial nephrectomy. In this study we prospectively evaluated the one-year results of cases treated by transperitoneal laparoscopic Burch with the MERT. Methods: The patients were evaluated with stress test, one-hour pad test, and were requested to complete the International Continence Society Incontinence Questionnaire short form (ICIQ-SF) in the postoperative period. The follow-up periods were postoperative 3, 6, and 12 months. Results: The primary outcome of this study was surgical success, defined as being cured of stress urinary incontinence (SUI) (no symptoms), experiencing improved symptoms of SUI in ICIQ-SF and negative stress test, and less than 2g urine leakage in a one-hour pad test.No statistically significant difference was found in terms of age, number of children, and body mass index (BMI) in patients according to the results of the 12 month postoperative stress test. We found statistically significant improvements at all control months in terms of stress test and pad weight. ICIQ-SF results showed a significant decrease at three months in patients who recovered after the operation. This rate has not changed in following control months. However, there was no statistical change in ICIQ-SF values in patients who did not recover after the operation. Conclusion: MERT seems to be one of the safe and effective modifications in the management of SUI with good one year outcomes when performed by suitably trained experienced surgeons.

Prone versus Barts "flank-free" modified supine percutaneous nephrolithotomy: a match-pair analysis

Background/aim: In this study, we aimed to compare the results of prone and Barts "flank-free" modified supine percutaneous nephrolithotomy (PCNL) operations in our clinic. Materials and methods: The data from patients that underwent Barts "flank-free" modified supine PCNL (BS-PCNL) (n = 52) between June 2018 and July 2020 and prone PCNL (P-PCNL) (n = 286) between April 2014 and June 2018 were retrospectively evaluated. Of those 286 patients, 104 patients whose sex, age, body mass index, American Society of Anesthesiology score, stone localization, stone size, and hydronephrosis matched the BS-PCNL group in a 1:2 ratio were included in the study. The groups were compared in terms of intraoperative outcome, complication rates, and stone-free rates. Results: The mean age of all patients (58 females, 98 males) included in the study was 41.8 ± 15.2 years, and the mean body mass index (BMI) was 24.7 ± 2.9 kg/m2. The mean operation time was significantly shorter in the BS-PCNL group than in the P-PCNL group (80.2 ± 15.1 min vs. 92.4 ± 22.7 min and p = 0.01). There was no significant difference between the two groups in terms of fluoroscopy time, intraoperative complications, postoperative complications, and stone-free rates. Conclusion: Our study shows that BS-PCNL is an effective and safe method that significantly reduces the operation time and should be considered as one of the primary treatment options for patients scheduled for PCNL.

Comparison of the Effects of Four Treatment Techniques Commonly Used in Ureteral Stone Treatment on Patients' Daily Physical Functioning: An Observational Randomized-Controlled Study.

Objective: To investigate the effect of four different techniques used in the treatment of ureteral stones on patients' daily physical functioning (PF) and quality of life (QoL). Materials and Methods: Patients who underwent ureterorenoscopy (URS)-with or without Double-J stenting (DJS)-and extracorporeal shock wave lithotripsy (SWL) were divided into four groups: Group I: SWL (n = 29), Group II: URS (n = 43), Group III: URS +4.8F DJS (n = 39), Group IV: URS +6F DJS (n = 42), and Group V: Control (n = 30). Short Form-36 (SF-36) was administered to each participant both preoperatively and 14 days after operation. Based on the SF-36 results, the changes in patients' PF and QoL were evaluated. Results: Ureteral stone treatment was performed in 202 patients. Of these, 153 patients who underwent an effective SWL or URS procedure in the first attempt were included in the study. Success rates in the first session were 53.7% (29/54) and 83.8% (124/148) for SWL and URS, respectively (p < 0.001). All the four groups were similar with regard to age, gender, body mass index, stone size, preoperative PF, and QoL. However, although postoperative PF, role limitations due to physical health, and energy/fatigue scores were similar in Group I, III, and IV, they were significantly higher in Group II. No major complication associated with SWL or URS occurred in any patient. However, in Group 2, DJS was inserted in three (7.7%) patients in the early postoperative period (within the first 48 hours) due to renal colic attacks secondary to ureterovesical junction mucosal edema. Conclusion: URS without DJS seems to be the most advantageous technique in the treatment of ureteral stones in terms of daily PF and QoL. However, it should be noted that patients undergoing URS may require postoperative emergency stenting, although rarely.

