Zero ischemia robotic partial nephrectomy: Oncological and functional outcomes of a multicenter study.

BACKGROUND: The functional and oncological outcomes of zero ischemia robotic partial nephrectomy (RPN) procedures were evaluated. METHODS: A total of 56 patients underwent zero ischemia RPN transperitoneally, and their data were collected prospectively. Radius, exo/endophytic, nearness, anterior/posterior, location (R.E.N.A.L.) nephrometry, and PADUA scores were calculated. Patient and tumor characteristics were evaluated. Intra- and perioperative (0-30 days) complications were evaluated by Clavien classification. The change in serum creatinine, and estimated glomerular filtration rates (eGFR) were evaluated during preoperative, immediate postoperative periods, and at postoperative 6th months. RESULTS: The mean age of the patients was 52.2 ± 8.1 (27-75) years. R.E.N.A.L. nephrometry and PADUA scores were 6.1 ± 1.3 and 7.3 ± 1.0, respectively. The duration of surgery was 108.4 ± 18.2 min and estimated blood loss was 166.2 ± 124.7 mL. There were no intraoperative complications in any of the patients. Clavien Grade 1 and 3 complications were seen in 2 patients in the perioperative period. In the perioperative period (1-30 days), one patient required blood transfusion and angiographic intervention due to postoperative bleeding (Clavien Grade 3), and one patient required hospitalisation due to prolonged subileus (Clavien Grade 1) that resolved conservatively. The radiological and pathological tumor sizes were 3.1 ± 1.1 cm and 2.8 ± 1.4 cm, respectively. The surgical margins were positive in two patients with tumour sizes of 1.5 and 4 cm. Neither local recurrence nor distant metastasis was detected, during 33.6 ± 12.3 (3-76) months. There were no statistically significant differences between preoperative eGFR and serum creatinine levels, compared with those of immediate postoperative and postoperative 6th month periods. DISCUSSION: Zero ischemia RPN is a safe and applicable method with acceptable oncological and functional outcomes in small renal tumors and even in selected larger renal tumors.

Diagnostic value of systemic immune inflammation index in acute appendicitis

SUMMARY OBJECTIVE: Clinical diagnosis of acute appendicitis is often difficult and involves a synthesis of clinical, laboratory, and radiological findings. The aim of this study was to investigate whether the systemic immune inflammation index can be used as an effective parameter in the diagnosis of acute appendicitis and its reliability in the differentiation of complicated vs. non-complicated appendicitis. METHODS: The study was conducted retrospectively with patients admitted to the emergency department with abdominal pain and diagnosed with acute appendicitis. In total, 150 patients and 150 control cases were included in the study. Demographic data, medical history, white blood cell count, platelet count, neutrophil count, systemic immune inflammation index values, Alvarado score, adult appendicitis score, and pathology result of appendectomy material were retrieved from the hospital automation system and recorded in the data form. RESULTS: Neutrophil-lymphocyte ratio and systemic immune inflammation index were significantly higher, and platelet-neutrophil ratio and lymphocyte-neutrophil ratio were significantly lower in the patient group compared to the control group (p<0.001). Receiver operating characteristic analysis revealed that the sensitivity and specificity of systemic immune inflammation index with a cutoff value of 840.13 was 82 and 66.7%, respectively, for the diagnosis of acute appendicitis. Correlation analysis revealed that systemic immune inflammation index, Alvarado score, and adult appendicitis score were positively correlated, and this correlation was statistically significant. CONCLUSION: Systemic immune inflammation index may be used to promote the diagnosis of acute appendicitis and may reduce the need for radiation exposure and diagnostic imaging tests such as contrast-enhanced abdominal computed tomography. It can also be used to differentiate between complicated and non-complicated acute appendicitis cases.

Detection of human papillomavirus subtypes harbored in the foreskin of asymptomatic boys: Controlled study.

