Female sexual dysfunction in urinary and double incontinence.

OBJECTIVES: To evaluate the sexual function of women with urinary incontinence (UI) and double incontinence (DI) comparing with a healthy control group by using the Female Sexual Function Index (FSFI). METHODS: This study was designed as a retrospective study consisting of UI, DI, and a control group, each containing age-matched 40 patients. Statistical comparisons were made among the UI, DI, and control groups in terms of the FSFI total score as well as each domain's score. RESULTS: The FSFI total scores were found to be 22.92, 20.53, and 20.32 for the control, UI, and DI groups, respectively, and no statistically significant difference was found among the groups. A statistically significant difference existed among the groups only in terms of satisfaction and pain. Significantly higher pain was found in the UI and DI groups compared with the control group (p=0.007 and p<0.001). Although there was significantly lower satisfaction in the DI group compared with the control group (p=0.012), no significant difference was found between the UI and control groups. CONCLUSION: The pain in the UI group and the pain and the low satisfaction in the DI group might be parameters that cause sexual dysfunction.

Bladder neck sparing during robot-assisted laparoscopic radical prostatectomy: Six-year experience.

OBJECTIVE: Prostate cancer is the most frequently diagnosed cancer among men in developed countries. Radical prostatectomy (RP) is the standard surgical treatment for patients with organ-confined disease and robot-assisted laparoscopic radical prostatectomy (RALP) procedures get more popular in the past 20 years. The most important factor of continence after RP is the preservation of the functional sphincter mechanisms. Tunc et al. described the novel bladder neck preserving technique in RALRP in 2015. The purpose of this study is to present our long-term results of our novel technique during RALP performed by single surgeon (LT). METHODS: In this study, 331 patients who went under procedure RALP between January 2012 and December 2017 analyzed retrospectively. Bladder neck sparing technique was performed for all patients used by a four-armed da Vinci robotic surgical system (Intuitive Surgical, Inc., Sunnyvale, CA). Quality of life (QoL) scores were assessed before RALP, after urethral catheter removal, and at the 1st month after RALP used by SF-12 QoL questionnaire. Patients without urine leakage during coughing or sneezing, as well as those who stayed totally dry, were considered as continent. Those who used more than 1 protective pad per day and/or had urine leakage during coughing, sneezing, or during the night were considered incontinent. RESULTS: The mean operation time, docking time, and anastomosis time were 76.9±28.9, 7.2±2.2, and 18±3.1 min, respectively. Estimated blood loss was 51.6±22.9 ml. The mean hospital stay was 2.2±0.8 days. The mean duration of the catheter was 7.1±1.3 days. After catheter removal, 310 (93.6%) of patients were continent immediately. During follow-up, 318 (96%) were continent after 1 month and 329 (99.3%) were totally continent after 1 year. No patient received surgical treatment for stress incontinence. CONCLUSION: Since we have defined bladder neck sparing technique, we have realized that our technique is very effective with our long-term results. Our novel technique provided very early continence at the time of catheter removal after RALP within short-term follow-up in addition to favorable oncologic results.

Descending laparoscopic radical nephrectomy and proven advantages in long term. / Nefrectomía radical laparoscópica descendente. Ventajas a largo plazo demostradas.

OBJECTIVES: We aim to present and analyze the long term results of descending transperitoneal laparoscopic nephrectomy (TLN) technique (Tunc technique). METHODS: A total of 308 patients that underwent descending TLN were included to the study between January 2011 and March 2018. Mean operation time, mean estimated blood loss, duration of hospital stay, complications, mean tumor size, and pathologic margin status were analyzed. RESULTS: A total of 308 patients underwent the descending TLN technique. Mean tumor size was 6.5±1.83 (range 3.5-12 cm). Mean intraoperative estimated blood loss was 38±6.91mL. Mean operation time was 24.97±6.8 minutes. Duration of hospital stay was1.85±0.69 days. Only one patient received postoperative blood transfusion for chronic anemia. Two of the patients had endoGIA stapler malfunction. None of the patients required conversion to open surgery intraoperative. There was no positive margin status. CONCLUSIONS: We could prove the safety and effectiveness of descending TLN technique. The main advantages of descending TLN over traditional ascending nephrectomy technique are shorter operation time and hospital stay.

