The effects of topical aloe vera on an experimentally designed penile fracture model in rats.

BACKGROUND: This study assessed the histopathological and oxidative effects of topical Aloe Vera (AV) on penile fractures (PF) formed experimentally in a rat model. METHODS: Forty Wistar albino rats (220-250 g) were used. The PF model was created experimentally with a number 15 lancet. Then, the rats were randomly and equally divided into five groups. In the first group (C), no incision was formed. In the second group (P), an incision was formed. In the third group (PR), the incision line was closed primarily. In the fourth group (PA), AV was locally applied onto the incision without suturing for three days. In the last group (PRA), AV was applied to the primary repair region for three days. All groups were compared to each other according to histopathological and biochemical data. RESULTS: Hyperemia-bleeding was observed to be suppressed in the PRA group compared to the other groups (p<0.001). Inflammation was observed only in Groups PR and PRA (p<0.001). Significant fibrosis was observed in the PA and PRA groups compared to the other groups (p<0.001). Superoxide Dismutase (SOD) and Glutathione (GSH) values increased in favor of Group PRA (p=0.009 and p=0.035, respectively). Total Oxidative Status (TOS) and Malondialdehyde (MDA) values decreased in favor of Group PA (p=0.036 and p=0.026, respectively). Tumor Necrosis Factor-alpha (TNF-α) and Interleukin-1 beta (IL-1ß) levels decreased mostly in the PRA group, but these changes did not reach statistical significance (p>0.05). CONCLUSION: Topical AV application reduces tissue inflammation and oxidative stress but appears to increase the development of fibrosis after PF.

Management Patterns of Male Urethral Stricture Disease among Urologists: What Do the Guidelines Say? What Do Urologists Do?

BACKGROUND: The aim of the present study is to evaluate and analyze the daily clinical practice for male urethral stricture disease (MUSD) among urologists. METHODS: Considering the latest guidelines on urethral stricture disease, a survey was developed regarding the various treatment options and preferences in different sites of male urethral stricture disease. The survey was sent to urologists via e-mail and phone application. RESULTS: A total of 266 urologists completed the survey and were included in the final analysis. In regard to workplace, 62 (23.3%), 58 (21.8%), 71 (26.7%), and 75 (28.2%) respondents worked in university hospitals, training and research hospitals, state hospitals, and private practice hospitals, respectively. In regard to the diagnostic method used in male urethral strictures, 88.7% of the participants would choose uroflowmetry + postvoiding residual (UF + PVR), and 64.6% would choose retrograde urethrography (RUG). Direct vision internal urethrotomy (DVIU) was the most frequently chosen method in penile urethral strictures (PUS), being chosen by 72.9%. Direct vision anterior internal urethrotomy was the most common method for both ≤2 cm and >2 cm strictures, 63.1%, and 30.8%, respectively. The most preferred graft for augmentation urethroplasty was buccal mucosa (75.8%). Endoscopic incision/resection (transurethral resection (TUR)) is the most frequently applied treatment method for posterior urethral/vesicourethral anastomotic strictures (86.4%). CONCLUSIONS: The present study clearly shows that most urologists still prefer DVIU and urethral dilatation to urethroplasty in MUSD, which contradicts current guidelines. Urologists should be encouraged to perform urethroplasty and/or refer patients to experienced centres for recurrent MUSD.

Management Patterns of Male Urethral Stricture Disease among Urologists: What Do the Guidelines Say? What Do Urologists Do?

