Parameters affecting the success rate of microscopic testicular sperm extraction in male patients with a solitary testis and non-obstructive azoospermia.

PURPOSE: We aimed to compare the success rate of spermatozoa retrieval through microscopic testicular sperm extraction (mTESE) in non-obstructive azoospermic (NOA) men with a solitary testis with that of mTESE in NOA men with bilateral testes and the parameters affecting these rates. METHODS: A retrospective cross-sectional study of factors contributing to infertility in NOA patients with a solitary testis and men with bilateral testes was carried out. In this multicenter study, 74 patients with NOA with a solitary testis were matched with 74 patients with bilateral testes in terms of age, duration of infertility, and volume of the solitary testis from 2770 patients with NOA with bilateral testes. Hormonal parameters, presence of varicocele, history of varicocelectomy, history of undescended testis and karyotype analysis results were compared. RESULTS: Spermatozoa were obtained from 40 (54.1%) patients with a solitary testis and 42 (56.76%) patients with bilateral testes. No differences were found regarding age, duration of infertility, or mean testicular volume between patients with a solitary testis and patients with bilateral testes. When serum follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels were compared regardless of sperm retrieval status, it was observed that both levels were greater in the group of patients with a solitary testis (p < 0.01). Patients with solitary and bilateral testes from whom spermatozoa were obtained had larger testes than those from whom spermatozoa could not be obtained (p < 0.05). Similarly, the serum levels of FSH and LH were significantly greater in patients with a solitary testis than in those with bilateral testes (p < 0.05). CONCLUSIONS: To the best of our knowledge, this is the first study in the literature to evaluate the parameters that influence mTESE outcome in NOA patients with a solitary testis and NOA patients with bilateral testes. Greater testicular volume was found to positively affect spermatozoa retrieval for patients with a solitary testis. The higher levels of FSH and LH in patients with a solitary testis than in patients with bilateral testes of similar testicular volume may be due to a compensatory mechanism developed by the hypothalamic-pituitary-gonadal axis. The fact that these hormones are higher in patients with a solitary testis does not mean that the number of spermatozoa obtained through mTESE will be decreased.

Is 3D Volumetric Evaluation Consistent with Postoperative Renal Parenchymal Preservation in Open and Robot-Assisted Laparoscopic Partial Nephrectomy?

Introduction: To evaluate by using 3D renal volumetric assessment and compare renal parenchymal preservation between patient who underwent open partial nephrectomy (OPN) and robot assisted laparoscopic partial nephrectomy (RALPN). Methods: We retrospectively reviewed the records of the patients to evaluate the effect of OPN (23 patients) or RALPN (19 patients) partial nephrectomy on renal parenchymal preservation. The CT or MRI were examined using 3D-Slicer image processing software. The tumor volume and preoperative and postoperative non-tumor bearing parenchymal volumes were evaluated with the segmentation. The preoperative and postoperative parenchymal volumes, serum creatinine levels, and estimated glomerular filtration rates (eGFRs) were compared between the surgical techniques. Results: The data of 42 patients were included in the final analysis. The patient and tumor characteristics were similar between the two groups. Postoperative renal parenchymal volumetric changes were seen similar between groups. Although the serum creatinine levels and eGFRs did not change postoperatively in the RALPN group (P = .145 and P = .085, respectively), creatinine increased while eGFR decreased in the OPN group (P = .003 and P = .002, respectively). Conclusions: Our analysis showed that RALPN could be considered similar to OPN in terms of parenchymal volume preservation, but the rate of parenchymal volume preservation was not associated with the change in functional parameters. These results should be supported by further research.

First worldwide correction of ventral Peyronie's disease utilizing rigicon inflatable penile prosthesis combined with plaque incision & grafting with collagen fleece (PICS-technique) for residual curvature.