Efficacy of Alfuzosin in Male Patients with Moderate Lower Urinary Tract Symptoms: Is Metabolic Syndrome a Factor Affecting the Outcome?

PURPOSE: The present study was designed to compare the efficacy of alfuzosin therapy as an alpha-blocker in metabolic syndrome (MetS) and non-MetS patients with moderate lower urinary tract symptoms (LUTS). MATERIAL AND METHODS: This prospective study included male patients with obstructive voiding and had a moderate LUTS according to International Prostate Symptom Score (IPSS). Patients were divided into two groups: MetS and Non-MetS. Following the measurement of uroflowmetric parameters (maximum flow rate [Qmax], post-void residual volume [PVR], urine volume) and the determination of IPSS scores, the patients were initiated on alfuzosin 10 mg once daily for a period of 12 weeks. At the end of the therapy, treatment outcomes were determined based on uroflowmetric parameters and IPSS scores. RESULTS: 301 patients were included in the study (MetS: 160, non-MetS: 141). Pre-treatment uroflowmetric measurements and IPSS scores were similar in both groups. After the therapy, the median Qmax level increased from 12.80 (10.62-14.82) ml/s to 14.55 (12.00-16.60) ml/s in the MetS group and from 12.60 (8.60-14.60) ml/s to 15.70 (13.20-17.20) ml/s in the non-MetS group (p<0.001 for both). Similar statistically significant changes were valid for PVR and IPSS. Post-treatment Qmax, PVR values and IPSS scores were higher in the non-MetS patients compared to MetS patients. CONCLUSION: Although the non-MetS patients had greater benefit from the alfuzosin therapy compared to the MetS patients, alfuzosin is an effective alpha-blocker in the treatment of MetS patients with moderate LUTS. Based on these findings, it is tempting to consider that MetS might be a negative factor for benign prostate hyperplasia treatment.

Distribution of psychogenic and vascular impotence in a tertiary health-care center's cohort: a retrospective study using penile Doppler imaging / Distribución de la impotencia psicógena y vascular en la cohorte de un centro sanitario de tercer nivel: estudio retrospectivo con imágenes Doppler peneanas

PURPOSE: In this study, we retrospectively reviewed the penile color Doppler ultrasound (PCDU) scans of the patients who had admitted to our clinic with erectile dysfunction and aimed to evaluate the contribution of penile Doppler scan results to the clinical decisions. MATERIAL-METHOD: The data of patients admitted to our outpatient clinic with complaints of erectile dysfunction (IIEF-5 score<22 or IIEF-EF score<26) between January 2005 and January 2018 were retrospectively evaluated. Patients whose testosterone level is lower than 280ng/ml or who had undergone radical prostatectomy were excluded from the analysis. RESULTS: Three thousand ninety patients were included in the study. The mean age of our patients was 55.05±13.05 years. In total, 2139 (69%) patients had normal PCDU findings, 351 (11%) patients had arterial insufficiency, 531 (17%) patients had venous insufficiency, and 69 (2%) patients had arterial insufficiency with concurrent venous leakage. When the patients were divided into 2 groups ≤40 years (Group 1) old and >40 years (Group 2) old; normal PCDU findings were found in 432 patients (84%) of the Group 1 patients and normal PCDU findings in 1707 (66%) patients of the Group 2 patients (p < 0.0001). There were arterial insufficiency findings in 24 (4.7%) and 327 (12.7%) patients of the Group 1 and 2, respectively (p = 0.002). CONCLUSION: The etiology is psychogenic in the majority of patients who present with ED complaints to the urology clinic. With age, the prevalence of psychogenic ED is decreasing but still more than organic