INTRODUCTION: Human papillomavirus infection (HPV) is one of the most common sexually transmitted infections and can cause penile and anal cancer in men, and invasive cervical cancer in women. OBJECTIVE: To evaulate the colonization of 32 HPV subtypes in the foreskin of boys. STUDY DESIGN: A prospective analysis was made of the data of 62 healthy boys who had undergone standard circumcision. Deoxyribonucleic acid (DNA) was isolated from the foreskin tissues, and the integrity of DNA was tested. The DNA of each patient was further assessed with real-time polymerase chain reaction (PCR) and the presence of 32 subtypes of HPV was explored. To confirm the results, melting curve analysis and agarose gel electrophoresis (AGE) were performed for all samples. Further analysis was made using LCD-array on six randomly selected samples to confirm the results together with negative and positive controls. RESULTS: The mean age of the boys was 6.8 ± 2 years at the time of surgery. All positive controls and samples were positive, all negative controls were negative in the first HPV amplification assay. All positive controls had typical melting curve peaks, whereas all sample amplifications had non-specific, atypical melting curves not fitting with those of the positive controls. Two bands of expected sizes (124 and 405 bp) were only observed in positive controls, but not in negative controls or samples on AGE. The same results were observed on the 6 randomly selected samples using LCD-array. Consequently, all the foreskin samples were evaluated as negative for the 32 HPV types investigated in the study. DISCUSSION: Literature shows a high prevalence of genital HPV in newborns, in early infancy, late adolescence and adulthood. However there is a lack of data in literature on the prevalence in early and late childhood. The negative results of HPV colonization on the foreskin in the current study may be attributed to the conservative and mostly monogamous nature of most family structures in Turkey. CONCLUSION: The results of the present study have shown that foreskin tissue is not a natural reservoir for HPV and subclinical HPV infection is not likely in the absence of suspected sexual contact.

Does mean platelet volume (MPV) have a role in evaluation of erectile dysfunction and its severity? / ¿El volumen plaquetario medio desempeña un papel en la evaluación de la disfunción eréctil y su gravedad?

PURPOSE: The mean platelet volume (MPV) has important role in the pathophysiology of vascular diseases as a marker of the platelet activity. To investigate the association between mean platelet volume and erectile dysfunction (ED) and to search whether this marker can be used for diagnosis of ED. MATERIALS AND METHODS: Of the 312 patients with ED of various degrees, 122 patients without ED (IIEF-5>21) were included in this prospective study. Severity of ED was determined according to IIEF-5 questionnaire. MPV, fasting serum glucose, cholesterol, low density lipoprotein (LDL) and serum testosterone levels are also recorded. The mean platelet volume was calculated by the Coulter counter technique and sexual function was determined by International Index of Erectile Function erectile function domain (IIEF-5). RESULTS: The mean age of patients was 58.4 years. The mean MPV value of patients with ED was significantly higher compared to the non-ED patients (8.91 vs. 8.22, p = 0.0001). The severity of ED was shown to have a positive strong correlation with MPV values (r=0.719, p = 0.001). Mean serum triglyceride, glucose, total cholesterol and LDL cholesterol levels were noted higher in patients with ED. MPV values were found to be significantly higher in patients with ED. CONCLUSION: MPV level shows significant correlation with severity of ED. This cheap laboratory test can have potential to be a marker of ED. Further prospective larger studies with vascular wall thickness measurements should be conducted