Background: The aim of the present study is to evaluate and analyze the daily clinical practice for male urethral stricture disease (MUSD) among urologists. Methods: Considering the latest guidelines on urethral stricture disease, a survey was developed regarding the various treatment options and preferences in different sites of male urethral stricture disease. The survey was sent to urologists via e-mail and phone application. Results: A total of 266 urologists completed the survey and were included in the final analysis. In regard to workplace, 62 (23.3%), 58 (21.8%), 71 (26.7%), and 75 (28.2%) respondents worked in university hospitals, training and research hospitals, state hospitals, and private practice hospitals, respectively. In regard to the diagnostic method used in male urethral strictures, 88.7% of the participants would choose uroflowmetry + postvoiding residual (UF + PVR), and 64.6% would choose retrograde urethrography (RUG). Direct vision internal urethrotomy (DVIU) was the most frequently chosen method in penile urethral strictures (PUS), being chosen by 72.9%. Direct vision anterior internal urethrotomy was the most common method for both ≤2 cm and >2 cm strictures, 63.1%, and 30.8%, respectively. The most preferred graft for augmentation urethroplasty was buccal mucosa (75.8%). Endoscopic incision/resection (transurethral resection (TUR)) is the most frequently applied treatment method for posterior urethral/vesicourethral anastomotic strictures (86.4%). Conclusions: The present study clearly shows that most urologists still prefer DVIU and urethral dilatation to urethroplasty in MUSD, which contradicts current guidelines. Urologists should be encouraged to perform urethroplasty and/or refer patients to experienced centres for recurrent MUSD (AU)

Factors affecting urinary incontinence-related quality of life in geriatric patients: an observational cross-sectional study in a tertiary hospital urology clinic in Turkey / Factores que afectan la calidad de vida relacionada con la incontinencia urinaria en pacientes geriátricos: un estudio transversal observacional en una clínica de urología de un hospital terciario en Turquía

Introduction: Geriatric syndromes are associated with morbidity and poor quality of life (QOL). Urinary incontinence (UI) is one of the most prevalent geriatric syndromes. However, there is little research on the association of UI and UI-related QOL with other geriatric syndromes. The aim of this exploratory study were to examine the effect and coexistence of geriatric syndromes, admission type and surgical severity on UI-related QoL in patients hospitalized in the urology clinic. Materials and methods: This study was conducted among 250 older inpatients (aged 65 years and older between October 2019 and March 2020) at Zonguldak Bulent Ecevit University department of Urology, Zonguldak, Turkey. After ethical approval and patient consent, we examined geriatric syndromes and related factors including cognitive impairment, delirium, depression, decreased mobility, multiple drug use, malnutrition, pain and fecal incontinence as well as hospitalization patterns and surgical severity of the patients. UI-related QOL was assessed using the International Consultation on Incontinence Questionnaire-Short Form. Multiple logistic regression analysis was used to evaluate these associations. Results: Geriatric syndromes and related factors were associated with UI. Moderate cognitive decline (odds ratio [OR], 3.764; 95% confidence interval [CI], 1.621- 8.742), Charlson Comorbidity Index (CCI) (odds ratio [OR], 1.56; 95% confidence interval [CI], 1.24–5.05) and the number of medication used (odds ratio [OR], 1,33; 95% confidence interval [CI], 1.11–1.58) were associated with increased probability of having UI. Cognitive impairment, length of hospital stay had an inverse and age of patients had a direct effect on patients UI-related QoL. Conclusions: UI-related quality of life was associated with some factors. Especially in the urology clinic, evaluating the cognitive functions of elderly patients, ... (AU)

Introducción: Los síndromes geriátricos se asocian con morbilidad y mala calidad de vida (CV). La incontinencia urinaria (IU) es uno de los síndromes geriátricos más prevalentes. Sin embargo, hay poca investigación sobre la asociación de la IU y la CdV relacionada con la IU con otros síndromes geriátricos. El objetivo de este estudio exploratorio fue examinar el efecto y la coexistencia de los síndromes geriátricos, el tipo de ingreso y la gravedad quirúrgica en la calidad de vida relacionada con la IU en pacientes hospitalizados en la consulta de urología. Materiales y métodos: este estudio se realizó entre 250 pacientes hospitalizados mayores (de 65 años o más entre octubre de 2019 y marzo de 2020) en el departamento de Urología de la Universidad Zonguldak Bulent Ecevit, Zonguldak, Turquía. Después de la aprobación ética y el consentimiento del paciente, examinamos los síndromes geriátricos y los factores relacionados, incluidos el deterioro cognitivo, el delirio, la depresión, la disminución de la movilidad, el uso de múltiples drogas, la desnutrición, el dolor y la incontinencia fecal, así como los patrones de hospitalización y la gravedad quirúrgica de los pacientes. La calidad de vida relacionada con la IU se evaluó mediante el Cuestionario de consulta internacional sobre incontinencia: formato corto. Se utilizó análisis de regresión logística múltiple para evaluar estas asociaciones. Resultados: Los síndromes geriátricos y factores relacionados se asociaron con la IU. Deterioro cognitivo moderado (odds ratio [OR], 3,764; intervalo de confianza [IC] del 95 %, 1,621-8,742), índice de comorbilidad de Charlson (ICC) (odds ratio [OR], 1,56; intervalo de confianza [IC] del 95 %, 1,24– 5,05) y el número de medicamentos utilizados (odds ratio [OR], 1,33; intervalo de confianza [IC] del 95 %, 1,11–1,58) se asociaron con una mayor probabilidad de tener IU. El deterioro cognitivo, la duración de la estancia hospitalaria tuvieron un efecto inverso y la edad ... . (AU)

