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 Impact of Histological Variants on Oncological Outcomes in Patients with Muscle Invasive Bladder Cancer Treated with Radical Cystectomy.

OBJECTIVE: Bladder cancer is a heterogeneous entity characterized by a wide range of different morphologies. The aim of this study was to investigate the prognostic effect of bladder tumor with variant histology that is treated with radical cystectomy on oncological outcomes. METHODS: One hundred eighty-six patients who underwent radical cystectomy between September 2001 and June 2020 were included in the study. The patients were divided into 2 groups variant histology group (n = 54) and transitional cell cancer group (n = 132). Clinicopathologic data were compared between the two groups. RESULTS: The groups were similar in terms of demographic characteristics. In the mul- tivariate analysis of cancer-specific survival in transitional cell cancer against variant histology, high-grade detection of primary transurethral bladder tumor pathology, cystectomy pT, cystectomy positive lymph node, and positive surgical margin in cys- tectomy were determined to be statistically significant. Diagnosis of pT2 and high grade of primary transurethral bladder tumor pathology, cystectomy ≥ pT3, cystec- tomy positive lymph node, and positive surgical margin in cystectomy were statis- tically significant in multivariate analysis of overall survival. Cancer-specific survival time was estimated at 65.1 ± 8.3 months for variant histology and 134.2 ± 10.4 months for transitional cell cancer (P=.004). The estimated overall survival time was 61.9 ± 8.0 months in variant histology and 119.0 ± 9.8 months in transitional cell cancer (P = .014). CONCLUSION: Pathological features and prognosis of bladder cancer with variant histol- ogies are worse than those of pure urothelial bladder cancer. Overall survival and can- cer-specific survival are shorter in bladder cancer with variant histology than in pure urothelial bladder cancer. Following the diagnosis of variant histology in transurethral bladder tumor, poor prognosis must be considered in the treatment plan.

The effect of bioelectric impedance analysis on the success of extracorporeal shock wave lithotripsy.

Bioelectric impedance analysis (BIA) is a non-invasive method that can show the distribution of fatty and lean mass of the body. In this study, we aimed to determine the effect of BIA on extracorporeal shock wave lithotripsy (SWL) success. Our secondary aim was to determine the factors predicting transition from a single SWL session to multiple sessions. Patients who underwent SWL due to kidney stones were prospectively included. Demographics, pre-procedural BIA parameters (fat percentage, obesity degree, muscle mass, total water and metabolic rate), stone parameters, and number of SWL sessions were recorded. Univariate and multivariate regression analyzes were made to determine independent risk factors for success. Then, the successful group was divided into two subgroups according to their SWL session number as one session or multiple sessions and multivariate regression analysis was made to determine independent risk factors. Stone-free status was achieved in 114 (61.2%) of 186 patients. Stone Hounsfield Unit (HU) (OR: 0.998, p = 0.004), stone volume (OR: 0.999, p = 0.023) and fat percentage (OR: 0.933, p = 0.001) were independent risk factors for stone-free status in multivariate analysis. HU value of the stone (OR: 1.003, p = 0.005) and age (OR: 1.032, p = 0.031) were determined as independent risk factors for transition to multiple sessions in the subgroup analysis of the successful group. Fat percentage, stone volume, and stone density were determined as factors affecting success in SWL. Routine use of BIA may be considered to predict success before SWL. The probability of SWL success in a single session decreases as the age and stone's HU value increase.

Factors influencing the decision-making in laparoscopic partial nephrectomy for small renal masses.

BACKGROUND AND OBJECTIVES: We analyzed the factors affecting the decision on surgical approach such as hilum dissection, vessel clamping, and the warm ischemia time (WIT) in laparoscopic partial nephrectomy (LPN) for small renal masses (SRMs). METHODS: Patients who underwent LPN for SRMs between 2011 and 2021 in two centers were retrospectively screened. Standardized R.E.N.A.L. nephrometry score (RNS) and each of the components were scored on a Likert scale and the effect on the surgical approach was examined by using them separately. RESULTS: A total of 133 patients, 85 of whom were on-clamp and 48 were off-clamp, were included in the study. Greater tumor size, low BMI, higher RNS, upper pole tumor, low exophytic rate, and nearness to the collecting system were statistically significant for both on/off-clamp and hilar dissection decisions. In multivariate analysis, greater tumor size, upper pole tumor, lower rate of exophytic part (E2), nearness to the collecting system (N3) were independent risk factors for vessel clamping. Greater tumor size and lower exophytic tumor rate (E2) were independent risk factors for hilum dissection. We could not identify any factor affecting WIT. CONCLUSION: Individual components of RNS may serve as a better tool for decision-making on vessel clamping and hilum dissection during LPN for SRMs.

Comparison of safety and efficacy of one shot dilation vs. gradual dilation technique in supine percutaneous nephrolithotomy.

