Can Neoadjuvant Chemotherapy Cause Postoperative Hydronephrosis After Radical Cystectomy?

OBJECTIVE: This study's objective is to assess the effect of preoperative factors on postoperative hydroureteronephrosis (HUN) after radical cystectomy (RC) in patients with bladder cancer (BC). METHODOLOGY: Patients who underwent RC for BC between January 2019 and November 2022 and had unilateral or bilateral postoperative HUN were retrospectively analyzed. Patients without preoperative HUN but with postoperative HUN constituted the patient group, while patients without both preoperative and postoperative HUN constituted the control group, and they were compared with each other. RESULTS: Neoadjuvant chemotherapy (NAC) and postoperative metastasis were positively correlated with postoperative HUN (r = 0.238, P = 0.007, and r = 0.203, P = 0.021, respectively). Multivariate logistic regression analysis showed that the postoperative HUN was significantly associated with NAC (P = 0.048; Exp(B) = 6.896, 95% confidence interval [CI] 1.02-46.9) but not associated with the presence of metastasis (P = 0.054). Moreover, NAC increased the possibility of undergoing revision surgery (P = 0.002; Exp(B) = 26.9, 95% CI 3.2-225). CONCLUSIONS: NAC is an independent factor for impaired anastomotic healing, increased postoperative HUN, and the need for revision surgery in patients with BC.

Could twinkling artifact be a parameter in predicting the success of shock wave lithotripsy? A prospective study.

Introduction: It is important to predict success before the treatment of urolithiasis. We aimed to predict the success of shock wave lithotripsy (SWL) by comparing twinkling artifact (TA) revealed through colour Doppler ultrasonography (CDUS) with stone density in non-contrast computed tomography (NCCT). Material and methods: Eighty patients who underwent SWL between January 2021 and January 2022 were included in the study. Patients with stones of 5-20 mm in the renal pelvis and proximal ureter at NCCT were included. Patients' demographics, Hounsfield units (HU) in NCCT, and TA grades in CDUS were recorded. The stone-free rate after SWL, additional treatments, overall success rates, and the association between TA and success rates were evaluated. Results: The mean age was 47.41 ±15.08 years. The mean BMI was 24.49 ±3.67 kg/m2. Twenty-three (28.8%) patients were TA grade 0, 33 (41.2%) patients were grade 1, and 24 (30%) were grade 2. The mean HU of TA grades 0, 1, and 2 of stones were 628 ±107, 864 ±123, and 1166 ±292, respectively. The HU increased along with the increase in the TA grade of the stone (p <0.01). The mean number of SWL sessions was 2.26 ±0.75 in patients with TA grade 0, and 2.92 ±0.40 in patients with TA grade 2. The mean number of SWL sessions increased along with the increase in TA grade (p <0.01). The stone-free rate decreased as the TA grade increased. Stone diameter and TA were the only predictors of SWL success. Conclusions: We think that TA may be useful in predicting SWL success.

Distinct Adverse Clinical Outcomes of Small and Large Cribriform Patterns on Gleason 7 Prostate Cancer: A Preliminary Study.

OBJECTIVE: We aimed to evaluate the effect of large and small cribriform morphology on survival following radical prostatectomy. METHODS: We included 30 patients who underwent radical prostatectomy with curative intent between 2015 and 2022. Patients with the final pathology of Gleason 7 were included. Patients' radical prostatectomy specimens were reviewed by an experienced genitourinary pathologist. The diverse growth patterns of Gleason grade 4 were specified as poorly formed/fused glands, cribriform glands, and glomeruloid glands. The cribriform morphology was subdivided into small and large cribriform. Large cribriform growth morphology was defined by its size, which was double that of benign prostate glands. Small and large cribriform glands' percentages were indicated semiquantitatively. The cribriform morphology subtype present at 50% and higher was defined as the dominant pattern. The effect of histopathological patterns on biochemical recurrence and clinical progression was analyzed. RESULTS: Thirteen patients were small cribriform pattern dominant (group 1), whereas 14 of the patients were large cribriform pattern dominant (group 2). Pathological T, N stages, and surgical margin positivity were similar between groups. Biochemical recurrence and clinical progression rates were significantly higher in group 2. The large cribriform dominant patients had worse 2-year biochemical recurrence-free survival than small cribriform dominant patients (45.5% vs. 66.7%). In the univariate analysis, International Society of Urological Pathology grade, Gleason pattern 4 percentage, large cribriform pattern dominancy, and pT stage were predictors for biochemical recurrence-free survival. International Society of Urological Pathology grade was the only independent predictor for biochemical recurrence-free survival. CONCLUSION: Large cribriform pattern dominancy is associated with worse biochemical recurrence-free survival in Gleason 7 prostate cancer.