OBJETIVOS: El objetivo fue presentar y analizar los resultados a largo plazo de la técnica de nefrectomía laparoscópica transperitoneal (TLN) descendente (técnica Tunc).MÉTODOS: Un total de 308 pacientes sometidos a TLN descendente se incluyeron en el estudio entre enero de 2011 y marzo de 2018. Se analizaron el tiempo medio de operación, la pérdida sanguínea estimada media, la duración de la estancia hospitalaria, las complicaciones, el tamaño tumoral medio y el estado del margen patológico. RESULTADOS: Un total de 308 pacientes se sometieron a la técnica de TLN descendente. El tamaño promedio del tumor fue de 6,5 ± 1,83 (rango de 3,5-12 cm). La pérdida de sangre estimada intraoperatoria media fue de 38 ± 6,91 ml. El tiempo medio de operación se calculó en 24,97 ± 6,8 minutos. La duración de la estadía hospitalaria fue de 1,85 ± 0,69 días. Solo un paciente recibió transfusión de sangre postoperatoria por anemia crónica. Dos de los pacientes tenían mal funcionamiento de la engrapadora endoGIA. Ninguno de los pacientes requirió conversión a cirugía abierta intraoperatoria. No hubo un estado de margen positivo. CONCLUSIONES: Podríamos demostrar la seguridad y efectividad de la técnica de TLN descendente. Las principales ventajas de la TLN descendente sobre la técnica tradicional de nefrectomía ascendente son el tiempo de operación más corto y la estancia hospitalaria.

Nefrectomía radical laparoscópica descendente. Ventajas a largo plazo demostradas / Descending laparoscopic radical nephrectomy and proven advantages in long term

Objetivos: El objetivo fue presentar y analizar los resultados a largo plazo de la técnica de nefrectomía laparoscópica transperitoneal (TLN) descendente (técnica Tunc). Métodos: Un total de 308 pacientes sometidos a TLN descendente se incluyeron en el estudio entre enero de 2011 y marzo de 2018. Se analizaron el tiempo medio de operación, la pérdida sanguínea estimada media, la duración de la estancia hospitalaria, las complicaciones, el tamaño tumoral medio y el estado del margen patológico. Resultados: Un total de 308 pacientes se sometieron a la técnica de TLN descendente. El tamaño promedio del tumor fue de 6,5 ± 1,83 (rango de 3,5-12 cm). La pérdida de sangre estimada intraoperatoria media fue de 38 ± 6,91 ml. El tiempo medio de operación se calculó en 24,97 ± 6,8 minutos. La duración de la estadía hospitalaria fue de 1,85 ± 0,69 días. Solo un paciente recibió transfusión de sangre postoperatoria por anemia crónica. Dos de los pacientes tenían mal funcionamiento de la engrapadora endoGIA. Ninguno de los pacientes requirió conversión a cirugía abierta intraoperatoria. No hubo un estado de margen positivo. Conclusiones: Podríamos demostrar la seguridad y efectividad de la técnica de TLN descendente. Las principales ventajas de la TLN descendente sobre la técnica tradicional de nefrectomía ascendente son el tiempo de operación más corto y la estancia hospitalaria

Objectives: We aim to present and analyze the long term results of descending transperitoneal laparoscopic nephrectomy (TLN) technique (Tunc technique). Methods: A total of 308 patients that underwent descending TLN were included to the study between January 2011 and March 2018. Mean operation time, mean estimated blood loss, duration of hospital stay, complications, mean tumor size, and pathologic margin status were analyzed. Results: A total of 308 patients underwent the descending TLN technique. Mean tumor size was 6.5 ± 1.83 (range 3.5-12 cm). Mean intraoperative estimated blood loss was 38 ± 6.91 mL. Mean operation time was 24.97 ± 6.8 minutes. Duration of hospital stay was1.85 ± 0.69 days. Only one patient received postoperative blood transfusion for chronic anemia. Two of the patients had endoGIA stapler malfunction. None of the patients required conversion to open surgery intraoperative. There was no positive margin status. Conclusions: We could prove the safety and effectiveness of descending TLN technique. The main advantages of descending TLN over traditional ascending nephrectomy technique are shorter operation time and hospital stay

A Ureteral Inguinoscrotal Hernia from a Pelvic Kidney.