PURPOSE: To compare the efficacy and safety of gradual dilation (GD) and one-shot dilation (OSD) techniques in patients who underwent supine percutaneous nephrolithotomy (PCNL). METHODS: The data of 176 patients who underwent supine PCNL were reviewed. Eighty-seven patients who underwent OSD were defined as group 1, and 89 patients who underwent GD were defined as group 2. Both surgical techniques were compared with each other in terms of various parameters. Then, regression analysis of factors predicting stone-free status and complications in patients who underwent supine PNL were performed. Then, regression analysis of factors predicting success rate and complications in patients who underwent supine PNL were performed. RESULTS: No statistical difference was found in terms of stone-free rate, Clavien-Dindo complication grade and operation time. No statistical difference was found in terms of success rate, Clavien-Dindo complication grade and operation time. However, the fluoroscopy time was found to be significantly shorter in group 1 (p < 0.001). In the analysis of factors predicting stone-free status, the presence of calyceal stones, increased stone size and number were associated with a decrease in stone-free rate. In the analysis of factors predicting success, the presence of calyceal stones, increased stone size and number were associated with a decrease in success rate. Increased fluoroscopy and operation time, increased complication rates were found to be significantly associated with residual stone. Analysis of factors predicting complications found a higher complication rate in patients with low BMI and severe hydronephrosis. Increased complication was associated with increased time to nephrostomy removal and hospital stay, decrease in stone-free rate, decrease in Hb and increase in Cre value at the postoperative 24th hour. CONCLUSION: When comparing OSD and GD in patients undergoing supine PCNL, both techniques have similar stone-free and complication rates. When comparing OSD and GD in patients undergoing supine PCNL, both techniques have similar success and complication rates. Compared to GD, the OSD technique can be preferred primarily due to its shorter fluoroscopy time.

Comparison of Biparametric and Multiparametric Prostate Magnetic Resonance Imaging in Predicting Oncologic Outcomes After Radical Prostatectomy.

Objective: This study aimed to evaluate the difference in predicting the pathological stage of retropubic radical prostatectomy (RRP) and biochemical recurrence (BCR) in patients with Prostate Imaging Reporting and Data System (PIRADS) scores of 3 and 4 on biparametric prostate magnetic resonance imaging (bpMRI) compared to patients who upgraded from PIRADS 3 to PIRADS 4 based on the contrast-enhanced PIRADS version 2.1. Methods: This study evaluated 107 patients who underwent RRP and had preoperative multiparametric prostate magnetic resonance imaging (mpMRI) and were followed regularly. Group 1 included 31 patients evaluated as PIRADS 3 in both bpMRI and mpMRI, group 2 included 31 patients evaluated as PIRADS 3 in bpMRI and PIRADS 4 in mpMRI, and group 3 included 45 patients evaluated as PIRADS 4 without contrast. Comparisons were made between groups 1 and 2 and between groups 2 and 3. Results: No significant difference was found between the groups in terms of demographic data, preoperative or postoperative radiology, and pathology findings. Extraprostatic extension positivity and BCR were more common in group 2 compared to group 1 although not significant. Multivariate regression analysis was performed to determine the risk factors in predicting BCR, which revealed the positivity of seminal vesicle invasion and high pathological stage in the pathology report as significant factors. Prostate-specific antigen (PSA) and PSA density were higher in group 3 than in group 2, but without significance. Conclusions: This study revealed that mpMRI did not contribute in predicting BCR after RRP compared to bpMRI.

Biopsy with Ureterorenoscopy Before Radical Nephroureterectomy is Associated with Increased Intravesical Recurrence in Urothelial Cancer Located in the Kidney.

OBJECTIVE: Diagnostic ureterorenoscopy is used to identify upper tract urothelial cancer before radical nephro ureterectomy, especially for uncertain lesions in imaging modalities or urine cytology. However, diagnostic ureterorenoscopy can potentially cause intravesical tumor spillage and can increase intravesical recurrence rates. We aimed to investigate the impact of diagnostic ureterorenoscopy before radical nephroureterectomy, with and without biopsy, on intravesical recurrence rates of patients with upper tract urothelial cancer. MATERIAL AND METHODS: Patients with localized upper tract urothelial cancer from 8 different tertiary referral centers, who underwent radical nephroureterectomy between 2001 and 2020, were included. Three groups were made: no URS (group 1); diagnostic ureterorenoscopy without biopsy (group 2); and diagnostic ure terorenoscopy with biopsy (group 3). Intravesical recurrence rates and survival outcomes were compared. Univariate and multivariate Cox regression analyses were performed to determine the factors that were asso ciated with intravesical recurrence-free survival. RESULTS: Twenty-two (20.8%), 10 (24.4%), and 23 (39%) patients experienced intravesical recurrence in groups 1, 2, and 3, respectively (P=.037) among 206 patients. The 2-year intravesical recurrence-free sur vival rate was 83.1%, 82.4%, and 69.2%, for groups 1, 2, and 3, respectively (P=.004). Cancer-specific survival and overall survival were comparable (P=.560 and P=.803, respectively). Diagnostic ureterore noscopy+biopsy (hazard ratio: 6.88, 95% CI: 2.41-19.65, P < .001) was the only independent predictor of intravesical recurrence in patients with upper tract urothelial cancer located in the kidney, according to tumor location. CONCLUSION: Diagnostic ureterorenoscopy+biopsy before radical nephroureterectomy significantly increased the rates of intravesical recurrence in tumors located in kidney. This result suggests tumor spillage with this type of biopsy, so further studies with different biopsy options or without biopsy can be designed.