The Clinical Efficacy of Manual Irrigation for the Prevention of Postoperative Bleeding of Transurethral Prostate Resection / La eficacia clínica de la irrigación manual para la prevención del sangrado posoperatorio de la resección transuretral de próstata

Introduction: Postoperative blood loss after prostate surgery is thought to be associated with an increase in urinary fibrinolytic activity. We investigated the effects of the local dilution of fibrinolytic agents with manual irrigation on postoperative bleeding after the transurethral resection of the prostate (TUR-P). Materials and methods: Between April 2017 and April 2021, 128 patients were prospectively randomised into two equal groups. Monopolar TUR-P was applied to all patients for benign prostatic hyperplasia, but post procedure manual irrigation was used in group 2 only. Haemoglobin levels were evaluated before and after TUR-P. Intra-op and post operative bleeding, amount of saline used for irrigation, duration of catheterisation and length of hospital stay were noted. The patients were followed up 1 month after the TUR-P. Results: The resected adenoma weight was 12.64 g in group 1 and 13.11 g in group 2. There was no difference between groups 1 and 2 in terms of haemoglobin loss and total blood loss within the first 24 h after TUR-P, which were 0.82 g and 0.95 g (P = 0.443) and 90.45 mL and 67.80 mL (P = 0.102), respectively. There was also no significant difference between the groups in the saline volume used for irrigation (19 vs. 17.3 L), catheter duration and hospital stay (2.6 vs. 2.6 days). Conclusions: We could not show the positive effects of manual irrigation on bleeding complications after TUR-P, though it is a simple and safe-seeming procedure with no specific operative technique. (AU)

Introducción: Se cree que la pérdida de sangre postoperatoria después de la cirugía de próstata está asociada con un aumento en la actividad fibrinolítica urinaria. Investigamos los efectos de la dilución local de fibrinolíticos con irrigación manual sobre el sangrado postoperatorio tras la resección transuretral de próstata (RTU-P). Materiales y métodos: entre abril de 2017 y abril de 2021, 128 pacientes fueron aleatorizados prospectivamente en dos grupos iguales. Se aplicó RTU-P monopolar a todos los pacientes por hiperplasia prostática benigna, pero solo en el grupo 2 se usó irrigación manual posterior al procedimiento. Los niveles de hemoglobina se evaluaron antes y después de la RTU-P. Se registraron el sangrado intraoperatorio y posoperatorio, la cantidad de solución salina utilizada para la irrigación, la duración del cateterismo y la duración de la estancia hospitalaria. Los pacientes fueron seguidos 1 mes después de la RTU-P. Resultados: El peso del adenoma resecado fue de 12,64 g en el grupo 1 y de 13,11 g en el grupo 2. No hubo diferencia entre los grupos 1 y 2 en cuanto a la pérdida de hemoglobina y la pérdida total de sangre dentro de las primeras 24 h después de la RTU-P, que fueron de 0,82. g y 0,95 g (P = 0,443) y 90,45 mL y 67,80 mL (P = 0,102), respectivamente. Tampoco hubo diferencias significativas entre los grupos en el volumen de solución salina utilizada para la irrigación (19 frente a 17,3 l), la duración del catéter y la estancia hospitalaria (2,6 frente a 2,6 días). Conclusiones: No pudimos mostrar los efectos positivos de la irrigación manual sobre las complicaciones hemorrágicas después de la RTU-P, aunque es un procedimiento simple y aparentemente seguro sin una técnica quirúrgica específica. (AU)