Adjunctive residual curvature correction by plaque incision and grafting with a sutureless graft during inflatable penile prosthesis (IPP) implantation in patients with Peyronie's disease (PD) is our preferred technique. The PICS Technique (Penile Implant in Combination with the Sealing Technique) uses a self-adhesive collagen fleece (TachoSil®, Corza Medical, MA, USA) to cover the defect after plaque incision. The graft does not require sutures improving operative speed and avoiding needle stick of the implant cylinders. In this article, we present the first known application worldwide of a Rigicon Infla10® X (Rigicon, Ronkonkoma, NY, USA) device to Peyronie's ventral curvature. The patient's residual curvature of 80° after implantation was corrected by PICS through an additional subcoronal incision. At the conclusion of surgery, the penis was totally straight and rigid. No intra- and postoperative complications occurred. At the early follow-up of 12 weeks postoperatively, the patient was able to inflate and deflate the device and sexual intercourse was possible. A combination of the Rigicon Infla10® X and the PICS Technique represents a safe and successful approach for residual curvature correction during IPP in patients with ventral Peyronie's curvature. The Rigicon Infla10® X device showed excellent rigidity, and controlled expansion of the X cylinders means it can be used with the PICS Technique without restrictions. Early results are promising. Long-term follow-up and more patients are needed.

Adjustable Male Sling for The Treatment of Postprostatectomy Stress Urinary Incontinence: Intermediate-Term Follow-Up Results.

Objective To evaluate the outcomes of adjustable male sling (Argus®) implantation in the management of post-prostatectomy incontinence (PPI) with intermediate-term follow-up results. Materials and methods The data on adjustable male sling surgery between September 2015 and September 2020 were retrospectively analyzed. Patients were preoperatively evaluated with a voiding diary, 24-hour pad test, and validated questionnaire. Functional outcomes were also evaluated using 24-hour pad requirement and pad weight, and the International Consultation on Incontinence (ICIQ-SF) score. Results A total of 16 patients (eight having undergone the transurethral resection of the prostate [TUR-P] and eight radical prostatectomy [RP]) were enrolled in the study. Thirteen patients had moderate (81.25%) PPI, and three patients (18.75%) had severe PPI. With the mean follow-up of 36.9±14.3 months, nine patients (56.2%) were noted as cured and four (25%) as improved, with an overall success rate of 81.2%. At the last follow-up visit, the median number of pads used per day decreased from 3.5 to 1, and the 24-hour pad test result decreased from 300 to 50 gr (p < 0.001 and p < 0.001, respectively). The ICIQ-SF score decreased from the initial mean of 15.8 ± 2.3 to 7.1 ± 6.6 (p < 0.001). When the outcomes were compared according to the etiology, there was no statistically significant difference (p = 0.522). Conclusions Male sling surgery can be performed safely in patients with moderate and severe stress urinary incontinence with low complication and high success rates. The results of TUR-P-related PPI are similar to those of surgery performed due to the etiology of RP.

In-vivo or in-vitro stone attenuation: what is more valuable for the prediction of renal stone composition in non-contrast-enhanced abdominal computed tomography?

OBJECTIVES: To compare the efficacy of in-vivo and in-vitro stone attenuation in the prediction of stone composition using non-contrast-enhanced abdominal computed tomography (NCCT). METHODS: This study included a total of 104 patients with renal stones who received percutaneous nephrolithotomy treatment for renal stones between December 2016 and December 2019 and underwent NCCT before the procedure. Preoperative (in-vivo) and postoperative (in-vitro) kidney stone attenuations were compared using the NCCT images of the patients. Renal stone fragments were analysed with the infrared spectrophotometer method. RESULTS: The mean age of the 104 patients was 49.5 (interquartile range: 37-61) years. According to the receiver operating characteristics analysis, the cut-off values for the prediction of uric acid stones were determined to be 556 HU for the in-vivo and 774 HU for the in-vitro attenuation measurement. Sensitivity and specificity were 100% and 96.6%, respectively, for the in-vivo and 90.9 and 91%, respectively, for the in-vitro images. The cut-off values for the prediction of calcium stones were determined to be 824 HU and 1065 HU for the in-vivo and in-vitro attenuation measurements, respectively. Sensitivity and specificity were 97.3 and 96% for the in-vivo and 96 and 96% for the in-vitro images. CONCLUSIONS: In-vivo stone attenuation measurement in NCCT was slightly superior to in-vitro measurement due to the reduction in the composition and size of the stone. Our findings show that NCCT in-vivo stone attenuation might differentiate uric acid and calcium stones from the other stone types.

Comparison of split-cuff nipple and modified Lich-Gregoir ureteroneocystostomy in iatrogenic distal ureteral injuries: tertiary care center experience.