The Role of Preoperative Urinalysis in Predicting Postoperative Infection After Retrograde Intrarenal Surgery in Patients with Sterile Urine Culture.

OBJECTIVE: Postoperative urinary tract infection is the most common complication of retrograde intrarenal surgery, and no consensus has been obtained that would reveal exact reasons yet. It was aimed to determine the possible factors, especially preoperative urinalysis, of postoperative urinary tract infection after retrograde intrarenal surgery. MATERIAL AND METHODS: Patients who underwent retrograde intrarenal surgery in our clinic between 2013 and 2019 were retrospectively screened. Stone size 2 cm and pediatric patients were excluded from the study. The patients were divided into 2 groups as those with and without urinary infections in the early postoperative period. Urine analysis parameters and sterile urine cultures that were taken before the procedure were also analyzed separately. RESULTS: A total of 289 patients meeting the defined criteria were included in the study. There was no statistical difference between the 2 groups in terms of demographics. The number of patients with previous urinary tract infection history (55% vs. 20.5%) and operation time (62.5 ± 16.6 minutes vs. 60 ± 19.4 minutes) were significantly higher in those who had postoperative early urinary tract infection. Among urinalysis, the presence of pyuria, leukocyte count, leukocyte esterase positivity, and nitrite positivity were significantly higher in those who had postoperative early urinary tract infection. In multivariate analysis, urinary tract infection history, operation time, and nitrite positivity were found as independent factors in predicting postoperative early urinary tract infection. CONCLUSION: Previous urinary tract infection history, prolonged operation time, and nitrite positivity in urinalysis were determined as independent risk factors for postoperative urinary tract infection in kidney stones between 1 and 2 cm.

Effects of androgen deprivation therapy on metabolic markers and bioelectrical impedance analyze in prostate cancer patients.

INTRODUCTION AND OBJECTIVES: Prostate cancer (PCa) is the most widespread malignancy within men. Androgen deprivation therapy (ADT), which is the central component of advanced PCa treatment, causes side effects. The goal of this study was to examine the metabolic changes and bioelectrical impedance analysis differences in PCa patients who received ADT. MATERIALS AND METHODS: After age-related match-pair analysis, a total of 519 patients with PCa and control group who had benign disease were enrolled in the study. Biochemical blood parameters and TANITA measurements were recorded for all patients. Patients were categorized into three groups, ADT group (Group 1, n=124) and non-ADT group (Group 2, n=248), control group (Group 3, n=147). RESULTS: The mean age of groups was similar. Body mass index, waist circumference, body fat mass and fat ratio, which were among the TANITA parameters, were higher in group 1 (p<0.05). Total cholesterol, high density lipoprotein, non- high density lipoprotein, triglycerids and fasting blood glucose values were also higher in group 1 (p<0.05). Myocardial infarction and metabolic syndrome rates were also higher in this group. CONCLUSIONS: While the use of ADT is manifested by an increase in fat mass and fat ratio in body composition, it negatively affects waist circumference measurements. It is associated with metabolically unfit body composition changes that predispose to diabetes mellitus and may increase cardio-vascular disease. For this reason, it is necessary to be careful about metabolic and endocrinological diseases in long-term therapy.

Evaluation of the role of thiol / disulfide homeostasis in the etiology of idiopathic male infertility with a novel and automated assay.