Comparison of transcutaneous tibial nerve stimulation versus percutaneous tibial nerve stimulation in category IIIB chronic prostatitis/chronic pelvic pain syndrome: A randomized prospective trial.

BACKGROUND: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a heterogenous condition that impacts the Quality of life severely, and it has multimodal complex treatment options. We aimed to compare the efficacy of two well-described neuromodulation therapies, transcutaneous tibial nerve stimulation (TTNS) versus percutaneous tibial nerve stimulation (PTNS) in the treatment of category IIIB CP/CPPS. METHODS: This study was designed as a randomized prospective clinical trial. We randomized category IIIB CP/CPPS patients into two treatment groups as TTNS and PTNS groups. Category IIIB CP/CPPS was diagnosed by two or four-glass Meares-Stamey test. All patients included in our study were antibiotic/anti-inflammatory resistant. Transcutaneous and percutaneous treatments were applied 30 min sessions for 12 weeks. Patients were evaluated by Turkish-validated National Health Institute Chronic Prostatitis Symptom Index (NIH-CPSI) and visual analogue scale (VAS) initially and after treatment. Treatment success was evaluated within each group and also compared with each other. RESULTS: A total of 38 patients in the TTNS group and 42 patients in the PTNS group were included in the final analysis. The mean VAS scores of the TTNS group were lower than the PTNS group initially (7.11 and 7.43, respectively), (p = 0.03). The pretreatment NIH-CPSI scores were similar between groups (p = 0.07). VAS scores, total NIH-CPSI, NIH-CPSI micturation, NIH-CPSI pain, and NIH-CPSI QoL scores decreased significantly at the end of the treatment in both groups. We found a significantly higher VAS and NIH-CPSI scores decrease in the PTNS group compared to the TTNS group (p < 0.01). CONCLUSION: Both PTNS and TTNS are effective treatment methods in category IIIB CP/CPPS. Comparing the two methods, PTNS provided a higher level of improvement in terms of pain and quality of life.

Impact of COVID-19 on the progression of benign prostatic hyperplasia and aggravation of related symptoms: A prospective study.

OBJECTIVE: This study aims to evaluate the lower urinary tract symptoms (LUTS) of the patients with benign prostatic hyperplasia (BPH) who were admitted due to coronavirus disease (COVID-19) and to show the effect of COVID-19 on BPH. METHODS: This prospective study included patients over the age of 45 admitted due to COVID-19 between June 2021 and December 2021 and treated with alpha-blockers for BPH. During admission, the patients were evaluated by prostate volumes, prostate-specific antigen (PSA) values, and International Prostate Symptom Scores (IPSS). Furthermore, treatment duration due to COVID-19, frequency, nocturia, and voided volumes obtained from the voiding diary was recorded. Finally, the sequent IPSS values were compared by inviting the patients to the urology polyclinic in the first month. RESULTS: The mean age of 142 patients was 72.42 ± 10.21 years. The IPSS scores of the patients increased from 10.66 ± 4.46 to 12.99 ± 3.58 1 month after the diagnosis (p < 0.01). Moreover, the IPSS quality of life (QoL) scores were 2.44 ± 0.58 and 2.75 ± 0.51, respectively (p < 0.01). The mean frequency obtained from the voiding diary data increased from 5.10 ± 1.5 to 5.65 ± 1.36 (p < 0.01), mean nocturia count increased from 1.13 ± 0.05 to 1.39 ± 0.66 per day (p < 0.01), and the mean voiding volume decreased from 320.56 ± 46.76 ml to 298.84 ± 39.74 ml (p < 0.01). CONCLUSION: In this study, we detected an increase in LUTS during COVID-19 treatment. Therefore, it should be noted that symptomatic or asymptomatic COVID-19 patients may refer to urology polyclinics due to aggravation of LUTS.

