The effect of transversus abdominis plane block application on postoperative analgesia quality and patient satisfaction after varicocele surgery: a randomized clinical trial.

Background: Postoperative pain management is an important aspect of anesthesia care and multimodal analgesic techniques are generally recommended. Objective: To compare the effect of spinal anesthesia + transversus abdominis plane (TAP) block application on postoperative analgesia quality and patient satisfaction with spinal anesthesia + intrathecal morphine (ITM) application. Methods: A total of 70 patients were randomly separated into 2 groups as spinal anesthesia + TAP block (TAP block group, n = 34) and spinal anesthesia + ITM group (ITM group, n = 36). The groups were compared in respect of age, body mass index values, and visual analog scale (VAS) values at 0 h, 2 h, 6 h, 12 h, and 18 h, and patient satisfaction was scored by Quality Improvement in Postoperative Pain Management at 24 h. Results: The mean age of the patients was 32.52 ± 6.50 years in the TAP block group and 30.11 ± 5.62 years in the ITM group, with no statistically significant difference determined. There was no statistically significant difference in terms of VAS values at 0 h, 2 h, 6 h, 12 h, and 18 h. When the factors affecting postoperative patient satisfaction were evaluated, feeling fatigue after the surgery (r = -0.811, P = 0.001) and postoperative complications such as nausea, vomiting, and itching (r = -0.831, P = 0.001) were found to have a negative effect on patient satisfaction. Conclusion: Due to low complication rates, TAP block is an effective application for postoperative analgesia management in varicocele operations that increases patient satisfaction postoperatively.

What is the impact of inflammasome mechanisms on male infertility?

BACKGROUND: Mechanisms to explain inflammation in male infertility of unknown cause are still being investigated. The inflammasome is a key regulator of innate immunity in the inflammatory response to infections. Our study aims to investigate the effects of varicocele on infertility, its relationship with antioxidant and inflammasome mechanisms, and how it could be guided in azoospermic or nonazoospermic patients. METHODS: A cross-sectional cohort study was conducted at the department of urology in our university hospital. Eightyeight randomly selected men aged 20-45 admitted to our hospital because of infertility between September 2019 and July 2020 were included in the study. Patients were divided into four equal groups according to their clinical status, those with/without azoospermia and with/without varicocele. Blood and semen samples were taken from the patients. NOD-like receptor pyrin domain-containing 3 (NLRP3) and interleukin-1 beta (IL1ß) and total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) levels were measured in serum and semen, and the groups were compared statistically. RESULTS: Serum and semen NLRP3, IL1ß, TAS, TOS, and OSI values of the patients with varicocele or azoospermia were significantlyhigher than those without either varicocele or azoospermia (p < 0.05). The oxidative stress markers TAS, TOS, and OSI values were significantly higher in the other groups than those without azoospermia and varicocele (p < 0.05). DISCUSSION: Inflammasome mechanisms, such as NLRP3 and IL1-ß molecules, may provide additional benefit in evaluating the need and benefit of surgical or medical treatment in infertility with and without vascular pathology and with and without azoospermia.

Multiorgan Echinococcosis with Uterine Involvement Causing Bilateral Hydronephrosis in a Child: Case Report.

Hydatid cyst is a parasitic infection transmitted by oral ingestion of Echinococcus granulosus eggs. Hydatid cyst of the genital tract is rare and the occurrence in the uterus is an extreme rarity. We present an 8-yr-old girl with complaints of swelling of lower abdomen, pollakiuria and bilateral flank pain was brought to Emergency Department of Harran University, Turkey, in Jun 2019. The patient had simultaneous hydatid cysts of the liver, mesentery and uterus. We performed abdominal exploration and completely removed the inner germinal layer of cyst through an incision made in the anterior of the uterine fundus. Then, we applied total excision to the two cysts in the right and left colon mesentery. Finally, we performed partial cystectomy to the cyst in the liver, and we removed the cyst membrane totally. In endemic regions, hydatid cysts should be considered for the diagnosis of children with cystic mass lesions. Uterine-sparing approach should be kept in mind as an option, especially in young women. Early surgical treatment of large pelvic cysts that cause obstructive uropathy may prevent the progression of renal damage.