Idiopathic male infertility (IMI) is the absence of a reason to explain a patient's infertility, and it occurs at a frequency of %31. In this study we aimed to investigate the oxidant/antioxidant status of patients with IMI and compare their results to those of healthy controls.A total of 79 patients with IMI (group 1) and 90 healthy individuals (group 2) were included in the study. We used Erel & Neselioglu's thiol/disulfide homeostasis test. Collective and individual measurements of oxidative/antioxidative balance components were carried out by this novel thiol/disulfide homeostasis test. Serum antioxidant (total thiol (toSH), native thiol (SH)) and oxidant (disulfide (SS)) levels of all study participants were measured. The results from both groups were compared and analyzed statistically. After toSH, SH, and SS levels were determined, SS/toSH% and SS/SH% levels for each group were analyzed separately and compared statistically.The toSH, SH levels, and SS/SH%, SS/toSH% ratios were significantly different between the groups (p < 0.05).While antioxidant parameters (toSH and SH values) decreased in group1, oxidant parameters (SS/SH%, SS/toSH%) increased significantly. Although SS values were higher in group 1, the difference was not significant (p = 0.214). The SH cutoff value of 507.15 µmol/L predicted the probability of IMI development with 72.2% sensitivity and 74.4% specificity and toSH cutoff value of 545.45 µmol/L predicted IMI development with 70.9% sensitivity and 73.3 specificity (p < 0.001). Multivariate logistic regression analysis showed that the only independent risk factor for the development of IMI is SH. Patients with IMI had a significant change in their thiol/disulfide homeostasis, which suggests the involvement of this imbalance in the pathophysiology of IMI. Furthermore, these results also support the notion of the involvement of oxidative stress in sperm dysfunction. It also points to the possibility of using antioxidants in IMI treatment.Abbreviations: IMI: idiopathic male infertility; toSH: total thiol; SH: native thiol; SS: disulfide; OS: oxidative stress; ROS: reactive oxygen species; DCF: dichlorofluorescein; MiOXSYS: male infertility oxidative system; MOSI: male oxidative stress infertility; LC: L-carnitine; LAC: L-acetylcarnitine; Vit: vitamin; OAT: oligoasthenozoospermia; TMSC: total motile sperm count; WHO: World Health Organization; BMI: body mass index; DTNB: 5,5'-dithiobis-2-nitrobenzoic acid; CV: coefficient variation; ROC: receiver operating characteristic; PR: progressive, NP: non-progressive.

Thermal intravesical chemotherapy in adjuvant treatment of high risk non-muscle invasive bladder cancer. / Quimioterapia intravesical térmica como tratamiento adyuvante en pacientes de cáncer de vejiga alto riesgo no-musculoinvasivos.

OBJECTIVES: To evaluate the oncological results of hyperthermic Mitomycin C (MMC) in adjuvant treatment of high-risk non-muscle invasive bladder cancer and to assess its side-effect profile. METHODS: Patients who were followed up in two reference university hospitals due to high-risk non-muscle invasive bladder tumors were included in the study. High-risk patients according to the EAU non-muscle invasive bladder cancer guideline, patients who were rejected early cystectomy, patients who could not be treated with BCG due to a shortage, and patients for whom the cystectomy would be too risky due to their comorbidities were included in the study. All patients were followed up forat least 24 months with physical examination, cystoscopy, and urine cytology at 3-month intervals. Transurethral tumor resection was performed in all patients and a non-muscle invasive urothelial carcinoma was diagnosed pathologically. Hyperthermic MMC was administered with Synergo system SB-TS 101. Records were kept prospectively and evaluated retrospectively. RESULTS: Fifty-eight high-risk group patients 18 (31%) of whom were at pTa stage and 40 (69%) at pT1 stage were included in the study. During a mean follow-up of 42 months, 34 (58%) patients had recurrence, while 5 (8%) patients progressed to muscle-invasive disease. Eleven (19%) of the patients under went radical cystectomy. The mean time to relapse was 10 months (3-34 months), and the mean time to progression was 41 months (6-87 months). Five-year overall survival, cancer-specific survival, progression-free survival, and relapse-free survival of the patients were 76%, 88%, 90% and 38%, respectively. Multifocality alone was found to be an independent risk factor (HR: 0.26; 95% Cl: 0.08-0.78; p=0.016) affecting recurrence. The observed side effects included tachycardia, cystitis, dysuria, macrohematuria, procedure-related pain, and allergic skin reactions. Treatment had to be discontinued in one patient due to a diffuse skin reaction. CONCLUSIONS: Thermal intravesical MMC therapyis a safe treatment and it could be effective treatment option in preventing disease progression in patients with high risk and non-muscle invasive bladder cancer with unsuccessful Bacillus Calmette-Guérin (BCG) or who could not be treated with BCG for other reasons.

OBJETIVOS: Evaluar los resultados oncológicos de Mitomicina C hipertérmica en tratamiento adyuvante para el cáncer de vejiga de alto riesgono-musculoinvasivo y para evaluar el perfil de efectos secundarios.MÉTODOS: Se incluyeron en el estudio pacientes evaluados en dos centros universitarios de referencia por cáncer de vejiga no-musculoinvasivo de alto riesgo. Fueron incluídos en el estudio los pacientes de alto riesgo según las guías europeas de cáncer de vejiga no-musculoinvasivo, pacientes que no aceptaron la cistectomía precoz o pacientes en los que la cistectomía implicaría demasiado riesgo quirúrgico debido a las comorbilidades. Todos los pacientes fueron seguidos como mínimo por 24 meses con exploración física, cistoscopia y citología de orina en intervalos de 3 meses. La resección transuretral de tumores se realizó en todos los pacientes y el diagnóstico anatomopatológico de carcinoma urotelial no-musculoinvasivo fue determinado. La MMC hipertermia se administró con el sistema Synergo SB-TS101. Los datos se reportaron prospectivamente y retrospectivamente. RESULTADOS: 58 pacientes de alto riesgo, 18 (31%) de los cuales fueron pTa y 40 (69%) pT1 fueron incluidos en el estudio. Durante la media de seguimiento de 42 meses, 34 (58%) recurrieron, mientras que 5 (8% )progresaron a musculo-invasivo. 11 (19%) de los pacientes recibieron una cistectomía radical. La mediana de tiempo a la recidiva fue de 10 meses (3-34 meses) y la mediana a la progresión fue de 42 meses (6-87 meses). La supervivencia global, cáncer-especifica, libre de progresión y libre de recurrencia a 5 años fue de 76%, 88%, 90% y 38%, respectivamente. La multifocalidad fue un factor de riesgo independiente (HR:0,26; 95% Cl: 0,08-0,78; p=0,016) afectando la recurrencia. Los efectos secundarios observados fueron la taquicardia, cistitis, disuria, macrohematuria, dolor con el procedimiento y reacción alérgica. El tratamiento tuvo que pararse en un paciente debido a una reacción cutánea difusa. CONCLUSIONES: La terapia con Mitomicina C térmica es un tratamiento seguro y puede ser un tratamiento efectivo para la prevención de la progresión en pacientes de alto riesgo no-musculoinvasivo en los que la BCG ha fallado o que no se pueden tratar con BCG por otras razones.