OBJETIVO: En este estudio, revisamos retrospectivamente las ecografías Doppler a color del pene (PCDU) de los pacientes que ingresaron en nuestra clínica con disfunción erectile, el objetivo era evaluar la contribución de los resultados de la ecografía Doppler peneana a las decisiones clínicas. MATERIAL Y MÉTODO: Los datos de los pacientes ingresados en nuestra clínica ambulatoria con quejas de disfunción eréctil (puntuación IIEF-5<22 o puntuación IIEF-EF<26) entre enero de 2005 y enero de 2018 se evaluaron retrospectivamente. Los pacientes cuyo nivel de testosterona fuera inferior a 280ng/ml o a los cuales se les hubiera realizado una prostatectomía radical se excluyeron del análisis. RESULTADOS: En el estudio se incluyó a 3.090 pacientes. La media de edad de nuestros pacientes fue de 55,05±13,05 años. En total, en 2.139 pacientes (69%) hubo hallazgos normales en la PCDU; en 351 (11%) se observó insuficiencia arterial; en 531 (17%) insuficiencia venosa y en 69 (2%) insuficiencia arterial con reflujo venoso simultáneo. Cuando los pacientes se dividieron en 2 grupos, ≤40 años (grupo 1) y >40 años (grupo 2), se encontraron hallazgos normales de la PCDU en 432 pacientes (84%) de los pacientes del grupo 1 y hallazgos normales de PCDU en 1.707 pacientes (66%) del grupo 2 (p < 0,0001). Hubo hallazgos de insuficiencia arterial en 24 (4,7%) y 327 (12,7%) pacientes de los grupos 1 y 2, respectivamente (p = 0,002). CONCLUSIÓN: La etiología es psicógena en la mayoría de los pacientes que presentan quejas de en la clínica de urología. Con la edad, la prevalencia de la DE psicógena va disminuyendo, pero todavía es más psicógena que orgánica

Distribution of psychogenic and vascular impotence in a tertiary health-care center's cohort: A retrospective study using penile Doppler imaging.

PURPOSE: In this study, we retrospectively reviewed the penile color Doppler ultrasound (PCDU) scans of the patients who had admitted to our clinic with erectile dysfunction and aimed to evaluate the contribution of penile Doppler scan results to the clinical decisions. MATERIAL-METHOD: The data of patients admitted to our outpatient clinic with complaints of erectile dysfunction (IIEF-5 score<22 or IIEF-EF score<26) between January 2005 and January 2018 were retrospectively evaluated. Patients whose testosterone level is lower than 280ng/ml or who had undergone radical prostatectomy were excluded from the analysis. RESULTS: Three thousand ninety patients were included in the study. The mean age of our patients was 55.05±13.05 years. In total, 2139 (69%) patients had normal PCDU findings, 351 (11%) patients had arterial insufficiency, 531 (17%) patients had venous insufficiency, and 69 (2%) patients had arterial insufficiency with concurrent venous leakage. When the patients were divided into 2 groups ≤40 years (Group 1) old and >40 years (Group 2) old; normal PCDU findings were found in 432 patients (84%) of the Group 1 patients and normal PCDU findings in 1707 (66%) patients of the Group 2 patients (p<0.0001). There were arterial insufficiency findings in 24 (4.7%) and 327 (12.7%) patients of the Group 1 and 2, respectively (p=0.002). CONCLUSION: The etiology is psychogenic in the majority of patients who present with ED complaints to the urology clinic. With age, the prevalence of psychogenic ED is decreasing but still more than organic.

Relationship between oxidative stress and detrussor overactivity: a case control study.

PURPOSE: We analyzed the role of oxidative stress in detrusor overactivity (DO) by measuring serum total antioxidant capacity (TAC), total oxidant status (TOS), binding capacity of exogenous cobalt to human albumin (IMA), serum advanced oxidation protein products (AOPP), paraoxonase (PON), and arylesterase. MATERIALS AND METHODS: The study included 38 female patients diagnosed with DO and 29 healthy female subjects forming the control group. Serum total antioxidant capacity (TAC), total oxidant status (TOS), binding capacity of exogenous cobalt to human albumin (IMA), serum advanced oxidation protein products (AOPP), paraoxonase (PON), and arylesterase were analyzed. The results of serum TAC, TOS, IMA, AOPP, PON, and arylesterase of the subjects in both groups were compared. RESULTS: There was no difference between the groups in terms of age. When compared to the control group, serum TAC and IMA levels were statisticaly lower (P  < 0,001)  and higher (P = 0,003), respectively. However, TOS, AOPP, PON, arylesterase levels were similar in both groups ( p > 0.05 ). CONCLUSION: There seems to be an association between DO and oxidative damage according to our results, this can be measured by analyzing TAC and IMA in this patient group.

Diagnosis and Conservative Management of Ureteral Orifice Injury During Robotic Prostatectomy for a Large Prostate with a Prominent Median Lobe.