OBJETIVO: El volumen plaquetario medio (VPM) desempeña un papel importante en la fisiopatología de las enfermedades vasculares como marcador de la actividad plaquetaria. El objetivo fue investigar la asociación entre el VPM y la disfunción eréctil (DE), y averiguar si este marcador puede utilizarse para el diagnóstico de la DE. MATERIALES Y MÉTODOS: De los 312 pacientes con disfunción eréctil de diversos grados, 122 pacientes sin disfunción eréctil (Índice Internacional de la Función Eréctil [IIEF-5]>21) se incluyeron en este estudio prospectivo. La gravedad de la DE se determinó según el cuestionario IIEF-5. También se analizaron el VPM, la glucosa sérica, el colesterol, la lipoproteína de baja densidad (LDL) y los niveles séricos de testosterona. El volumen plaquetario medio se calculó mediante la técnica de contador Coulter y la función sexual se estableció mediante el dominio de la función eréctil del IIEF-5. RESULTADOS: La media de edad de los pacientes fue de 58,4 años. El valor medio del VPM de los pacientes con DE fue considerablemente mayor en comparación con los pacientes sin DE (8,91 frente a 8,22; p = 0,0001). La gravedad de la DE mostró una fuerte correlación positiva con los valores de VPM (r=0,719; p = 0,001). Los niveles séricos de triglicéridos, glucosa, colesterol total y colesterol-LDL fueron más altos en pacientes con DE. Los valores del VPM se encontraron considerablemente mayores en pacientes con DE. CONCLUSIÓN: El nivel del VPM muestra una correlación importante con la gravedad de la DE. Esta prueba de laboratorio barata puede tener el potencial de ser un marcador de DE. Se deben realizar más estudios prospectivos más grandes con mediciones del espesor de la pared vascular

The change in Thiol-Disulphide Homeostasis levels as an oxidative stress marker after varicocelectomy: Is there a relationship with sperm parameters?

One of the most important causes of varicocele-related infertility is oxidative stress (OS). One of the markers considered as an indicator of OS is thiol-disulphide homeostasis (TDH). Based on the hypothesis that OS should decrease after varicocelectomy in the light of this information, in our current study, we investigated the relationship between TDH levels and sperm parameters. The data of 56 infertile varicocele men were prospectively analysed. The post-operative total and native thiol levels were significantly higher than those pre-operative total and native thiol levels (477.7 & 436.7 nmol/L, 417.6 & 372.1 nmol/L). Positive correlation was found between total thiol change and change in semen volume (ρ: .277, p: .039), ratio of spermatozoa with normal morphology (ρ: .342, p: .01), progressive (ρ: .334, p: .012) and nonprogressive motility (ρ: .385, p: .003). Positive correlation was also found between native thiol change and semen volume (ρ: .349, p: .008), ratio of spermatozoa with normal morphology (ρ: .362, p: .006), progressive (ρ: .297, p: .026) and nonprogressive motility (ρ: .368, p: .005). Change in the level of TDH was found as positively correlated with progressive and nonprogressive motility change. According to these results, OS decreases with varicocelectomy in infertile patients and TDH can be used as a useful method for measuring OS.

Does mean platelet volume (MPV) have a role in evaluation of erectile dysfunction and its severity?

PURPOSE: The mean platelet volume (MPV) has important role in the pathophysiology of vascular diseases as a marker of the platelet activity. To investigate the association between mean platelet volume and erectile dysfunction (ED) and to search whether this marker can be used for diagnosis of ED. MATERIALS AND METHODS: Of the 312 patients with ED of various degrees, 122 patients without ED (IIEF-5>21) were included in this prospective study. Severity of ED was determined according to IIEF-5 questionnaire. MPV, fasting serum glucose, cholesterol, low density lipoprotein (LDL) and serum testosterone levels are also recorded. The mean platelet volume was calculated by the Coulter counter technique and sexual function was determined by International Index of Erectile Function erectile function domain (IIEF-5). RESULTS: The mean age of patients was 58.4 years. The mean MPV value of patients with ED was significantly higher compared to the non-ED patients (8.91 vs. 8.22, p=0.0001). The severity of ED was shown to have a positive strong correlation with MPV values (r=0.719, p=0.001). Mean serum triglyceride, glucose, total cholesterol and LDL cholesterol levels were noted higher in patients with ED. MPV values were found to be significantly higher in patients with ED. CONCLUSION: MPV level shows significant correlation with severity of ED. This cheap laboratory test can have potential to be a marker of ED. Further prospective larger studies with vascular wall thickness measurements should be conducted.

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.

Does Type 2 Diabetes Mellitus Have an Impact on Postoperative Early, Mid-Term and Late-Term Urinary Continence After Robot-Assisted Radical Prostatectomy?