Predictive risk factors of urinary tract infection following flexible ureteroscopic lithotripsy.

OBJECTIVES: The goal of current study was to evaluate prevalence of postoperative urinary tract infections (UTI) following flexible ureteroscopy (f-URS) and to determine predictive factors for those UTIs. METHODS: A total of 420 patients with urolithiasis that underwent f-URS between August 2018 and August 2019 were enrolled in the study. Peri-operative characteristics of patients with and without postoperative UTIs were compared using univariate analyses. Predictive factors for UTIs following f-URS were determined using multivariate logistic regression analysis. RESULTS: Forty-one (9.8%) out of 420 patients had postoperative urinary infection after f-URS and those patients were classified as group 1. Group 2 consisted of 379 patients that did not develop postoperative UTIs. The percentage of female gender was 58.5% vs 42% in groups 1 and 2, respectively (p=0.042). The preoperative UTI history rate was 51.2% vs 20.8% (p<0.001) and preoperative double J stent (DJS) insertion rate 39% vs 17.7% in groups 1 and 2, respectively (p=0.001). Univariate regression analyses showed that the female gender (OR=1.98), history of UTI (OR=3.99), and preoperative DJS insertion (OR=2.98) significantly increased the possibility of postoperative UTI (p<0.05). Multivariate regression analyses revealed that history of UTI (OR=3.41, 95%CI:1.73-6.72, p<0.001) and preoperative DJS insertion (OR=2.30, 95%CI:1.13-4.68, p=0.021) were independent risk factors for infectious complications following f-URS. If both factors are present, the probability of infection is 55.2%. CONCLUSIONS: Even if f-URS is considered a safe procedure, the risk of postoperative infectious complications is far from negligible. We found that the presence of UTI history and preoperative DJS were independent risk factors for UTI after f-URS.

OBJETIVOS: El objetivo del presente estudio fue evaluar la prevalencia de las infecciones del tracto urinario (UTI) postoperatorias después de la ureteroscopia flexible (f-URS) y determinar los factores predictivos de esas infecciones. MÉTODOS: Se inscribieron en el estudio un total de420 pacientes con urolitiasis que se sometieron a f-URSentre agosto de 2018 y agosto de 2019. Las característicasperioperatorias de los pacientes con y sin ITUUTI postoperatorias se compararon mediante análisisunivariados. Los factores predictivos de las infeccionesurinarias después de f-URS se determinaron mediante unanálisis de regresión logística multivariante. RESULTADOS: Cuarenta y uno (9,8%) de 420 pacientes tuvieron infección urinaria postoperatoria después de f-URS y esos pacientes se clasificaron como grupo 1. El grupo 2 consistió en 379 pacientes que no desarrollaron UTI postoperatorias. El porcentaje de sexo femenino fue del 58,5% frente al 42% en los grupos 1 y 2, respectivamente (p=0,042). La tasa de antecedentes de UTI preoperatoria fue del 51,2% frente al 20,8% (p<0,001) y la tasa de inserción preoperatoria de un stent doble J (DJS) del 39% frente al 17,7% en los grupos 1 y 2, respectivamente (p=0,001). Los análisis de regresión univariante mostraron que el sexo femenino (OR=1,98), los antecedentes de UTI (OR=3,99) y la inserción preoperatoria de DJS (OR=2,98) aumentaron significativamente la posibilidad de UTI postoperatoria (p<0,05). Los análisis de regresión multivariante revelaron que los antecedentes de UTI (OR=3,41, IC del 95%: 1,73­6,72, p<0,001) y la inserción preoperatoria de DJS (OR=2,30, IC del 95%: 1,13­4,68, p=0,021) eran factores de riesgo independientes para las complicaciones infecciosas después de f-URS. Si ambos factores están presentes, la probabilidad de infección es del 55,2%. CONCLUSIONES: Incluso si la f-URS se considera un procedimiento seguro, el riesgo de complicaciones infecciosas postoperatorias está lejos de ser insignificante. Encontramos que la presencia de antecedentes de UTI y la DJS preoperatoria eran factores de riesgo independientes de UTI después de f-URS.