Comparison of two different minimally invasive techniques used in bladder stone surgery for preschool-aged children.

BACKGROUND: This study was designed to compare the outcomes of mini-percutaneous cystolithotomy (mPCL) and transurethral cystolithotripsy (TUCL) in treating bladder stones in preschool-aged children (≤6 years old). METHODS: Twenty-four patients treated with mPCL and 28 patients treated with TUCL for bladder stones were compared retrospectively. The operative and postoperative outcomes of both groups were analyzed. RESULTS: The mean age and gender distribution were similar between the groups. The mean stone size was 16.5 ± 0.5 mm for the mPCL group and 14.9 ± 5.7 mm for the TUCL group (p = 0.318). The mean operative time was 41.1 ± 9.9 min for the mPCL group and 39.0 ± 12.3 min for the TUCL group (p = 0.182). Catheterization times and hospitalization times were statistically significantly longer in the mPCL group (p = 0.000). The rate of urinary retention after urethral catheter removal was significantly higher in the TUCL group (p < 0.05). Reintervention was performed for one patient in Group 1 due to urinary leakage and for five patients in Group 2 due to urinary retention. The stone-free rate (SFR) after a single procedure was 100% in the mPCL group and 89.3% in the TUCL group (p = 0.099). After auxiliary procedures performed for three patients, the overall SFR also reached 100% for the TUCL group. DISCUSSION: Both mPCL and TUCL are effective methods in the treatment of bladder stones of <30 mm in the preschool age group. Although TUCL has some advantages over mPCL, such as shorter hospital stays and catheterization times, there is a risk of urinary retention with increased stone sizes. It may be more advantageous to apply mPCL for the reduction of complications and reintervention rates, especially in small children with bladder stones of >20 mm.

Do inflammatory markers such as NLRP3 and IL1-ß have an effect on the prediction of testicular sperm extraction success in infertile men?

Infertility is defined as the inability of couples to have a baby without contraception after at least 1 year of regular sexual intercourse. Mechanisms to explain inflammation in male infertility of unknown causes are still being investigated. The inflammasome is a key regulator of innate immunity, which is involved in the inflammatory response to infections and various diseases through the activation of caspase-1 and the use of inflammatory cytokines. Although many factors are believed to affect the success of mTESE in infertile patients with non-obstructive azoospermia (NOA), the inflammation mechanisms in the environment have not been clearly explained in the aetiology of infertility. In this study, we aimed to investigate the effect of NLRP3 and similar inflammasome mechanisms on antioxidant mechanisms on the success of mTESE. A total of 24 NOA patients with micro-testicular sperm extraction (mTESE +) and no sperm found (mTESE -) participated in the study between January 2020 and January 2021. NLRP3, IL1-ß, TAS, TOS and OSI amounts in serum and seminal plasma parameters were compared statistically, and their effects on mTESE success were investigated. FSH, LH, estradiol and testosterone values did not differ significantly (p > 0.05) in the group with mTESE (-) and mTESE (+). Serum IL-1 Beta, NLRP3, TOS, TAS, and OSI values did not differ significantly (p > 0.05) in the group with mTESE (-) and mTESE (+). Seminal plasma TOS and OSI values were significantly lower in the group with mTESE (+) than the group with mTESE (-). Although inflammasomes such as NLRP3 and IL1-ß do not have a significant predictive value in the success of mTESE, we think the high seminal plasma values of infertile patients may be understandable with further studies. This study was conducted to determine how inflammasomes are involved in IL-1ß, pathway NLRP3, and sperm retrieval in micro testicular sperm extraction (mTESE) in infertile men.