A 74-year-old male patient with prostate cancer under remission was admitted with left inguinoscrotal swelling. He underwent scrotal ultrasound demonstrating a giant in-guinoscrotal hernia. Contrast-enhanced computerized tomography of the abdomen and pelvis demonstrated a left pelvic kidney associated with severe hydroureteronephrosis secondary to a ureteral inguinoscrotal hernia. Upon exploration with left inguinal incision, a paraperitoneal ureteral in-guinoscrotal hernia and a hypertrophic left spermatic cord were observed. The elongated and tortuous left ureter, being pulled down to the scrotum by the hernia, was released from the herniating tissues fullfilling left hemiscrotum. The ureter was tapered followed by ureteroureterostomy. The accompanying left spermatic cord was excessively elongated and curled, necessitating cordectomy. The hernia was repaired with prolene mesh after removal of herniating peritoneal tissue. This is a rare case of a paraperitoneal ureteral inguinoscrotal hernia of the left pelvic kidney.

Detailed Surgical Anatomy of Prostate: Relationship between Urethra and Dorsal Vein Complex with Apex.

AIM: To describe our surgical technique for dissecting the apex of prostate during robotic-assisted laparoscopic radical prostatectomy (RALP) and detailed surgical anatomy of prostate including relationship between urethra and dorsal vein complex with apex. MATERIALS AND METHODS: In retrospective view of prospective collected data, 73 patients underwent RALP between December 2012 and September 2014. Surgical anatomy of prostate was revealed in all procedures. Quality of life (QoL) scores were assessed before, immediately after catheter removal, and 1 month after surgery. We divided urinary continence into 3 groups, as very early continence; continence at time of urethral catheter removal, early continent; and continence 1 month after surgery. The rest of the patients were accepted as continence. RESULTS: The mean follow-up was 10.2 ± 5.4 months and mean age was 61.5 ± 6.6. Maximum protection of urethra could be provided in all. Mean catheter removal was 8.9 ± 1.7 days, and all patients were continent at the time of catheter removal. QoL scores before RALP could be protected after surgery (p = 0.2). Neither conversion to open/conventional laparoscopic surgery nor complications related with bladder neck were detected. CONCLUSIONS: Our surgical technique can be a strong candidate for being a surgical technique for preserving urethra and very early continence could be provided after surgery.

Safety of ESWL in elderly: evaluation of independent predictors and comorbidity on stone-free rate and complications.

AIM: Urinary stone disease affects people of all ages. With its satisfactory efficacy ranges in all age groups and lack of side-effects, extracorporeal shock wave lithotripsy (ESWL) has become the preferred treatment modality for uncomplicated renal and proximal calculi ≤ 20 mm. In the present study, we aimed to assess the safety and efficacy of the ESWL treatment in elderly patients. METHODS: A retrospective study was carried out on patients aged over 65 years who underwent shock wave lithotripsy at our Department from 2009 to 2011, with a Siemens Lithostar electromagnetic shockwave lithotripter. A total of 231 patients (157 males, 74 females) out of 1694 (13.6%) were studied. The patients were divided into two groups (group 1 = 65-70; group 2 >70). The effect of age and other possible predicting factors (sex, stone localization and stone size) were investigated. Concomitant diseases and related complications were also evaluated. RESULTS: An overall stone-free rate (SFR) of 82.2% was found. The influence of sex on SFR was non-significant. There was no significant difference when comparing SFR between the age groups. When patients were divided into those with renal and ureteral stones, the SFR were 94.4% and 67.6% (P < 0.01), respectively. The SFR of the stone size groups, ≤ 10 mm and > 10 mm were 80% and 84.4%, respectively. Comorbidity was present in 148 patients. Complications were noted in 56 of 231 patients. Of 56 patients, 43 had minor complications and 13 major complications. CONCLUSION: ESWL seems to be an effective first-line treatment choice for urinary stones in elderly patients with careful patient selection and personalized preparation.