The effect of renal localization on the fate of clinically insignificant residual fragments after retrograde intrarenal surgery: A prospective 1-year follow-up study. / El efecto de la localización renal en el destino de los fragmentos residuales clínicamente insignificantes después de la cirugía intrarrenal retrógrada: Un estudio prospectivo de seguimiento de 1 año.

OBJECTIVES: Even after a successful retrograde intrarenal surgery (RIRS), clinically insignificant residual fragments (CIRF) could not pass from the kidney. We aimed to find out the differences on the fate of CIRF according to being in the lower pole or other renal localizations. METHODS: 81 patients whose stones were fragmented completely by RIRS were subdivided into two groups as group 1 (lower pole with 41 patients) and group 2 (upper pole, midpole, and renal pelvis with 40 patients). Basal characteristics, urine culture, and renal stone screening were evaluated before and 1-year later from the surgery. RESULTS: While the number of stone-free patients was less and patients with CIRF ≤4 mm was higher in the lower pole stone group 1-year later from the surgery, there was no statistical difference between the two groups (p=0.158, p=0.136). The number of patients whose CIRFs regrew was 46.3% in group 1 and, 52.5% in group 2. A positive correlation was detected between preoperative stone size and first-year maximal residual fragment size in group 1. Linear regression analysis suggested that preoperative stone size is a predictor of the postoperative first-year residual fragment size in group 1. CONCLUSIONS: We observed that almost the half of the CIRFs in all renal localizations regrew and became symptomatic. There is an effect of the stone size on the residual fragment size while performing RIRS for particularly the lower pole renal stones. Patients with CIRF are needed to be followed-up more closely regardless of the renal localization in order to assess the requirement of retreatment.

OBJETIVOS: Incluso después de una cirugía intrarrenal retrógrada exitosa (CRIR), fragmentos residuales clínicamente insignificantes (FRCI) no pudieron pasar del riñón. Nuestro objetivo fue conocer las diferencias en el destino del FRCI según esten en el polo inferior u otras localizaciones renales.MATERIAL Y MÉTODOS: 81 pacientes cuyos cálculos se fragmentaron completamente por CRIR se subdividieron en dos grupos: grupo 1 (polo inferior con 41 pacientes) y grupo 2 (polo superior, polo medio y pelvis renal con 40 pacientes). Las características basales, urocultivo y cribado de cálculos renales se evaluaron antes y un año después de la cirugía. RESULTADOS: Mientras que el número de pacientes sin cálculos fue menor y los pacientes con FRCI ≤4 mm fue mayor en el grupo de cálculos del polo inferior 1 año después de la cirugía, no hubo diferencia estadística entre los dos grupos (p=0,158, p=0,136). El número de pacientes cuyo FRCI volvió a crecer fue del 46,3% en el grupo 1 y del 52,5% en el grupo 2. Se detectó una correlación positiva entre el tamaño del cálculo preoperatorio y el tamaño máximo del fragmento residual del primer año en el grupo 1. El análisis de regresión lineal sugirió que el tamaño del cálculo preoperatorio es un predictor del tamaño del fragmento residual del primer año posoperatorio en el grupo 1. CONCLUSIÓNES: Observamos que casi la mitad de los FRCI en todas las localizaciones renales volvieron a aparecer y se volvieron sintomáticos. Hay un efecto del tamaño del cálculo sobre el tamaño del fragmento residual mientras se realiza la CRIR, en particular, para los cálculos renales del polo inferior. Es necesario realizar un seguimiento más detenido de los pacientes con FRCI independientemente de la localización renal para evaluar la necesidad de retratamiento.

A risk grouping algorithm for predicting factors of persistently elevated prostate-specific antigen in patients following robot-assisted radical prostatectomy.