PURPOSE: In this study, we aimed to compare the results of split-cuff nipple and modified Lich-Gregoir ureteroneocystostomy, which are the most commonly used techniques in stage ≥ 3 iatrogenic distal ureteral injuries. METHODS: The files of patients who were treated for iatrogenic distal ureteral injuries in our clinic between January 2013 and January 2019 were retrospectively reviewed. A total of 60 patients who underwent either intra-vesical split-cuff nipple ureteroneocystostomy (Group A) or extra-vesical modified Lich-Gregoir ureteroneocystostomy (Group B) operations were included in the study. The success of ureteroneocystostomy was defined as no additional surgery requirement, no progression of hydronephrosis on imaging, and normal contrast transition on imaging. RESULTS: Thirty-four patients underwent split-cuff nipple and 26 patients underwent modified Lich-Gregoir ureteroneocystostomy. The treatment was successful in 53 (88.3%) patients and failed in seven (11.7%). Complications occurred in 19 (31.7%) patients, of whom 14 (23.3%) had minor and five (8.3%) had major complications. The rate of postoperative complications was significantly higher in Group A than in Group B (p = 0.019). There was no significant difference between Group A and Group B in terms of the success ratio (p = 1), rate of major complications (p = 0.372), and postoperative hospitalization times (p = 0.254). CONCLUSION: In this study, a higher complication rate was found in patients with iatrogenic ureteral injuries who underwent ureteroneocystostomy with the split-cuff ureteral nipple technique compared to those who underwent this operation with the modified Lich-Gregoir technique. However, no significant difference was observed between these two techniques in terms of treatment success and major complications.

The association between ureteral wall thickness and need for additional procedures after primary ureteroscopy in patients with ureteral stones above the iliac crest.

PURPOSE: To examine the parameters affecting the need for additional procedures in the primary ureteroscopy treatment in patients with ureteral stones above the iliac crest level. METHODS: Seventy-one patients were included in the study who were ≥ 18 years old and had undergone ureteroscopy (URS) for ureteral stones above the iliac crest level between 2018-2020 and had a non-contrast-enhanced abdominal computed tomography before the procedures were included in the study. Patients and stone characteristics were prospectively collected. The results were evaluated six weeks after URS. The absence of any residual fragment was thought to indicate stone-free status. The patients with failure were referred for the additional procedures. RESULTS: The median patient age was 51 years [interquartile range (IQR): 18-66]. The median transverse stone diameter was 9.5 mm (IQR: 7.1-11.4), and the median ureteral wall thickness (UWT) was 5.8 mm (IQR: 4.3-6.5). In the univariate analysis, UWT (p < 0.001), presence of multiple stones (p = 0.008), and stone length (p = 0.022) affected stone-free status. The multivariate analysis revealed UWT as the only independent factor affecting the need for additional procedures after URS (p = 0.028). In the receiver operating characteristic curve analysis, the best threshold value for UWT according to the outcomes was identified as 5.8 mm. CONCLUSION: Ureteral wall thickness was the only independent parameter determining the need for additional procedures and affecting the treatment outcomes after the URS procedure.

A Rare Case of Female Bladder Outlet Obstruction: Severe Introital Stenosis.

Herein, we report a rare case of severe introital stenosis in a 22-year female who presented with obstructive voiding symptoms and inability to have sexual intercourse. Introital stenosis had been caused by the emergency primary closure after major vulvoperineal trauma 15 years ago. To our knowledge, this is the first case report in the literature that describes a very long time from primary closure to dilation and reconstruction. A detailed systematic evaluation and pelvic examination were performed. The dilation procedure was performed and the patient was closely followed up. Reconstructive surgery, which involved the removal of the granulation tissue and approximation of healthy vaginal mucosal edges in several sessions, was performed after the initial dilation procedure. Follow-up was performed with the clinical assessment of the symptoms, physical examination, and uroflowmetry. Our technique was effective and did not lead to any complications. The sexual dysfunction and voiding complaints of the patient completely resolved within a post-operative period of 11 months. Key Words: Introital stenosis, Bladder outlet obstruction, Dilation, Female, Reconstruction.

Comparison of Laparoscopic and Open Ureterolysis for Retroperitoneal Fibrosis: Results from a Tertiary Referral Center.