Healthcare providers' compliance with guidelines for catheter-associated urinary tract infections in a rural teaching and referral hospital / Cumplimiento de las pautas para las infecciones del tracto urinario asociadas con el catéter por parte de los proveedores de atención médica en un hospital rural docente y de referencia

Introduction: Healthcare professionals (HCPs) play a key role in the prevention of catheter-associated urinary tract infections (CAUTI). This study aims to determine the compliance of healthcare personnel with urethral catheterisation standards and the factors affecting it. Materials and Methods: This study is a prospective survey and was conducted between February and March 2021 after ethical approval and patient consent. An internet-based, structured 39-item questionnaire was sent via email to all HCPs at Zonguldak Bulent Ecevit University Hospital, Zonguldak, Turkey. A to evaluate their knowledge and attitudes towards the prevention of CAUTI. The questionnaire was completed by 156 health professionals. For categorical parameters Fisher’s exact test, though for scale parameters student t-test, Mann–Whitney U and Kruskal–Wallis tests were used. All statistical analysis was done using SPSS 17.0. Results: The average years of experience of the HCPs who participated in the survey was 12.5 years. The level of knowledge of the doctors and the nurses about the indication of catheter insertion was similar, whereas the level of knowledge about CAUTI prevention was higher among the doctors. However, none of the participants could fully describe how to prevent CAUTI. Conclusions: The level of knowledge of CAUTI preventive measures among the participants was insufficient. To effectively preventing CAUTI, there is a need to change HCPs’ perspective on this issue, which can be achieved through training, and advantage current technologies. (AU)

Introducción: Los profesionales de la salud (PS) juegan un papel clave en la prevención de infecciones del tracto urinario asociadas al catéter (ITUAC). Este estudio tiene como objetivo determinar el cumplimiento de las normas de sondaje uretral por parte del personal sanitario y los factores que lo afectan. Materiales y métodos: Este estudio es una encuesta prospectiva y se realizó entre febrero y marzo de 2021 después de la aprobación ética y el consentimiento del paciente. Se envió un cuestionario estructurado de 39 ítems basado en Internet por correo electrónico a todos los HCP en el Hospital Universitario Zonguldak Bulent Ecevit, Zonguldak, Turquía. A para evaluar sus conocimientos y actitudes hacia la prevención de la ITUAC. El cuestionario fue completado por 156 profesionales de la salud. Para los parámetros categóricos se utilizó la prueba exacta de Fisher, aunque para los parámetros de escala se utilizaron la prueba t de Student, la U de Mann-Whitney y la de Kruskal-Wallis. Todos los análisis estadísticos se realizaron con SPSS 17.0. Resultados: El promedio de años de experiencia de los profesionales de la salud que participaron en la encuesta fue de 12,5 años. El nivel de conocimiento de los médicos y las enfermeras sobre la indicación de la inserción del catéter fue similar, mientras que el nivel de conocimiento sobre la prevención de las ITUAC fue mayor entre los médicos. Sin embargo, ninguno de los participantes pudo describir completamente cómo prevenir ITUAC. Conclusiones: El nivel de conocimiento de las medidas preventivas de ITUAC entre los participantes fue insuficiente. Para prevenir CAUTI de manera efectiva, es necesario cambiar la perspectiva de los profesionales de la salud sobre este tema, lo que se puede lograr a través de la capacitación y aprovechar las tecnologías actuales. (AU)

The Diagnostic Power of the Platelet Mass Index for Testicular Tumours: A Simple Blood Test / El poder diagnóstico del índice de masa plaquetaria para los tumores testiculares: un simple análisis de sangre