OBJECTIVE: After radical prostatectomy, prostate-specific antigen(PSA) value measuring ≥0.1 ng/mL is defined as persistent PSA(pPSA) and in many studies, it was found to be associated with aggressive disease and poor prognosis. Our aim in this study is to point out the pathological and clinical factors affecting pPSA among the patients who underwent robot-assisted radical prostatectomy(RARP) in an experienced academic centre and to make a useful risk grouping algorithm that can predict pPSA value based on operative data. METHODS: We examined records of 1273 patients who underwent RARP retrospectively. Preoperative, operative and postoperative data were collected. Based on the PSA values (ng/mL) measured after 4-to-8 weeks of RARP, patients were divided into two groups as pPSA group (Group1)(n = 97) with PSA values ≥0.1 ng/mL and undetectable PSA group (Group2)(n = 778) with PSA values <0.1 ng/mL. Later on, Group1 was further divided into Group1a (PSA:0.1-0.2 ng/mL) and Group 1b (PSA≥0.2 ng/mL) to evaluate biochemical recurrence(BCR). RESULTS: Multivariate logistic regression analyses of the collected data revealed that preoperative PSA≥20 ng/mL, operation time, a postoperative international society of urological pathology (ISUP) grade of ≥4, pT 3-4 and pN were independently associated with pPSA. Based on these results, a risk grouping algorithm predicting pPSA was developed. By looking at the risk grouping algorithm pPSA was found in 98.9% of the cases with a preoperative PSA value of ≥20 ng/mL, an operation time of 150 min, a postoperative ISUP grade of 4-5, a positive lymphovascular invasion (LVI) status, pT3-T4, and pN+; while pPSA was found in 25.5% of the cases with a preoperative PSA value of <20 ng/mL, an operation time of 100 min, a postoperative ISUP grade of <4-5, a negative LVI status, pT<3-4 and pN-. The estimated BCR-free survival time was 16.3 months in Group 1a and 57.0 months in Group2 (P < .001). Adjuvant treatment ratio was 64.9% in Group1 and 7.1% in Group2 (P < .001). CONCLUSION: For the patients who underwent RARP, factors associated with aggressive disease can predict the PSA persistence. To plan our treatment modalities accurately, an applicable risk grouping algorithm in daily practice would be useful.

El efecto de la localización renal en el destino de los fragmentos residuales clínicamente insignificantes después de la cirugía intrarrenal retrógrada: un estudio prospectivo de seguimientode 1 año / The effect of renal localization on the fate of clinically insignificant residual fragments after retrograde intrarenal surgery: a prospective follow-up study 1 year

Objetivos: Incluso después de una cirugía intrarrenal retrógrada exitosa (CRIR), fragmentosresiduales clínicamente insignificantes (FRCI) no pudieron pasar del riñón. Nuestro objetivo fue conocer lasdiferencias en el destino del FRCI según esten en el poloinferior u otras localizaciones renales.Material y métodos: 81 pacientes cuyos cálculosse fragmentaron completamente por CRIR se subdividieron en dos grupos: grupo 1 (polo inferior con 41pacientes) y grupo 2 (polo superior, polo medio y pelvis renal con 40 pacientes). Las características basales,urocultivo y cribado de cálculos renales se evaluaronantes y un año después de la cirugía.Resultados: Mientras que el número de pacientes sincálculos fue menor y los pacientes con FRCI ≤4 mm fuemayor en el grupo de cálculos del polo inferior 1 añodespués de la cirugía, no hubo diferencia estadística entre los dos grupos (p=0,158, p=0,136). El número depacientes cuyo FRCI volvió a crecer fue del 46,3% enel grupo 1 y del 52,5% en el grupo 2. Se detectó unacorrelación positiva entre el tamaño del cálculo preoperatorio y el tamaño máximo del fragmento residual delprimer año en el grupo 1. El análisis de regresión linealsugirió que el tamaño del cálculo preoperatorio es unpredictor del tamaño del fragmento residual del primeraño posoperatorio en el grupo 1.Conclusiones: Observamos que casi la mitad delos FRCI en todas las localizaciones renales volvierona aparecer y se volvieron sintomáticos. Hay un efectodel tamaño del cálculo sobre el tamaño del fragmentoresidual mientras se realiza la CRIR, en particular, paralos cálculos renales del polo inferior. Es necesario realizar un seguimiento más detenido de los pacientes conFRCI independientemente de la localización renal paraevaluar la necesidad de retratamiento.(AU)

Objetives: Even after a successful retrograde intrarenal surgery (RIRS), clinically insignificantresidual fragments (CIRF) could not pass from the kidney.We aimed to find out the differences on the fate of CIRFaccording to being in the lower pole or other renal localizations.Methods: 81 patients whose stones were fragmentedcompletely by RIRS were subdivided into two groups asgroup 1 (lower pole with 41 patients) and group 2 (upper pole, midpole, and renal pelvis with 40 patients).Basal characteristics, urine culture, and renal stonescreening were evaluated before and 1-year later fromthe surgery.Results: While the number of stone-free patients wasless and patients with CIRF ≤4 mm was higher in the lower pole stone group 1-year later from the surgery, therewas no statistical difference between the two groups(p=0.158, p=0.136). The number of patients whoseCIRFs regrew was 46.3% in group 1 and, 52.5% ingroup 2. A positive correlation was detected betweenpreoperative stone size and first-year maximal residualfragment size in group 1. Linear regression analysis suggested that preoperative stone size is a predictor of thepostoperative first-year residual fragment size in group 1.Conclsions: We observed that almost the half ofthe CIRFs in all renal localizations regrew and becamesymptomatic. There is an effect of the stone size on theresidual fragment size while performing RIRS for particularly the lower pole renal stones. Patients with CIRF areneeded to be followed-up more closely regardless of therenal localization in order to assess the requirement ofretreatment.(AU)

The effect of ideal urine culture time on urinary infections after flexible ureteroscopy: A match-pair case-control study.