Antegrade placement of JJ catheter in the treatment of malignant ureteral obstruction: Retrospective analysis of a single centre.

OBJECTIVE: The aim of the present study was to examine the results of antegrade JJ stent placement in upper urinary tract obstruction in patients where retrograde placement was not possible. METHODS: In this retrospective study, patients who underwent antegrade JJ stent placement for malignant ureteral obstruction in the urology clinic of a university hospital between January 1, 2018 and December 31, 2020 were included in the study. JJ stent was placed under local or general anaesthesia guided by ultrasonography and fluoroscopy. Age, gender, kidney function values, pathologies causing obstruction, and complications of the patients were examined. RESULTS: In this study, 40 patients (16 men, 24 women) who underwent antegrade JJ stent placement were included. The mean ages of the women and men included were 51 (31-91) years and 62.5 (26-81) years, respectively. In all, antegrade JJ stenting was performed in 61 renal units of these patients. Of these, 21 were bilateral, 11 in the right collecting system and 8 in the left collecting systems. Clinical and technical success was achieved in 59 of the 61 procedures (96.6%). Arteriovenous fistula developed in only one patient, whereas no serious complications such as massive bleeding, resistant hematuria or pseudoaneurysm occurred in the remaining patients. The procedure was completed in a mean time of 15-30 minutes. CONCLUSIONS: Antegrade JJ stent placement is a procedure with a high success rate and low risk of complications that can be used in patients with severe ureteral obstruction owing to malignant or benign aetiologies. This method should be applied in centres experienced in malignant ureteral obstruction and on patients where retrograde placement was not possible. Furthermore, it should be considered as an alternative treatment option to open surgery as it can be performed under local anaesthesia in patients at a high risk of anaesthesia.

Are there factors in the disease of peroneal necrotizing fasciitis which should be used when choosing the anesthetic technique?: Descriptive analysis of a cohort from two centers.

BACKGROUND: This study aims to examine the factors affecting the selection of anaesthesia method in Fournier's gangrene. METHODS: A retrospective evaluation was made of 113 patients operated on because of Fournier's gangrene between January-May 2019. The operations were performed under spinal anaesthesia in 78 cases (Group S) and under general anaesthesia in 35 cases (Group G). The patients were evaluated regarding age, gender, the anaesthesia method used (spinal, general) anaesthetic agent applied, presence of sepsis, and biochemical, hematological and inflammatory parameters. RESULTS: When the patients were evaluated regarding the Fournier Gangrene Severity Index (FGSI), patients in Group S had lower scores (p=0.001). Examination of the tomography images revealed that in 13 (37.1%) patients, air values were seen in the right or left gluteal area, or both, extending to the subcutaneous tissue. In the evaluation of the factors affecting the selection of general anaesthesia, a positive correlation was determined between an increase in FGSI (r=0.482, p=0.001) and the presence of sepsis (r=0.485, p=0.001) and gluteal region involvement (r=0.628, p<0.001). CONCLUSION: The selection of anaesthesia method in Fournier gangrene patients is a complex process affected by factors, such as the patients' general condition, sepsis, and whether or not there is bleeding diathesis. The risk -benefit balance in the selection of anaesthesia method should be evaluated individually for patients.

Is there a relationship between renal scarring and neutrophil-to-lymphocyte ratio in patients with vesicoureteral reflux?