Objectives: To compare the surgical outcomes of open and laparoscopic ureterolysis procedures in patients requiring surgical treatment for ureteral obstruction caused by retroperitoneal fibrosis (RPF). Materials: This study was designed retrospectively. The clinical records of patients who underwent ureterolysis between January 2005 and April 2019 because of ureteral obstruction caused by RPF were examined. According to the type of surgery, the patients were divided into two groups as Group 1 (open ureterolysis) and Group 2 (laparoscopic ureterolysis). Demographic features, preoperative-postoperative renal functions, duration of follow-up with ureteral stents, and perioperative-postoperative complications were examined. The requirement of ureteral stent placement during the follow-up period was accepted as unsuccessful ureterolysis. Results: Ureterolysis was performed in 13 patients and 23 renal units. Eleven of these patients were men and two were women. The median age of the patients was 54 (44-68) years. There were six patients and 12 renal units in Group 1 and seven patients and 11 renal units in Group 2. Postoperatively, a total of four patients (30%) had minor complications (Clavien-Dindo 1-2) and one patient had a major complication (Clavien-Dindo 3a). Ureterolysis was determined to be effective in 21 of the renal units (91%) [11/12 (92%) in Group 1 vs 10/11 (91%) in Group 2]. No statistically significant difference was found between the groups in terms of the success and complication rates (p = 1 and p = 0.529, respectively). Postoperative hospitalization length and recovery time to return to normal preoperative activities were significantly shorter in Group 2 than in Group 1 (p = 0.011 and p = 0.041, respectively). Conclusions: The success and complication rates were similar between the open and laparoscopic methods for ureterolysis. Laparoscopic approach was advantageous over open approach in terms of postoperative hospitalization length and recovery time to return to normal preoperative activities.

Signal abnormalities of the bladder wall detected by native T1 mapping in patients with overactive bladder.

OBJECT: Native T1 mapping provides tissue-specific T1 relaxation times, which can be used to identify structural changes in the various organs. The object of this article was to evaluate the bladder wall of patients with overactive bladder using native T1 mapping and compare the relaxation times of patients and healthy controls. MATERIAL AND METHODS: Seventeen patients with a diagnosis of overactive bladder and 15 healthy controls were enrolled in this prospective study. All participants underwent pelvic MRI and T1 maps were acquired. Native T1 relaxation times were calculated via regions of interest acquired from the anterosuperior wall of the bladder in all participants. Mean T1 relaxation times of the overactive bladder patients were compared with those of controls. RESULTS: Overactive bladder patients had statistically significantly higher T1 relaxation times compared with controls (p = 0.004). In the subgroup analysis, there was no statistically significant difference between males (1113.42 ± 62.4) and females (1176.70 ± 100.9) regarding the T1 relaxation times (p = 0.165). There were no correlations between age and T1 relaxation times in patient or control groups (r = 0.057, p = 0.825, and r = 0.052, p = 0.932, respectively). CONCLUSION: Native T1 mapping can identify structural changes in the bladder wall of patients with overactive bladder. This technique has a promising role in the diagnosis of patients with suspected overactive bladder.

Penile fracture: Tertiary care center experience and long-term complications after immediate repair.

BACKGROUND: In the literature, there is not sufficient data on factors affecting the development of complications in patients with penile fracture after early surgical intervention. OBJECTIVES: To investigate the predictors of long-term complications in patients who underwent immediate surgical repair for penile fracture. MATERIALS/METHODS: This clinical study included a total of 31 cases of penile fracture in which surgical treatment was performed within the first 24 h and penile fracture was confirmed during the operation. The patients with and without late complications were compared in terms of parameters such as age, tear size of the tunica albuginea of the penis, bilateral involvement of the corpora cavernosa involvement, urethral injuries, and duration from penile fracture to surgery. RESULTS: The median age of the patients was 42 years (interquartile range: 34-51 years). The median time from penile fracture to surgery was 13 h (8-18 h). The median tear size was 16 mm (11-21 mm). Late complications were seen in 13 (41.9%) patients in the post-operative period. Erectile dysfunction developed in five (16.1%) patients in the post-operative period. There was no statistically significant relationship between age, tear size, time from penile fracture to surgery, and bilateral corporeal involvement in terms of erectile dysfunction development. Painful erections, penile deviations, urethral strictures, tunical scars, and re-fracture were the other late complications. There was a significant relationship between the development of any complication and time from penile fracture to surgery (p = 0.028) and tear size (p = 0.031). In the receiver operating characteristic analysis of complication development, the cut-off value for the time from penile fracture to surgery was 13.5 h. DISCUSSION AND CONCLUSION: We found that the longer time interval between penile fracture and surgery worsened the patient outcomes. In addition, tear size was determined to be a predictor for long-term complications. In our opinion, early treatment of penile fracture can prevent severe complications in these cases.

Short-term effects of COVID-19 on semen parameters: A multicenter study of 69 cases.