OBJECTIVE: We evaluated the effect of diabetes mellitus (DM) on urinary continence after robotic radical prostatectomy (RARP). PATIENTS AND METHODS: Overall, 99 patients with DM and 213 patients without DM who underwent RARP with at least 2-year follow-up were included. The preoperative prostate biopsy Gleason scores and clinical stages of the groups were similar. The patients who were dry or used one safety pad per day were regarded as continent. Early (0-3 months), mid-term (4-12 months), and late-term (>12 months) continence rates were evaluated. RESULTS: In diabetic and nondiabetic groups, mean age was 63.3 ± 6.5 and 61.3 ± 6.8 years, respectively (p = 0.015). On the day of the removal of the urethral catheter, 61.6% (n = 61) of the diabetic patients and 99.1% (n = 211) of the nondiabetic patients were continent (p = 0.000). At third-month follow-up, 80.8% (n = 80) of the diabetic patients and 99.1% (n = 211) of the nondiabetic patients were continent (p = 0.000). At sixth-month follow-up, 89.9% (n = 89) of the diabetic patients and 99.1% (n = 211) of the nondiabetic patients were continent (p = 0.000). At first-year follow-up, 93.9% (n = 93) of the diabetic patients and 100% (n = 213) of the nondiabetic patients were continent (p = 0.001). At 18th-month follow-up, 96.0% (n = 95) of the diabetic patients and 100% (n = 213) of the nondiabetic patients were continent (p = 0.013). At second-year follow-up, 98.0% (n = 97) of the diabetic patients and 100% (n = 213) of the nondiabetic patients were continent (p = 0.115). Multivariate analysis showed that age and body mass index had no impact on urinary continence (p > 0.05). Presence of diabetes (p = 0.008) and duration (≥5 years) of diabetes (p = 0.004) were independent factors that had a significant negative impact on urinary continence. CONCLUSIONS: Diabetes seems to be a significant disadvantage in gaining urinary continence compared with nondiabetic patients particularly in the first 18 months after RARP. Diabetic patients should be informed about possible late recovery of postoperative urinary continence compared with nondiabetic patients after RARP.

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.

Does steep Trendelenburg positioning effect the ocular hemodynamics and intraocular pressure in patients undergoing robotic cystectomy and robotic prostatectomy?

PURPOSE: To examine the effect of steep Trendelenburg position (ST) on intraocular pressure (IOP), resistive index of the central retinal artery, and venous impedance index of the central retinal vein during robotic prostatectomy and cystectomy. METHODS: A total of fifty-three male patients were included into the study (prostatectomy: 43, cystectomy: 10). During robotic surgery, the effect of the ST on IOP, resistive index of the central retinal artery (CRA-RI), and venous impedance index of the central retinal vein (CRV-VI) was prospectively examined. The measurement times of IOP are as follows: T1: before anesthesia while supine and awake; T2: anesthetized and supine; T3: anesthetized and ST; T4: anesthetized, ST, and intraperitoneal insufflation; T5: anesthetized in ST at the end of the procedure with CO2; T6: anesthetized in ST after desufflation; and T7: anesthetized supine before awakening. RESULTS: There was no difference between the IOP values of the right and left eyes in both groups. The highest IOP values were reached at T4 and T5. CRA-RI values were different, while CRV-VI values were similar at T1 and T4. CONCLUSIONS: Despite staying in the ST for a long time provided that the ophthalmologic examination was normal, ocular complication risk is low in robotic prostatectomy and cystectomy.

Impact of robotic partial nephrectomy with and without ischemia on renal functions: experience in 34 cases.