Efficacy of transcutaneous tibial nerve stimulation in the treatment of bladder pain syndrome.

Background: This study aimed to demonstrate the effectiveness of transcutaneos tibial nerve stimulation (TTNS) in the treatment of bladder pain syndrome (BPS). Materials and methods: The data of 16 female patients, diagnosed with BPS in our clinic between 2019 and 2021 and had TTNS twice a week for 12 weeks, were retrospectively analyzed. Results: The mean age of the patients was 46.00 ±â€Š13.11 years, and the mean body mass index was 26.43 ±â€Š3.07 kg/m2. After the treatment, the median day time frequency of the patients decreased from 13.37 (3.69) to 10.25 (4.56) (p < 0.001). Nocturia also decreased after treatment from 4.37 (1.81) to 3.00 (1.94) (p = 0.001). The median voiding volume increased by 26.5 mL (p = 0.001). The median of the patients' visual analog scale scores decreased after treatment (median of visual analog scale score changed from interquartile range 8 [1] to 7 [4]) (p = 0.001). In addition, the median interquartile range interstitial cystitis symptom index scores decreased from 17 (4) to 15 (10) (p = 0.002). Conclusions: In this study it was demonstrated that TTNS is an alternative method that can be successfully applied before invasive methods in the treatment of BPS.

How effectively do we apply first-line treatment in overactive bladder?

INTRODUCTION AND HYPOTHESIS: We aimed to reveal the effectiveness of the combination of behavioral therapy (BT), drug therapy, and pelvic floor muscle training (PFMT) in patients with the diagnosis of overactive bladder (OAB) who did not respond to drug therapy. METHODS: Seventy female patients aged between 18 and 65 years diagnosed with wet-type OAB, who did not respond to drug therapy, were included in our study, which was planned as a prospective randomized controlled trial. The patients were randomly assigned to one of two groups. BT and a combination of anticholinergic + beta3-agonist was implemented in the control group for 12 weeks. BT and PFMT were applied with a combination of anticholinergic + beta3-agonist in the active therapy group for 12 weeks. Post-treatment changes in OAB, ICIQ-SF scores, and frequency and nocturia were compared. RESULTS: The age and BMI averages of the groups were similar (p>0.01). After the treatment, no significant decrease was observed in OAB scores in the control group (p = 0.06), but a significant decrease was observed in the active therapy group (p<0.01). The mean ICIQ-SF scores and the number of nocturia were found to decrease in both groups after 12 weeks of treatment (p<0.01). There was no significant decrease in frequency in the control group (p = 0.054). It regressed significantly in the active therapy group (p<0.01). After the treatment, 3 of 30 the patients in control group (10%) and 11 of the 32 patients in the active therapy group (34.3%) said that their complaints had regressed and that they were pleased with their current situation. Although after the treatment, 4 patients in the control group were dry (13.3%), 10 patients in the active therapy group were dry (31.25%). CONCLUSIONS: We demonstrated that drug therapy, BT, and PFMT, which are recommended in the first-line treatment of OAB reduce the need for invasive treatments when they are well explained to the patients and combined.

The Impact of COVID-19 Pandemic on Urological Emergencies, 8 Months Results of a Multicenter Retrospective Study From Turkey.

Objectives: We aimed to reveal the change of urological emergencies during the COVID-19 pandemic compared to the same period of the previous year. Methods: The number of admissions to the emergency department (ED), admissions to the urology outpatient clinic, emergency urological consultations, and urological and emergency urological surgeries during the periods April-November-2019 and April-November-2020 were recorded. The data of the COVID-19 period were compared with the previous year. Results: While the number of admissions to the urological outpatient clinic was 160,447 during the COVID period, it was 351,809 during the non-COVID period. The number of admissions to the ED decreased from 3.2 million to 2.4. The number of admissions to the urology outpatient clinic significantly decreased by 54% during the pandemic (p=0.001). Percutaneous cystostomy performed due to acute urinary obstruction decreased by 27.96%, double J stent, nephrostomy decreased by 16.61%, and ureterorenoscopy decreased by 12.26%. Urogenital trauma also decreased. On the contrary, surgical procedures performed due to penile fracture, gross hematuria, Fournier gangrene, and testicular torsion increased. Conclusion: During the COVID-19 pandemic, a significant decrease was observed in non-COVID patients' admissions to the emergency and urology department, and in urologic surgeries.