OBJECTIVE: COVID-19, which is known to be caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a global health problem that can cause multiorgan damage because of its use of the angiotensin-converting enzyme 2 (ACE2) receptor in its pathophysiology. We aimed to investigate whether SARS-CoV-2 had a short-term effect on spermatogenesis, which plays an important role in male reproductive health as it has abundant ACE2 expression in testicular tissue. MATERIAL AND METHODS: This multicenter study included 69 patients aged 20-45 years, who admitted to our hospitals between April 2020 and October 2020 with a history of a positive test result for SARS-CoV-2 based on the nasopharyngeal or oropharyngeal swab samples and had recovered from the disease at least three months earlier and who had undergone a spermiogram test in the hospital database within the last year before the onset of disease. The patients were divided into two groups according to their COVID-19 symptoms being mild or moderate, depending on whether they had received home treatment or required hospitalization for oxygen therapy. Semen samples taken before and after COVID-19 were compared within and between the groups in terms of sperm parameters. RESULTS: The mean age of the patients included in the study was 30.4±4.8 years in the mild symptomatic COVID-19 group and 31.06±4.2 years in the moderate symptomatic group. When the spermiogram samples of the patients before and after COVID-19 were evaluated, it was found that motility and vitality significantly decreased in the mild symptomatic group, while the decrease in all semen parameters was statistically significant in the moderate symptomatic group. CONCLUSION: Although the mechanism by which COVID-19 causes testicular involvement remains uncertain, its short-term results on spermatogenesis reveals that COVID-19 negatively affects sperm parameters.

Ureteral wall thickness is an independent parameter affecting the success of extracorporeal shock wave lithotripsy treatment in ureteral stones above the iliac crest.

BACKGROUND: To investigate the relationship between ureteral wall thickness (UWT) and other variables of patients who underwent extracorporeal shock wave lithotripsy (SWL) in the primary treatment of the ureteral stone above the iliac crest level. MATERIAL AND METHODS: A total of 147 patients aged 18 years and older, who underwent SWL in our clinic between December 2016 and December 2019 for the treatment of ureteral stones above the iliac crest level and had non-contrast enhanced abdominal computed tomography scans before the procedure were included in the clinical study. The results were evaluated at 3 months after SWL. The absence of residual fragments was considered as stone-free status, and the existence of any size residual fragment was considered as treatment failure. RESULTS: In our study, the mean age of the patients was 42.4 ± 12.8 years, and the stone-free rate was 92.5%. The median transverse stone size was 7.5 mm (min 2.8-max 15), and the median UWT was 4.2 mm (1-8.7). In the multivariate analysis, UWT (P = .002) and multiple stone presence (P = .027) were found to be independent factors affecting stone-free status. In the receiver operating characteristic curve analysis, the optimal threshold value for UWT was determined as 5.25 mm. CONCLUSIONS: We found that UWT was the most important independent variable associated with increased failure in SWL treatment. The presence of multiple stones was another independent factor that increased the failure rates. Using SWL technology through experience accumulated with the mechanical hardware of the machine, we can select patients who are more suitable for this treatment and improve treatment outcomes.

Erectile dysfunction and retinal microvascular network: an optical coherence tomography angiography study.

The aims of this study were to examine the microvascular network of the retina using the optical coherence tomography angiography (OCT-A) device in patients with erectile dysfunction (ED) and to determine whether the OCT-A values could assist in the differential diagnosis of ED. The study design was prospective, observational, and cross-sectional. The vessel densities (VD) of the superficial capillary plexus (SCP), deep capillary plexus (DCP), and retinal peripapillary capillary plexus (RPCP) were assessed using OCT-A in patients with ED and healthy subjects. All the participants were evaluated and scanned for systemic and hormonal disorders and those with ED also underwent penile Doppler ultrasonography (PDU). After recording the data, the participants were divided into three groups: organic ED, psychogenic ED, and healthy control. The relationships between the OCT-A parameters and other clinical findings were analyzed. The right eyes of 80 patients with ED and 40 healthy volunteers were evaluated in this study. Of the ED patients, 46 were included in the organic ED group according to the results of PDU. The VDs of DCP, SCP, and the temporal sector of RPCP were significantly lower in the organic ED group than the psychogenic ED and healthy control groups. The VDs of SCP and DCP were correlated with the peak systolic velocity of both left and right penile cavernous arteries. The VDs of DCP were also correlated with the left and right resistive indexes. In conclusion, the OCT-A data of SCP and especially DCP could be helpful in evaluating ED, and provide reliable information about the origin of the disease along with the other laboratory testing and penile vascular evaluation.