Introduction: Robot-assisted laparoscopic radical prostatectomy (RALRP) is now considered the standard treatment for localized prostate cancer. However, challenges may arise when dealing with large prostates with a prominent median lobe because the ureteral orifices may not always be visible during dissection and maybe injured in the process. We describe our experience on the diagnosis and conservative management of ureteral orifice injury in this situation. Case: A Gleason score 3 + 3 prostatic adenocarcinoma was detected during 12-quadrant prostate biopsy performed after measurement of a serum prostate specific antigen value of 8.1 ng/mL in a 65-year-old man presenting with lower urinary tract symptoms. The left ureter orifice was observed to have been injured by scissors at dissection of the neck of the bladder and enlarged median lobe at RALRP. An online video call was made to more experienced robotic surgeons for advice. Diagnosis and management of the ureteral injury are presented. Conclusion: Ureteral orifice injury during an RALRP may be managed conservatively with intraoperative ureteral stenting without the need for reimplantation nor conversion to open surgical techniques. Online video call with experienced robotic surgeons is helpful in the decision process.

Robotic radical prostatectomy in 93 cases: Outcomes of the first ERUS robotic urology curriculum trained surgeon in Turkey.

OBJECTIVE: This study presents the surgical, oncological, and functional outcomes of the first 93 robotic radical prostatectomy (RARP) procedures performed in Erzurum, Turkey. These procedures were performed by a single surgeon who had completed the European Association of Urology Robotic Urology Section (ERUS) RARP curriculum in an ERUS-certified training center in Ankara. MATERIAL AND METHODS: The study present the results of 93 RARP procedures performed by a single surgeon. The surgeon performing the operations completed an ERUS training program structured for RARP by two robotic surgeons holding ERUS training certificates in an ERUS-approved academic robotic surgery training center in Ankara. The RARP cases performed by the surgeon after completion of the training between April 2016 and August 2018 were retrospectively evaluated. RESULTS: The mean patient age was 63.62±7.04 years, and the mean preoperative serum prostate-specific antigen level was 8.34±4.96 ng/mL. Preoperatively, 82 and 4 patients had prostate biopsy Gleason scores of 3+3 and 4+3, respectively. Bilateral neurovascular bundle (NVB) sparing, unilateral NVB-sparing, and non-NVB-sparing surgery were performed in 21, 13, and 59 cases, respectively. The mean prostate weight was 85.34±47.57 g. Posterior rhabdosphincter reconstruction was performed in 60 (64.5%) cases. Mean console time, intraoperative blood loss, duration of hospital stay, and urethral catheter removal time were 170.49±36.50 min, 100.70±34.08 cc, 6.84±2.28 days, and 7.40±3.11 days, respectively. During the perioperative period (0-30 days), five minor (prolonged drain output, n=3; rectocele, n=1; gout arthritis, n=1) and six major (inguinal hernia, n=1; incisional hernia, n=2; anastomotic urinary leakage, n=2; myocardial infarction, n=1) complications were identified. No complication was detected during postoperative days 31-90. Postoperative pathological stages included pT2a, pT2b, and pT2c disease in 77 (82.8%), 9 (9.7%), and 7 (7.5%) patients, respectively. The positive surgical margin (SM) rate was 10.7% (n=10), including patients with pT2a (n=6) and pT2c (n=2) diseases. Eleven (11.8%) patients underwent pelvic lymph node (LN) dissection. The mean LN yield was 16.45±4.29. The mean length of follow-up was 11.17±8.01 months. Biochemical recurrence was observed in two patients, one of whom received maximal androgen blockage (MAB), and the other one received pelvic radiotherapy+MAB. All the patients with at least one-year follow-up (n=48, 51.6%) were fully continent (0 pads/day). Of the 40 (43%) patients with no preoperative erectile dysfunction (ED) and with at least three-month follow-up, 18 (45%) had no ED, with or without any additional medication including phosphodiesterase-5 (PDE5) inhibitors. CONCLUSION: RARP is a safe minimally invasive procedure with acceptable morbidity, excellent operative, pathological and oncological outcomes, and satisfactory functional results. The ERUS RARP curriculum provides effective and sufficient training.

Testis-sparing surgery: Experience in 13 patients with oncological and functional outcomes.