OBJECTIVE: In this study we aimed to compare renal functions in patients who underwent robotic partial nephrectomy (RPN) with on-clamp and zero- ischemia techniques. MATERIAL AND METHODS: Between 2009 and 2015, 12 off-clamp and 22 on-clamp RPN procedures were performed on a total of 34 patients in two centers. The main outcome parameters examined were serum creatinine, and estimated glomerular filtration rate (eGFR) during preoperative, immediate postoperative periods, and at postoperative 3rd months. RESULTS: There were no statistically significant differences between on-clamp and zero- ischemia groups regarding age, ASA score, BMI, PADUA and R.E.N.A.L. nephrometry scores, operation time and tumor size (p>0.05). Significant differences were found in the duration of hospital stay (3.8±0.9 days vs. 3.0±0.9 days) and amount of blood loss (85.9±49.6 mL vs. 183.3±176.2 mL) between the on-clamp and zero-ischemia groups (p<0.05). Statistically significant differences were found between preoperative and immediate post-operative periods, in terms of eGFR and serum creatinine levels in both groups. Moreover, statistically significant differences were found between preoperative and postoperative 3rd month periods, in the on-clamp group in terms of eGFR and serum creatinine levels. In the zero-ischemia group, the decrease in eGFR and serum creatinine levels at postoperative 3rd month relative to the preoperative period was not statistically significant. CONCLUSION: Off-clamp RPN technique is superior, in short-term outcomes involving renal functions, compared to on clamp approach. However, long- term data regarding the renal functions should be evaluated to arrive at a definitive decision.

Robotic partial nephrectomy for clinical stage T1 tumors: Experience in 42 cases.

The aim of this study was to evaluate outcomes of robotic partial nephrectomy (RAPN) procedures. At two centers, 42 patients underwent RAPN. Radius, Exo/Endophytic, Nearness, Anterior/Posterior, Location (R.E.N.A.L.) nephrometry and PADUA scores of patients were calculated by computed tomography (CT) or magnetic resonance imaging (MRI). Intra- and perioperative (0-30 days) complications were evaluated using modified Clavien classification. A four-arm da Vinci-S robotic surgical system was used and outcomes were evaluated retrospectively. Mean age of the patients was 52.3 ± 6.5 years. Mean tumor size was 3.1 ± 1.0 (1.4-6.6) cm. R.E.N.A.L. nephrometry and PADUA scores were 6.0 ± 1.5 and 7.5 ± 0.9, respectively. Mean surgical time was 127.7 ± 18.7 minutes and estimated blood loss was 100 ± 18.1 cc. Mean warm ischemia time was 16.0 ± 8.9 (0-30) minutes. Intraoperative complications did not develop in any patient. Median hospital stay was 3.0 (2-6) days. Except for 17 patients, hilar clamping was performed in 25 patients. Histopathology results included 34 renal cell carcinoma (22 clear cell, 7 chromophobe cell, 4 papillary cell, and 1 clear papillary cell). Oncocytoma (n = 4), adenoma (n = 1), fibroadipose tissue (n = 1), papillary epithelial hyperplasia (n = 1), and chronic pyelonephritis (n = 1) were present. Surgical margins were negative in all patients. During a median follow-up period of 15.5 ± 10.9 (3-46) months, neither local recurrence nor distant metastasis was detected. In conclusion, RAPN is a safe, minimally invasive surgical approach, with excellent surgical and oncological outcomes in T1 kidney tumors. Zero ischemia off-clamp RAPN is also safe in selected masses with the advantage of avoiding complete renal ischemia.

Robotic sequential right adrenalectomy and zero ischemia left partial nephrectomy in a patient with synchronous pheochromocytoma and renal cell carcinoma.

Currently, most renal masses are detected incidentally while still small in size because of the widespread use of radiological imaging, and most pheochromocytomas are localized in the adrenal glands as unilateral lesions. A 5 × 4-cm right adrenal mass and a 19 × 13-mm exophytic left renal mass were synchronously detected by contrast enhancement on computed tomography and magnetic resonance imaging in a 47-year-old male with hypertension. The patient's preoperative serum and 24-h urine catecholamine levels were elevated. Initially, robotic transperitoneal right adrenalectomy was performed, and histopathology confirmed a 4 cm pheochromocytoma. After 3 months, transperitoneal zero ischemia robotic left partial nephrectomy was performed, and histopathology demonstrated clear cell renal cell carcinoma, Fuhrman grade II, 17 mm in size with clear surgical margins. This case indicates that sequential robotic surgery is feasible and safe as a minimally invasive approach to remove bilateral renal and adrenal masses. Zero ischemia robotic partial nephrectomy is also feasible and safe for selected small renal masses.