Introduction: The relationship between inflammation and cancer has long been the focus of researchers' interest. There are many inflammatory markers studied for this purpose in the literature. In this context, we focused on the effects of platelet counts and platelet mass index (PMI) as inflammatory markers in the diagnosis of low-volume localized testicular cancer. Materials and methods: Thirty-eight patients with localized testicular cancer with a mean age of 30.84 ± 5.79 years and 38 patients with varicocele as a control group with a mean age of 32.8 ± 9.7 years were enrolled in the study. Number of platelets, mean platelet volume and value of PMI were calculated from peripheral blood samples obtained. Results: Number of platelets and PMI values were statistically significantly higher in patients with testicular cancer compared with the control group (p<.05). Conclusions: Both platelet counts and PMI values can be used as a simple test in the diagnosis of testicular cancer besides the well-known accurate serum tumor markers as AFP (alpha fetoprotein), hCG (human chorionic gonadotropin) and LDH (lactate dehydrogenase). (AU)

Introducción: La relación entre la inflamación y el cáncer ha sido durante mucho tiempo el foco de interés de los investigadores. Hay muchos marcadores inflamatorios estudiados con este propósito en la literatura. En este contexto, nos centramos en los efectos del recuento de plaquetas y el índice de masa plaquetaria (PMI) como marcadores inflamatorios en el diagnóstico de cáncer testicular localizado de bajo volumen. Materiales y métodos: Se incluyeron en el estudio 38 pacientes con cáncer testicular localizado con una edad media de 30,84 ± 5,79 años y 38 pacientes con varicocele como grupo control con una edad media de 32,8 ± 9,7 años. El número de plaquetas, el volumen medio de plaquetas y el valor de PMI se calcularon a partir de muestras de sangre periférica obtenidas. Resultados: El número de plaquetas y los valores de PMI fueron estadísticamente significativamente más altos en los pacientes con cáncer testicular en comparación con el grupo de control (p <.05). Conclusiones: Tanto el recuento de plaquetas como los valores de PMI se pueden utilizar como una prueba simple en el diagnóstico de cáncer testicular, además de los marcadores tumorales séricos precisos bien conocidos como AFP (alfa fetoproteína), hCG (gonadotropina coriónica humana) y LDH (lactato deshidrogenasa). (AU)

Effects of mirabegron on JJ stent-related symptoms: A multicentric study.

AIMS OF THE STUDY: To investigate the effect of mirabegron 50 mg/daily for JJ stent-related symptoms after ureteroscopic stone surgery. METHODS: Medical records of 145 patients who were given a single daily oral dose of 50 mg of mirabegron for relieving stent-related symptoms were retrospectively analysed. Demographic and clinical data and stone parameters were recorded. All participants completed the Turkish version of the Ureter Symptom Score Questionnaire (USSQ-T) on the postoperative 7th day, and again after at least 3 weeks, before JJ stent removal. The severity of stent-related symptoms was statistically compared before and after the mirabegron treatment. RESULTS: The mean urinary symptoms score decreased significantly from 30.87 ± 9.43 to 22.61 ± 6.78 (P < .0001), mean body pain score decreased significantly from 21.82 ± 11.22 to 14.03 ± 7.52 (P < .0001), mean work performance score decreased from 10.50 ± 8.61 to 7.02 ± 6.51 (P < .0001) and mean general health score decreased significantly from 15.43 ± 6.50 to 11.12 ± 3.70 (P < .0001). The mean sexual matters score significantly decreased from 3.88 ± 3.40 to 2.48 ± 2.03 (P < .0001), the additional problem score decreased from 9.31 ± 4.61 to 6.51 ± 2.83 (P < .0001) and the overall quality of life (QoL) score decreased from 5.18 ± 1.94 to 4.23 ± 1.71 after mirabegron use (P < .0001). CONCLUSION: Daily use of 50 g of mirabegron significantly improved stent-related symptoms, sexual matters and quality of life.

The effect of an antifibrotic agent, pirfenidone, on penile erectile function in an experimental rat model of ischemic priapism.