Does Previous Open Stone Surgery Affect the Outcome of Shock Wave Lithotripsy Treatment in Children?

INTRODUCTION: The aim of the study was to evaluate the efficiency of shock wave lithotripsy (SWL) in children who previously underwent ipsilateral open renal stone surgery (ORSS). METHODS: A total of 315 renal units (RUs) with renal stones underwent SWL treatment in our department over a period of 18 years. A total of 274 RUs (87%) with no history of ORSS were categorized as group 1 and 41 RUs (13%) with a history of ORSS were categorized as group 2. The characteristics of the patients and renal stones, as well as the treatment modalities, were reviewed retrospectively, and the results were compared in terms of the rates of stone-free patients and complications. RESULTS: The stone-free rates were statistically lower in patients with an existing history of ORSS (p = 0.002), especially for stones located at the lower calyx (p = 0.006). However, there were no differences between groups in the rate of complications (p = 0.75). History of ipsilateral ORSS, age, and stone burden were independent risk factors that predicted a stone-free status in the regression analysis (p = 0.016, p = 0.045, and p = 0.001, respectively). CONCLUSION: The overall stone-free rate after SWL was found to be significantly lower in children with a history of ORSS than in those without, and this finding was significantly prominent for lower calyx stones. In spite of the possible difficulties in achieving surgical access due to anatomical changes in retrograde intrarenal surgery or mini-/micro-percutaneous nephrolithotomy, we believe that these techniques might be good alternatives for SWL in future cases.

Clinical outcomes of radical surgery in patients with renal carcinoma and associated venous thrombosis: Single-centre experience in a tertiary care institution.

BACKGROUND: Renal carcinoma and associated venous thrombosis cause specific perioperative and postoperative challenges. We aimed to evaluate the factors affecting clinical outcomes in patients undergoing radical surgery because of renal carcinoma and associated venous thrombosis. MATERIALS AND METHODS: Hospital records were retrospectively reviewed to identify patients with renal carcinoma and associated venous thrombosis treated with radical surgery between 2006 and 2019. Preoperative, perioperative, and postoperative findings were analysed to determine the associations between clinical and survival outcomes. Overall and disease-free survival were analysed by the Kaplan-Meier method. Other associated prognostic variables were assessed using univariate and multivariate Cox regression analyses. RESULTS: Thirty-three patients with renal carcinoma and associated venous thrombosis were enrolled for this study. There were 15 (45.4%) patients with level I, five (15.2%) with level II, eight (24.2%) with level III, and five (15.2%) with level IV venous thrombosis according to the Mayo Clinic classification system. The median follow-up was 35.6 months. In the univariate analysis, increased tumour size was associated with poor overall and disease-free survival. Preoperative clinic M1 disease was associated with poor overall survival. A high Mayo Clinic thrombus level was associated with poor disease-free survival. In the multivariate analysis, only tumour size and clinic M1 disease were independently correlated with poor overall survival. No independent statistically significant association was detected between thrombus level and survival outcomes. CONCLUSIONS: Although the thrombus level was not associated with overall and disease-free survival, tumour size and clinic M1 disease were found to have an independent prognostic impact on overall survival.