A factor not to be ignored in post-COVID-19 erectile dysfunction; psychological effect, a prospective study.

It was aimed to show the effect of anxiety and depression on erectile dysfunction seen after coronavirus disease-2019 (COVID-19). Between March and July 2021, the participants completed the International Index of Erectile Function, Beck Depression Inventory and Generalised Anxiety Disorder 7 forms at the beginning and after the 1st month of the disease. We investigated the psychological impact of COVID-19 on the development of erectile dysfunction. The mean age of 156 male patients in the study was 54.74 ± 8.01 years. It was determined that the mean International Index of Erectile Function scores of the patients before COVID-19 were 73.42 ± 3.43 and decreased to 68.28 ± 12.86 after COVID-19 (p < .01). The patients' erectile function scores were significantly lower after COVID-19 (29.45 ± 1.23, 27.69 ± 4.33, p < .01, respectively). Their Beck Depression Inventory scores were statistically significantly higher after COVID-19 (1.69 ± 2.56, 2.22 ± 2.79, p < .01, respectively). Their Generalised Anxiety Disorder 7 scores were also statistically significantly higher after COVID-19 (4.69 ± 1.63 6.56 ± 2.40, p < .01, respectively). A negative correlation was found between the increase in the Beck Depression Inventory score during the pandemic process and the decrease in the International Index of Erectile Function score (r = -0.356, p = <.001). A negative correlation was also found between the increase in the Generalised Anxiety Disorder 7 score and the decrease in the International Index of Erectile Function score (r = -0.200, p = .012). One of the main factors post-COVID-19 erectile dysfunction is anxiety and depression due to the disease.

Comparison of transcutaneous tibial nerve stimulation (TTNS) protocols for women with refractory overactive bladder (OAB): A prospective randomised trial.

OBJECTIVES: Transcutaneous tibial nerve stimulation (TTNS) is a noninvasive method used in OAB treatment. Purpose of this study is to compare the effectiveness of the TTNS procedure applied once a week and three times a week in women diagnosed with wet type refractory OAB. METHODS: A total of 60 patients diagnosed with wet type OAB that was refractory to medical treatment were included in the study. Participants were equally and randomly divided into two groups: TTNS treatment was performed with a duration of 30 minutes for 12 weeks, once a week to Group I and three times a week to Group II. Pretreatment and posttreatment OAB-V8/ICIQ-SF scores and voiding frequencies recorded in the bladder diary were compared between groups. RESULTS: Four patients in Group 1 and eight in Group 2 left the study without completing the treatment. TTNS was performed in both groups for 12 weeks. There was a significant decrease in the voiding frequency, OAB-V8, ICIQ-SF scores in both group 1 and group 2 (P < .001). A significant decrease in the OAB-V8 score was observed in the 5th week in Group 1, and in the 3rd week in Group 2. Complete response was observed in 6 patients (23.1%) in Group 1 after 12 weeks of TTNS procedure. In Group 2, 10 patients (45.5%) had a complete response. After the 12-week TTNS procedure, no significant difference was observed between the groups in terms of treatment response. CONCLUSION: TTNS can be safely used before invasive treatments in resistant OAB. TTNS procedure three times a week seems more effective than performing it once a week. What's known TTNS is one of the effective alternative treatments in resistant OAB treatment. What's new As the number of sessions is increased in TTNS treatment, the success of the treatment can increase.

Is There a Correlation Between Behçet Disease and Lower Urinary Tract Symptoms?