AIMS: To investigate the effect of the ideal period (Δ-day), which is a period between the sterile urine culture and initiation of flexible ureteroscopy (f-URS), on postoperative urinary tract infections (UTI) in our tertiary referral centre. METHODS: After obtaining the approval of the local ethics committee, retrospective data were collected for all f-URS procedures performed between January 2017 and March 2019. Patients that developed UTI were matched in 1:1 proportion with patients that did not develop UTI based on their demographic and stone characteristics. The group of patients with postoperative UTI was compared with the control group. RESULTS: A total of 916 f-URS cases that had all required data were analysed. Sixty-eight patients with postoperative UTI were determined and a total of 136 patients were included in the study after match-pair. We found that if the Δ-day is longer than 2 weeks, the possibility of postoperative urinary infection rates increases with statistical significance (P = .006). According to our subgroup analysis, postoperative UTI was more common if the Δ-day >14 days. ROC curve analysis provided a 14.5-day period as a cut-off value of Δ-day for postoperative UTI. CONCLUSIONS: The present study is the first to examine the impact of the Δ-day for f-URS on postoperative UTIs. In brief, prolonging the Δ-day, especially if Δ-day >14 days, leads to an increase in the rates of postoperative UTI. We conclude that it is preferred to either perform the f-URS in the early period after the urine culture analysis or doing the urine culture analysis shortly before the surgery.

Efficacy of various laser devices on lithotripsy in retrograde intrarenal surgery used to treat 1-2 cm kidney stones: A prospective randomized study.

AIMS: To compare the efficacy of different laser devices and power ranges on lithotripsy in retrograde intrarenal surgery (RIRS) for 1-2 cm kidney stones. METHODS: A total of 223 participants undergoing RIRS for 1-2 cm kidney stones at our clinic between January 2015 and January 2017 were recruited for this prospective study (NCT02451319). Two hundred and four participants included in our study were randomly allocated into either ≤20 W with 20 W laser device (group 1) or ≤20 W with 30 W laser device (group 2) or >20 W with 30 W laser device (group 3). RESULTS: There was no significant difference between the groups in terms of demographic and stone characteristics. Operation and fluoroscopy times were significantly longer (P = .003 and P < .001, respectively) and stone-free rate (SFR) was significantly lower in group 1 (P = .002). Complications were similar in all three groups (P = .512). However, post-operative pain scores were significantly higher in group 1 (P < .001). The multivariate analysis revealed that stone size (95% CI: 0.654-0.878, OR = 0.758, P < .001), ureteral access sheath use (95% CI: 1.003-20.725, OR = 4.560, P = .049), and lithotripsy with 30 W laser device (95% CI: 1.304-11.632, OR = 3.895, P = .015; 95% CI: 1.738-17.281, OR = 5.480, P = .004, groups 2 and 3, respectively) were independent factors predicting SFR for RIRS used in 1-2 cm kidney stones. CONCLUSION: The 30 W laser device used in RIRS for 1-2 cm kidney stones had shorter operation times, higher SFRs, and lower post-operative pain scores compared with the 20 W device. The 30 W laser device is safe and more efficient in RIRS for treatment of 1-2 cm kidney stones.

The effect of the first wave of COVID-19 pandemic on urology practice and anxiety scores of patients awaiting surgery.

OBJECTIVE: We aimed to determine the effect COVID-19 pandemic on the daily urology practice of the level 3 centre located in one of the most affected regions in Turkey. We also aimed to assess anxiety and depression levels of patients whose procedures and surgeries had to be postponed due to COVID-19-related restrictions. METHODS: The number of patients admitted to the outpatient clinic, outpatient procedures, emergency consultation requests, hospitalised patients and the total number of surgeries between March 10, 2020 and June 15, 2020 were evaluated. These numbers were compared with the same period of 2019. Subsequently, patients who could not be operated or whose elective surgeries were postponed between March 10, 2020 and June 15, 2020 were determined(n:96). These patients were asked to fill out Beck Depression Inventory(BDI) and State-Trait Anxiety Inventory(STAI). The presence of difference between the baseline anxiety levels and the anxiety levels during the COVID-19 pandemic was investigated. Afterwards, these patients were divided into two groups based on planned procedures as oncological group (group1) and non-oncological group (group2). The presence of a difference between the anxiety and depression levels between the groups was investigated. RESULTS: There was a drastic decline in number of patients in all assessed parameters. The least amount of change was seen in the number of emergency consultations. The evaluation of anxiety and depression scores of the patients showed a significant difference between their STAI-S and STAI-T scores (51.8 ± 9.3, 38.2 ± 7.5, respectively)(P < .001). STAI-S scores of the patients were found to be compatible with severe anxiety. The patients' mean BDI score was found to be 15 ± 8.9, which indicated mild depression. However, the age and STAI-S values were significantly higher in group1. CONCLUSION: We noted that anxiety and depression levels increased in patients whose operations were delayed because of pandemic-related restrictions, especially in oncological patients. We believe that an important contribution can be made to the protection of public health by planning advance psychosocial interventions for high-risk groups during pandemics.