Variations in the Number of Patients Presenting With Andrological Problems During the Coronavirus Disease 2019 Pandemic and the Possible Reasons for These Variations: A Multicenter Study.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) pandemic caused unprecedented restrictions in outpatient services and surgical practices in urology as in other medical branches as well as in all areas of life. AIM: To investigate whether there have been variations in the presentations of male patients with sexual and reproductive health problems to the outpatient urology clinics during the COVID-19 pandemic and to understand the underlying factors for these variations, if any. METHODS: Male patients aged ≥18 years who presented to the outpatient urology clinics in 12 centers across Turkey from February 1, 2020 to June 1, 2020 were retrospectively evaluated. The patients were divided into 2 groups: those who presented to the outpatient clinic from February 1, 2020 to March 11, 2020 comprised the "pre-COVID-19 pandemic period" group, whereas those who presented to the outpatient clinic from March 12, 2020 to June 1, 2020 comprised the "COVID-19 pandemic period" group and compared with each other. MAIN OUTCOME MEASURES: The main outcome of this study was the number and diagnose of patients presented to urology outpatient clinics. RESULTS: Andrological problems were detected in 721 of 4,955 male patients included in the study. During the COVID-19 pandemic period, there was a significant increase in andrological diagnosis in these patients compared with the pre-COVID-19 pandemic period (n = 293 [17%] vs n = 428 [13.2%], P < .001, respectively). Similarly, there was a statistically significant increase in the number of patients diagnosed with male reproductive or sexual health problems during the COVID-19 pandemic period (n = 107 [6.2%] vs n = 149 [4.6%], P = .016 and n = 186 [10.8%] vs n = 279 [8.6%], P = .013, respectively). The number of patients diagnosed with erectile dysfunction during the pandemic was also significantly higher than the pre-COVID-19 pandemic period (n = 150 [8.7%] vs n = 214 [6.6%], P = .008). CONCLUSION: Presentations to the outpatient urology clinics owing to andrological problems markedly increased during the pandemic period. Although these problems are of multifactorial origin, psychogenic factors are also considered to significantly trigger these problems.MB Duran, O Yildirim, Y Kizilkan, et al. Variations in the Number of Patients Presenting With Andrological Problems During the Coronavirus Disease 2019 Pandemic and the Possible Reasons for These Variations: A Multicenter Study. Sex Med 2020;XX:XXX-XXX.

The Role of 68GA-PSMA PET/CT Scan In Patients with Prostate Adenocarcinoma who Underwent Radical Prostatectomy.

PURPOSE: To determine whether a 68Ga-PSMA PET/CT scan evaluation before radical prostatectomy (RP) is an effective imaging modality for clinical local and lymph node (LN) staging compared with the pathological results. MATERIALS AND METHODS: We performed a preoperative 68Ga-PSMA PET/CT scan in 51 patients with prostate cancer (PCa), who were scheduled for an RP operation between January 2014 and June 2016 in our clinic. The correlation between the RP pathology and the results of the 68Ga-PSMA PET/CT scan was investigated. RESULTS: When the 68Ga-PSMA PET/CT scan results were evaluated according to the risk groups, intraprostatic activity was found in 5 of 12 patients (41.7%) in the low-risk group, 15 of 19 patients in the intermediate risk group (78.9%), and 90% patients in the high-risk group. The 68Ga-PSMA PET/CT scan sensitivity, specificity, positive and negative predictive values and accuracy were calculated as 58.2%, 75.3%, 84.4%, 44%, and 63%, respectively for intraprostatic tumor localization; 68.4%, 75%, 61.9%, 80%, and %72.6%, respectively for extracapsular extension; 63.6%, 92.3%, 70%, 90%, and 86%, respectively for seminal vesicle involvement; 50%, 100%, 100%, 88%, and 89.3%, respectively for LN metastasis. CONCLUSION: The 68Ga-PSMA PET/CT scan accurately demonstrates intraprostatic tumor localization in high-risk group and presence of seminal vesicle involvement, which can help to accurately detect the target lesion before prostate biopsy. In addition, with its high sensitivity and specificity values, 68Ga-PSMA PET/CT is a valuable imaging method for the assessment of LN metastasis in intermediate- and high-risk groups and also provides accurate nodal staging before RP.

Renal Parenchymal Volumetric Expansion Assessed by CT Imaging After Laparoscopic Cyst Decortication.

PURPOSE: To delineate the expansion of the renal parenchyma using volumetric CT imaging before and after the laparoscopic cyst decortication procedure and to determine the possible associations between parenchymal expansion and laboratory parameters and cyst volume. MATERIALS AND METHODS: Thirty-five patients that underwent laparoscopic cyst decortication were included in this prospective study. Abdominal contrast-enhanced CT was performed in all patients in the preoperative and postoperative period. Semi-automatic volume quantification was undertaken offline, and renal parenchymal volumes before and after cyst decortication, as well as serum creatinine and estimated glomerular filtration rate (eGFR) were compared. RESULTS: The changes in serum creatinine and eGFR in the postoperative period were non-significant. The mean postoperative renal parenchymal volumes were higher compared to the preoperative measurements for both observations (P = .014 and .034 for the first and second measurements, respectively). There was no correlation between the volumetric change and the cyst volume (r = -0.18, P = .560). CONCLUSION: In patients undergoing laparoscopic cyst decortication, post-operative parenchymal expansion can be detected using volumetric CT imaging to confirm the immediate benefits of the procedure.