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.

Early postoperative effects of ureterorenoscopy on morbidity and renal functions in ureteral stone patients with nondialysis-requiring renal insufficiency.

In this study, we aimed to investigate the effects of ureterorenoscopy (URS) on morbidity and renal functions in patients with ureteral stones and nondialysis-requiring renal insufficiency. The data of 3200 patients who had ureterorenoscopic lithotripsy and diagnostic URS were analyzed retrospectively. Age, urea and creatinine levels in the preoperative period and 4 h after surgery, the size of the stone, duration of surgery, percentage change in urea and creatinine levels [(last level-first level/first level) × 100] and postoperative complications were noted. Student's t-test was used for the intergroup analysis of continuous variables. p < 0.05 was considered as statistically significant. There were 90 patients in nondialysis-requiring renal insufficiency group (group 1) and 101 patients in the control group (group 2). Percentage changes of urea and creatinine levels in the renal insufficiency and the control groups were found as -0.3% ± 3.3, 0.67% ± 3.9 and 2.3% ± 23.2, 2.5% ± 31.6 (p = 0.24 and p = 0.56), respectively. In group 1, three (3.3%) patients had postoperative febrile urinary infection, however febrile infections were not seen in any of the patients in group 2 (p = 0.06). Our results indicated that URS might be used safely in ureteral stones of the patients with nondialysis-requiring renal insufficiency.

Comparison of arterial blood supply to the testicles in the preoperative and early postoperative period in patients undergoing subinguinal varicocelectomy.

OBJECTIVE: Varicocele, which is the abnormal dilatation of internal spermatic veins, is known as the most surgically correctable cause of male infertility. In the evaluation of testicular arterial and venous blood supply, the scrotal colour Doppler ultrasound (CDU) is a valuable diagnostic method. The aim of this study was to investigate how the testicular blood flow is affected after varicocelectomy, and the place of scrotal CDU in the follow-up after varicocelectomy. MATERIAL AND METHODS: Thirty male patients who were diagnosed with left-sided varicocele were prospectively included in the study. Before the varicocelectomy, semen analyses were carried out, and peak systolic velocity (PSV), end-diastolic velocity (EDV), resistive index (RI) and pulsatility index (PI) were measured by CDU. In the third postoperative month, scrotal CDU and semen analysis were performed again and compared with the preoperative results. RESULTS: The arterial flow parameters PSV and EDV increased significantly, and the resistance parameters RI and PI decreased significantly, compared with the preoperative values. Sperm concentration, progressive motility and normal morphology improved in the postoperative semen analysis compared with the preoperative results. The increases in all three parameters were statistically significant. No statistically significant difference in vascular parameters was seen between the patients with improved and unimproved semen analysis. CONCLUSIONS: As confirmed by the results of semen analysis and CDU, testicular blood flow increases after varicocelectomy, resulting in the recovery of the haemodynamics of the testicle. CDU, which is generally used for diagnosis in the varicocele, can also be a valuable method of determining treatment success after surgery.

Evaluation of oxidative stress status and antioxidant capacity in patients with renal cell carcinoma.