INTRODUCTION: We present oncological and functional outcomes of patients who underwent testis-sparing surgery (TSS). METHODS: Overall, 13 patients were included. Mean patient age was 29.9±12.5 years. In five patients, TSS was performed for sequential bilateral testicular tumours. One patient underwent concurrent left radical orchiectomy and right TSS. In eight patients with normal contralateral testis, seven underwent left and one underwent right TSS. RESULTS: Mean pathological tumour size was 14.6±12.5 mm. Intraoperative frozen section evaluation of the mass was performed in eight patients that revealed benign lesions. No intraoperative tumour bed biopsies were taken in this patient group. Regarding the remaining five patients, intraoperative tumour bed biopsies were taken and testicular intraepithelial neoplasia (TIN) was reported in two (40%) patients; no local testicular radiotherapy was given postoperatively. Tumour pathology was malignant in all but one lesion, including Leydig cell tumour (n=1), seminoma(n=2), embryonal carcinoma (n=1), and adenomatoid tumour (n=1). During 47.2±22.5 months of followup, local recurrence was detected in one patient who underwent radical orchiectomy. No additional local recurrence or systemic metastasis was identified in other patients with malignant lesions. For patients with malignant tumours, of the three patients with a normal preoperative testosterone levels, testosterone level was normal in one patient (with no erectile dysfunction [ED]) and was decreased in two patients (with ED) following TSS. No ED was reported in the nine patients with benign lesions. CONCLUSIONS: In carefully selected cases, TSS appears to be a safe, feasible procedure with adequate cancer control that could preserve sexual function.

Does extent of prostate-specific antigen fluctuation can predict Gleason score upgrading in low-risk prostate cancer patients?

OBJECTIVE: To evaluate the effect of prostate-specific antigen (PSA) fluctuation on Gleason score (GS) upgrading, disease upstaging, oncological outcomes in low-risk prostate cancer (PCa) patients who underwent robot-assisted laparoscopic radical prostatectomy (RARP) and met the inclusion criteria for active surveillance (AS). MATERIAL AND METHODS: Data of 354 low-risk PCa patients who underwent RARP were retrospectively evaluated. Patients were divided into two groups: PSA fluctuation rate<9.5%/month (Group 1, n=192) and >9.5%/month (Group 2, n=162). Mainly compared parameters were GS upgrading, disease upstaging, biochemical recurrence (BCR) and surgical margin positivity (SMP) rates. RESULTS: GS upgrading, disease upstaging and SMP were detected in 128 (36.2%), 56 (15.8%) and 42 (11.9%) patients, respectively. After a median follow-up of 46 months, BCR was observed in 40 (11.3%) patients. GS upgrading (41.1% vs. 30.2%, p=0.033), disease upstaging (19.8% vs. 11.1%, p=0.028), SMP (15.1% vs. 8%, p=0.035) and BCR development (15.6% vs. 6.2%, p=0.005) rates were statistically significantly higher in Group 1 than Group 2. In multivariate analysis, digital rectal examination positivity, the presence of two positive cores and low PSA fluctuation rate were found to be significant predictors of GS upgrading. CONCLUSION: Low PSA fluctuation rate is associated with higher GS upgrading.

Does Presence of a Median Lobe Affect Perioperative Complications, Oncological Outcomes and Urinary Continence Following Robotic-assisted Radical Prostatectomy?

PURPOSE: To evaluate of the presence of a median lobe(ML) affect perioperative complications, positive surgical margins(PSM), biochemical recurrence(BCR) and urinary continence(UC) following robotic-assisted radical prostatectomy(RARP). MATERIALS AND METHODS: Data of 924 consecutive patients who underwent RARP for prostate cancer (PCa) and who have at least 1-year follow-up were evaluated retrospectively. All patients were divided into two groups: Group 1(n=252) included patients with ML and Group 2 (n=672) included patients without ML. The primary endpoint of this study was to compare complication rates between two groups. The secondary endpoints were to compare PSM, BCR and UC rates. RESULTS: Both groups were statistically similar in terms of demographics and variables about PCa. Mean prostate volume was higher in Group 1 vs. Group 2 (69± 31 vs. 56±23 mL, p<.001). Total operative time was longer in Group 1 vs. Group 2 (144±38 vs. 136±44 min, p=.01). Biochemical recurrence, PSM, perioperative and postoperative complication rates of our population were 13.6%, 14.9%, 1.7% and 8.7%, respectively. There were no statistical differences in terms of perioperative complication, PSM and BCR rates between the groups(p>0.05). At the first month after RARP, total continence rate was statistically significant lower in Group 1 vs. Group 2 (49.2% and 56.5%, p=.03), respectively. However, there were no significant differences in terms of continence rates at 3rd month, 6th month and 1st-year follow-up. CONCLUSIONS: Due to our experience, the presence of ML does not seem to affect perioperative complication, intraoperative blood loss, PSM and BCR following RARP. However, the presence of ML seems to be a disadvantage in gaining early UC following RARP.