PURPOSE: In this study, we aimed to determine the prevalence of lower urinary tract symptoms (LUTS) in patients with Behçet disease (BD) and to investigate the relationship between the severity of BD and LUTS. METHODS: Fifty-five patients with BD were included in this study from January to December 2018. All patients received a detailed urological evaluation. Additionally, BD activity was investigated using the Behçet Disease Current Activation Form. The International Prostate Symptom Score (IPSS), International Consultation on Incontinence Questionnaire Short Form, 8-item overactive bladder questionnaire forms, uroflowmetry, and postvoid residual urine volume were evaluated. RESULTS: The mean age of the patients was 42.6 years. The mean activity score of BD was 4.6±3.2 and the mean IPSS score was 7.3±7.3. Sex had no significant effect on the BD activity score. The BD activity score was significantly correlated with the IPSS score, frequency of daytime urination, nocturia, and urgency. It was also correlated with the presence and the severity of urinary incontinence and the effect of urinary incontinence on daily life. Peak flow rate, voided volume, and the postvoid residual urine volume were not correlated with the BD activity score. CONCLUSION: LUTS were highly prevalent in patients with BD, and the severity and current activity of BD were correlated with frequency, nocturia, urgency, and urinary incontinence. Therefore, a urological evaluation of patients with BD in whom the activity and severity of the disease is elevated should be carried out comprehensively and patients should be managed accordingly.

The use of biomarkers in the diagnosis and treatment of overactive bladder: Can we predict the patients who will be resistant to treatment?

AIMS: The main objective of this study was to define urinary biomarkers that can predict the severity of overactive bladder and detect patients who would benefit most from treatment. METHODS: Patients with an OAB diagnosis and healthy controls were included in the study. A bladder diary and a validated OAB questionnaire were given to all patients. In the OAB group, solifenacin 5 mg daily was given for 1 month. Urine samples were taken before the treatment and after the first month of the treatment in both groups and urinary BDNF, NGF, GAG, and MCP-1 levels were measured. RESULTS: A total of 45 OAB patients and 45 healthy age-matched controls were included. BDNF/Cre, NGF/Cre, MCP-1/Cre, and GAG/Cre levels were significantly higher in the OAB group. The levels of these biomarkers significantly decreased after 1 month of solifenacin treatment. After treatment, 66.7% of patients OAB symptoms were relieved and 33.3% did not respond to the treatment. Although basal biomarker levels did not differ between responder and non-responder groups, the ratio of decrease in biomarker levels was significantly higher in treatment-sensitive patients. Postmenopausal women were more resistant to treatment when compared with the premenopausal group. CONCLUSIONS: Urinary biomarkers have a role in the pathophysiology of OAB however they did not predict the patients who would benefit from the treatment and in whom antimuscarinics would be useless. Future studies with higher numbers of patients and different OAB subgroups are needed to investigate the exact role of these (and other) biomarkers. Neurourol. Urodynam. 36:390-393, 2017. © 2015 Wiley Periodicals, Inc.

A rare cause of ureteral injuries; simultaneous common iliac artery and ureter injury during posterior lumbar disc surgery.

Major vascular injuries during lumbar disc surgery are rare but well-recognized complications. However, vascular injuries of the branches of the aorta and ureteral injuries are very rare. Although its incidence is not known definitely, it is estimated to be 1/1000. Ureteral injuries comprise less than 1% of all genitourinary traumas. In this article, we report clinical progress of a patient who had simultaneous internal iliac artery and ureteral injury during lumbar discectomy. The patient was managed with primary ureteroureterostomy. To our knowledge, this is the first case reported with simultaneous ureter and iliac artery trauma during lumbar disc surgery.

The Prevalence of Nocturia and Nocturnal Polyuria: Can New Cutoff Values Be Suggested According to Age and Sex?