To date, no effective medical approach for the treatment of erectile dysfunction (ED) secondary to ischemic priapism (IP) has been described. The aim of this study was to evaluate the anti-inflammatory, antifibrotic, and antioxidant effects of pirfenidone (PFD) on cavernosal tissue in a rat model of IP. Forty-eight male albino rats aged 8-10 months, with mean weights of 410 ± 18.6 g were randomized into four groups (n = 12 in each group): no IP (group 1); IP for 1 h, followed by intracavernosal pressure (ICP) measurements using electrical cavernous nerve stimulation (CNS) (group 2); IP for 1 h, followed by ICP measurements using electrical CNS 6 weeks later (group 3); and IP for 1 h, oral PFD (30 mg/kg once daily) treatment by oral gavage, followed by ICP measurements using electrical CNS 6 weeks later (group 4). Malondialdehyde (MDA) and reduced glutathione levels were measured spectrophotometrically. In a histological evaluation, cavernosal collagen/smooth muscle ratios were calculated. The intracavernosal pressure values of group 1 were higher than those of groups 2 and 3 (p < 0.05) but similar to those of group 4 (p > 0.05). The mean MDA level was significantly higher in group 3, as compared with that in group 4 (p = 0.004). The mean collagen/smooth muscle ratio in groups 1-4 was 24%, 42%, 65%, and 48%, respectively. Physiological, biochemical, and histopathological evaluations of the PFD effect on cavernosal tissue in a rat model of IP were the strengths and the lack of molecular and immunohistochemical analysis were the limitations of this study. In this study, we examined the effects of PFD on cavernosal tissue in a rat model of IP. We found that PFD reduced cavernosal fibrotic activity and improved erectile function. We conclude that PFD may represent a new treatment option in IP treatment.

Which intraperitoneal insufflation pressure should be used for less postoperative pain in transperitoneal laparoscopic urologic surgeries?

ABSTRACT Purpose To determine whether using different intraperitoneal insufflation pressures for transperitoneal laparoscopic urologic surgeries decreases postoperative pain. Materials and Methods 76 patients who underwent transperitoneal laparoscopic upper urinary tract surgery at different insufflation pressures were allocated into the following groups: 10mmHg (group I, n=24), 12mmHg (group II, n=25) and 14mmHg (group III, n=27). These patients were compared according to age, gender, body mass index (BMI), type and duration of surgery, intraoperative bleeding volume, postoperative pain score and length of hospital stay. A visual analog scale (VAS) was used for postoperative pain. Results Demographic characteristics, mean age, gender, BMI and type of surgeries were statistically similar among the groups. The mean operation time was higher in group I than group II and group III but this was not statistically significant (P=0.810). The mean intraoperative bleeding volume was significantly higher in group I compared with group II and group III (P=0.030 and P=0.006). The mean length of postoperative hospital stays was statistically similar among the groups (P=0.849). The mean VAS score at 6h was significantly reduced in group I compared with group III (P=0.011). At 12h, the mean VAS score was significantly reduced in group I compared with group II and group III (P=0.009 and P<0.001). There was no significant difference in the mean VAS scores at 24h among three groups (P=0.920). Conclusion Lower insufflation pressures are associated with lower postoperative pain scores in the early postoperative period.

Which intraperitoneal insufflation pressure should be used for less postoperative pain in transperitoneal laparoscopic urologic surgeries?

PURPOSE: To determine whether using different intraperitoneal insufflation pressures for transperitoneal laparoscopic urologic surgeries decreases postoperative pain. MATERIALS AND METHODS: 76 patients who underwent transperitoneal laparoscopic upper urinary tract surgery at different insufflation pressures were allocated into the following groups: 10mmHg (group I, n=24), 12mmHg (group II, n=25) and 14mmHg (group III, n=27). These patients were compared according to age, gender, body mass index (BMI), type and duration of surgery, intraoperative bleeding volume, postoperative pain score and length of hospital stay. A visual analog scale (VAS) was used for postoperative pain. RESULTS: Demographic characteristics, mean age, gender, BMI and type of surgeries were statistically similar among the groups. The mean operation time was higher in group I than group II and group III but this was not statistically significant (P=0.810). The mean intraoperative bleeding volume was significantly higher in group I compared with group II and group III (P=0.030 and P=0.006). The mean length of postoperative hospital stays was statistically similar among the groups (P=0.849). The mean VAS score at 6h was significantly reduced in group I compared with group III (P=0.011). At 12h, the mean VAS score was significantly reduced in group I compared with group II and group III (P=0.009 and P<0.001). There was no significant difference in the mean VAS scores at 24h among three groups (P=0.920). CONCLUSION: Lower insufflation pressures are associated with lower postoperative pain scores in the early postoperative period.