Concurrent Repair of Inguinal Hernias with Mesh Application During Transperitoneal Robotic-assisted Radical Prostatectomy: Is it Safe.

PURPOSE: To assessment the safety of concurrent repair of inguinal hernia (IH) with mesh application during transperitoneal robotic-assisted radical prostatectomy(RARP). MATERIALS AND METHODS: Data of 20 patients (totally 25 procedures) who performed concurrent IH repair with mesh application during RARP were retrospectively enrolled in this study. Preoperative patient characteristics, intra and postoperative parameters (pathological Gleason grade, prostate volume at surgical specimen, operative time, herniorrhaphy time, estimated blood loss, complications, time of hospitalization, catheterization, and drainage) were evaluated. Standard PSA control and postoperative complications of mesh application such as herniarecurrence, mesh infection, seroma formation and groin pain were evaluated at every follow-up visits (every three in the first year, then every 6 months in years 2 to 5 and annually thereafter. RESULT: The mean age was 66 ± 8 years in our population. Fifteen (60 %) patients had a unilateral hernia and 5 (40%) patients had bilateral hernias. The mean operative time was 139 ± 21minutes and estimated mean blood loss was 108 ± 76 mL. The mean duration of IH repair in patients which was 27 ± 5 (range: 17- 40) minutes. The mean time of drainage, hospitalization, and catheterization were 2.5 ± 0.8 days (range: 2-6), 4 ± 0.9 days (range: 2-7) and 8.2 ± 1.9 days (range: 7-14), respectively. We did not observe any intra-operative complication due to RARP orIH repair. Wound evisceration at camera port site developed in only a patient on postoperative day 20. Our median follow-up time was 13 months and we did not observe mesh infection or hernia recurrence during follow-up. CONCLUSION: Concurrent IH repair with RARP procedure seem to be easy to perform, effective and safe procedure.

A giant pararectal cyst successfully treated by robotic surgery.

A 50 year-old patient was referred to our department with severe obstructive lower urinary tract symptoms, suprapubic pain and rectal fullness that started after a perianal fistula operation performed one year ago. Radiologic evaluation showed a large pararectal cystic lesion with septa formation on the right side compressing the bladder and prostate. Aspiration of the cystic fluid attempted initially but was not successful. A robotic transperitoneal approach was applied and the cyst was excised completely. On 1-year follow-up, patient did not have any symptoms and cyst was completely disappeared on radiology.

Open stone surgery: a still-in-use approach for complex stone burden.

INTRODUCTION: Urinary stone disease is a major urological condition. Endourologic techniques have influenced the clinical approach and outcomes. Open surgery holds a historic importance in the management of most conditions. However, complex kidney stone burden may be amenable to successful results with open stone surgery. In this article, we report our eighteen cases of complex urinary stone disease who underwent open stone removal. MATERIAL AND METHODS: A total of 1701 patients have undergone surgical treatment for urinary stone disease in our clinic between July 2012 and July 2016, comprising eighteen patients who underwent open stone surgery. Patients' demographic data, stone analysis results, postoperative clinical data, and stone status were evaluated retrospectively. The choice of surgical approach is mostly dependent on the surgeon's preference. In two patients, open surgery was undertaken because of perioperative complications. RESULTS: We did not observe any Clavien-Dindo grade 4 or 5 complications. Three patients were managed with a course of antibiotics due to postoperative fever. One patient had postoperative pleurisy, one patient had urinoma, and two patients had postoperative ileus. Mean operation time was 84 (57-124) minutes and mean hospitalization time was 5.5 (3-8) days. Stone-free status was achieved in 15 patients (83.3%). CONCLUSIONS: Endourologic approaches are the first options for treatment of urinary stone disease. However, open stone surgery holds its indispensable position in complicated cases and in complex stone burden. Open stone surgery is also a valid alternative to endourologic techniques in all situations.

A Large Posteriorly Located Prostatic Mass Lesion Challenging the Robotic Surgeon: Prostate Leiomyoma.