INTRODUCTION: We evaluated and compared the serum oxidative stress and antioxidant enzymes in patients with renal cell carcinoma (RCC) and the control group. MATERIAL AND METHODS: The prospective study consisted of 97 patients with RCC (Group 1) and 80 age and sex matched healthy volunteers (Group 2). Group 1 and 2 were compared concerning serum mean total oxidant status (TOS), total antioxidant capacity (TAC), paraoxonase-1 (PON-1), arylesterase, total thiol, catalase (CAT), myeloperoxidase (MPO) and ceruloplasmin. RESULTS: Patients' mean age was 58.5 ±12.3 and 56.9 ±15.8 years, respectively, in Group 1 and 2. No statistically significant differences were detected between the groups in terms of oxidative stress parameters and antioxidant capacity measured in the serum of patients including, TOS, TAC, PON1, arylesterase, total thiol, CAT, MPO, and ceruloplasmin levels (p >0.05 for all parameters). The PON-1 value was significantly higher in patients with pT1 stage than pT3 stage (p = 0.007). The arylesterase value was significantly higher in patients with Fuhrman's nuclear grade 3 than grade 2 (p = 0.035). There was no correlation between these parameters level and Fuhrman's nuclear grade, stage, or histopathological tumor type. CONCLUSIONS: Our results demonstrated that evaluation of these parameters in the serum of patients with localized RCC may not be used as a marker to discriminate between patients with RCC and healthy people.

Primary mature cystic teratoma mimicking an adrenal mass in an adult male patient.

Teratomas are bizarre neoplasms derived from embryonic tissues that are typically found only in the gonadal and sacrococcygeal regions of adults. Primary retroperitoneal teratomas are rare and present challenging management options. We report a case of a unilateral primary retroperitoneal mature cystic teratoma mimicking an adrenal mass in a 54-year-old male patient. Complete resection of the adrenal mass was performed by the flank approach by using the 11th rib resection. Because of the risk of malignancy, follow-up radiographic studies were performed to ensure the oncologic efficacy of resection. The patient has been free of recurrence for longer than 12 months.

Outcomes of robot-assisted laparoscopic transperitoneal pyeloplasty procedures: a series of 18 patients.

OBJECTIVE: We evaluated outcomes of our robot-assisted laparoscopic transperitoneal pyeloplasty (RALP) procedures. MATERIAL AND METHODS: Between July 2011 and March 2014, 18 RALP procedures were performed at our instutition. Ureteropelvic junction obstruction (UPJO) diagnosis was made based on clinical presentation and intravenous urography. All patients underwent basal and diuretic isotopic renography to evaluate the degree of obstruction and impaired renal function. Anderson-Hynes dismembered pyeloplasty technique was used with a transperitoneal approach by using the da Vinci-S 4-arm surgical robot. Outcomes were assessed retrospectively. RESULTS: Mean patient age was 31.3±11.7 (13-62) years. Male: female ratio was 9: 9. All procedures were primary surgeries. Of 18 patients, 10 (55.5%) had a crossing vessel and 8 (44.5%) had intrinsic obstruction. Mean operative time was 150.4±17.2 (115-185) minutes. Mean anastomosis time was 21.4±5.5 (10-33) minutes. Mean blood loss during the operation was 33.6±17.3 (10-60) cc. Mean hospital stay was 2.6±1.0 (1-6) days. No conversion to open surgery was required. No intraoperative and perioperative (0-30 days) complication occurred. Readmission rate during perioperative period was 0%. Median follow-up was 16.6±10.3 (3-35) months. Postoperative intravenous urography and renography showed improved results in all cases. CONCLUSION: Due to our experience, RALP is a safe and feasible minimally invasive approach in patients with UPJO with excellent surgical and functional outcomes.

Multiple giant prostatic urethral stones with an ureteral stone in a young patient.

Giant prostatic urethral stones have been reported as a very rare entity, and the etiology of these stones is not clear. We report a case of a 40-year-old man with giant multiple prostatic urethral stones whereby the entire gland was replaced, and a big ureteral stone presented with voiding difficulty and recurrent urinary tract infections. In the literature, to our knowledge, this is the youngest case wherein giant prostatic urethral stones coexisted with a big ureteral stone. Many different-sized stones were observed endoscopically, some protruding into the urethra, and some filling different cavities on the prostate. Following cystoscopy, multiple giant prostatic stones weighing a total of 151 g were removed by the open retropubic route. We treated the big ureteral stone endoscopically.