PURPOSE: The aims of this study were to assess the prevalence of nocturia and nocturnal polyuria (NP) and to define new cutoff values according to age and sex for both conditions. METHODS: Data from a population-based prevalence survey conducted among a random sample of 2,128 adults were analyzed in this study. Participants were requested to fill out a questionnaire including the International Continence Society (ICS) definitions of lower urinary tract symptoms and the International Consultation on Incontinence Questionnaire - Short Form. Additionally, a 1-day bladder diary was given to each individual. The participants were divided into 5 age groups. The prevalence of nocturia was calculated based on definitions of nocturia as ≥1 voiding episodes, ≥2 episodes, and ≥3 episodes. NP was evaluated according to the ICS definition. The mean±standard errors and 95th percentile values were calculated in each group as new cutoff values for NP. RESULTS: The prevalence of nocturia was estimated as 28.4%, 17.6%, and 8.9% for ≥1, ≥2, and ≥3 voiding episodes each night, respectively. When nocturia was defined as 2 or more voiding episodes at night, the prevalence decreased significantly. The mean NP index was 29.4%±15.0% in men and 23.1%±11.8% in women. For the age groups of <50 years, 50-59 years, and ≥60 years, the new cutoff values for the diagnosis of NP were calculated as 48%, 69%, and 59% for men and 41%, 50%, and 42% for women, respectively. CONCLUSIONS: We found that the definition of nocturia was still controversial and that waking up once for voiding might be within the normal spectrum of behavior. The definition of NP should be modified, and new cutoff values should be defined using the data presented in our study and in other forthcoming studies.

Prevalence of lower urinary tract symptoms, overactive bladder and urinary incontinence in western Turkey: results of a population-based survey.

OBJECTIVE: To estimate the prevalence of lower urinary tract symptoms, urinary incontinence and overactive bladder in western Turkey. METHOD: This cross-sectional, population-based survey was carried out between May and October 2012. A random sample of 2128 women and men aged ≥18 years was selected from the health registries. A questionnaire including sociodemographic data, comorbid conditions, lower urinary tract symptoms, overactive bladder and urinary incontinence symptoms, body mass index, vital signs, and dipstick urinalysis was developed. The questions were answered by the participants, and remaining data were provided by the site staff. International Continence Society definitions were used. RESULTS: A total of 1571 (74%) individuals agreed to participate, and analysis were carried out on 1555 people (636 men [40.9%] and 919 women [59.1%]) after 16 individuals with a nitrite-positive dipstick test were excluded. Lower urinary tract symptoms were reported by 71.0% of the study population. The prevalence of storage, voiding and post-micturition symptoms were 56.1% (44.2% men, 64.1% women), 39.3% (40.9% men, 37.8% women) and 30.7% (38.6% men, 28.7% women), respectively. The most prevalent storage symptom was urgency, which was reported by 29.3% of the study population (20.1% men, 35.6% women). The prevalence of urge, stress and mixed urinary incontinence were: 6.5% (3.9% men, 8.2% women), 14.1% (3.9% men, 21.2% women) and 5.6% (0.8% men, 9.0% women), respectively. CONCLUSION: The present study is the first and largest population-based survey evaluating the prevalence of lower urinary tract symptoms, urinary incontinence and overactive bladder in Turkey. Our findings show these symptoms are highly prevalent in western Turkey.

Optic-guided vaginal repair of vesicovaginal fistula.

BACKGROUND AND PURPOSE: The transvaginal approach for the repair of vesicovaginal fistula (VVF) can sometimes be challenging, especially in fistulas located near the vaginal cuff. We describe a simple technique for the vaginal repair of VVF with the use of endoscopic optics. PATIENTS AND METHODS: Three women were admitted to our department with urinary incontinence after total hysterectomy. Assessment with a clinical examination, imaging, and cystoscopy confirmed the diagnosis of VVF. All patients were operated on between December 2012 and January 2013. The operations were conducted under spinal anesthesia with the patients in the lithotomy position. Cystoscopy was performed and retrograde pyelography ruled out any ureteral damage or fistula. A 10F to 12F Foley catheter was inserted into the fistula. From this point, the operation proceeded with optic vision, mimicking laparoscopic dissection and suturing techniques using a standard 5 mm, 30-degree optic lens, a surgical monitor, and open surgical instruments. The fistula was circumferentially incised and widely mobilized from the surrounding tissues and closed without tension in two layers. A urethral Foley catheter was inserted and maintained for 14 days. RESULTS: The mean operative time was 70 (range 60-80) minutes. Estimated blood loss was minimal. All patients were discharged at postoperative day 1. No complications were observed. At the postoperative first and third month follow-up visits, all patients were voiding without any urinary leakage or complaints. CONCLUSIONS: The use of optics in the vaginal repair of VVF is a useful technique. Optic guidance facilitates surgical vision, dissection, and hemostasis. It is also excellent for surgeon comfort, ergonomics, and resident training.