Background: Prostatic leiomyoma is a benign and rare condition of the prostate. Robotic surgery is increasingly being applied in the surgical management of prostate cancer. Case Presentation: Herein, a mass lesion that was located in the posterior part of the prostate between seminal vesicles that was identified during robotic surgery is presented. This lesion further challenged the console surgeon during performing a robotic radical prostatectomy procedure for a 200 g large prostate with prostate cancer. Conclusion: Prostatic leiomyomas that are benign mesenchymal smooth muscle tumors might present as a posteriorly located mass lesion between seminal vesicles that could challenge the surgeon during surgery, which should be kept in mind.

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

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

Evaluation of oxidative stress status and antioxidant capacity in patients with painful bladder syndrome/interstitial cystitis: preliminary results of a randomised study.

PURPOSE: This study aimed to investigate oxidative stress in etiopathogenesis by analyzing serum total antioxidant capacity (TAC), total oxidant status (TOS), binding capacity of exogenous cobalt to human albumin (IMA), serum advanced oxidation protein products (AOPP), paraoxonase (PON), arylesterase, IgE, and C-reactive protein (CRP) in bladder pain syndrome/interstitial cystitis (BPS/IC). METHODS: The study included 16 female patients diagnosed with BPS/IC and 25 healthy female subjects forming the control group. A bladder biopsy was performed on all patients in the BPS/IC group by carrying out cystoscopy with hydrodistention under general anesthesia. The results of serum TAC, TOS, IMA, AOPP, PON, arylesterase, IgE, and CRP of the subjects in both groups were compared. RESULTS: The mean age of the 16 female patients in the BPS/IC group was 43.6 ± 14.5 years, and the mean age of the 25 healthy subjects in the control group was 42.0 ± 10.3 years. According to the criteria of International Society for the Study of Interstitial Cystitis (ESSIC), eight patients were classified as Type 2A, three patients as Type 2B, four patients as Type 2C, and one patient as Type 3C. In the BPS/IC group, while TAC was found significantly lower than in the control group, IMA, IgE, and CRP were found significantly higher (P < 0.05). When binary logistic regression analysis was performed, the created model was determined to have 81.3 % sensitivity and 80 % specifity. CONCLUSIONS: In the etiology of BPS/IC, mechanism of oxidative damage comes into prominence. In the diagnosis of BPS/IC, IgE, CRP, and TAC are not specific markers when used separately; however, a higher specifity and sensitivity could be reached when used jointly in the suspected patients.

Does anterior prostatic fat tissue removed during robotic radical prostatectomy contain any lymph nodes?

INTRODUCTION: We investigated whether anterior periprostatic fat (APPF) tissue removed during robotic radical prostatectomy (RARP) contains any lymph nodes (LNs). MATERIAL AND METHODS: APPF tissues removed during RARP in 129 patients were evaluated histopathologically. Correlation with postoperative pathologic stage was made. Patients with a history of previous prostate or bladder surgery and radiation therapy were excluded. RESULTS: Mean patient age, serum prostate specific antigen (PSA), prostate weight and body mass index (BMI) were 62.2 ±5.5 (range 45-74), 9.3 ±6.3 ng/dl (range 0.26-30.3), 60.3 ±27.2 grams (range 11.0-180) and 26.6 ±1.9 kg/m(2) (range 20.0-30.3), respectively. Overall, LNs in APPF tissues were detected in 14 (10.9%) patients with a mean LN yield of 1.1 ±0.7 LNs (range, 1-3). Among those found, no metastatic LN was detected. Of the patients with pT2a (n = 22), pT2b (n = 15), pT2c (n = 62) and pT3a (n = 21) disease, LNs in APPF tissues were detected in 1 (4.6%), 1 (6.7%), 11 (17.7%) and 1 (4.8%) patient in each group, respectively. Among the patients, LNs in APPF tissues were detected in 0 (0%), 5 (35.7%), 8 (57.1%) and 1 (7.1%) patients of underweight, optimal weight, overweight and obese patients due to body mass index, respectively. CONCLUSIONS: In our series, LNs were detected in around 10% of the patients. Therefore, this fat should, not be pushed back during RARP but should be removed and sent for pathologic evaluation. Although no metastatic LN was detected in our series, the presence of metastatic LNs might have an impact on the oncologic outcomes of the patients and warrants further research.