OBJECTIVES: Vesicoureteral reflux (VUR) exacerbates the risk of renal scarring by establishing a ground for pyelonephritis. It is known that the inflammatory process is more influential than the direct damage caused by bacterial infection in the development of renal scars after pyelonephritis. Therefore, the present study aims to investigate the relationship between renal scarring and systemic inflammatory markers in patients with VUR. MATERIAL AND METHODS: Hundred and ninety-two patients (116 females, 76 males) diagnosed with VUR were divided into two groups based on the presence or absence of renal scarring and into three groups according to the grade of VUR (low, moderate and high). Neutrophil count, lymphocyte count, mean platelet volume (MPV) and neutrophil-to-lymphocyte ratio (NLR) were compared among the groups. RESULTS: Of the 192 patients, 102 had renal scarring. The age and gender distribution did not differ significantly between the groups with and without renal scarring (p > 0.05). However, the grade of reflux and lymphocyte count were significantly higher in the group with renal scarring (p < 0.05), and the NLR was significantly lower in the group with renal scarring (p < 0.05). The lymphocyte count was significantly higher (p < 0.05) and NLR was significantly lower in the high-grade VUR group (p < 0.05). However, MPV values did not differ significantly (p > 0.05) between the groups. CONCLUSIONS: NLR can be used to predict renal scarring in patients with VUR, especially in the period of 3-6 months after the first attack of infection, and may even serve as a candidate marker for treatment selection. However, larger series and prospective studies are needed.

Do we have a limit for retrograde intrarenal surgery for solitary kidney stone?

OBJECTIVE: The management of urolithiasis in patients with a solitary kidney is challenging for urologists. This study aimed to evaluate the safety of retrograde intrarenal surgery (RIRS) in the treatment of stones in patients with solitary kidney and to reply to the question if there is any limit for this surgery. METHODS: Between January 2016 and December 2019, we enrolled 52 patients who had a solitary kidney and underwent RIRS. We collected data on preoperative patient characteristics, stone dimensions, and postoperative outcomes. Stone size, duration of operation, duration of fluoroscopy, type of anesthesia, and degree of surgical complication were evaluated retrospectively. Surgeries performed in less and more than 60 minutes and with and without complications were compared. RESULTS: A total of 52 patients with a kidney stone and a solitary kidney were evaluated. The mean stone size was 14 ± 0.4 cm and surgical success rate was 87.3%. In our study, 13 patients (24.5%) had grade 1 minor complications, and none required a blood transfusion. The mean operation time was 51.9 ± 17.3 minutes. The postoperative creatinine value increased in 6 patients. The duration of operation in the group with complications was significantly higher than that in the group without complications. In patients who underwent an operation lasting ≥ 60 minutes, stone size, fluoroscopy time, and complication rate were significantly higher than in patients who underwent an operation lasting ≤ 60 minutes. CONCLUSION: Our opinion is to be careful in patients with a solitary kidney with a big stone and we recommend assigning these procedure to experienced hands for not exceeding 60 minutes in one session.

Comparison of Conservative and Surgical Treatments in Symptomatic Pregnancy Hydronephrosis.

OBJECTIVES: This study aimed to evaluate the factors affecting the treatment choice in pregnant women with symptomatic hydronephrosis. METHODS: Hospital records of pregnant women who visited our clinic due to symptomatic hydronephrosis between December 2010 and December 2020 were analysed retrospectively. Patients were divided into 2 groups: conservative and surgical (JJ stent) treatment groups. Age, gestational week, primipara, trimester, visual analogue scale (VAS), and preterm birth rates as well as clinical, laboratory, and ultrasonography findings were compared between the groups. RESULTS: The study included 227 pregnant women (conservative treatment group, 133; JJ stent group, 94). Age, gestational week, primipara, trimester, hydronephrosis side, fever, pyelonephritis, pyuria, preterm labour and abortion, as well as blood urea nitrogen, creatinine, C-reactive protein, and white blood cell levels did not differ significantly between the groups (p > 0.05). In the JJ stent group, VAS, creatinine value, culture positivity rate, degree of hydronephrosis, and renal pelvis anterior-posterior (AP) diameter were significantly higher than those in the conservative treatment group (p < 0.05). The cut-off value for renal pelvis AP diameter was 16.5 mm in the first 2 trimesters and 27.5 mm in the third trimester. CONCLUSIONS: Surgical treatment should not be delayed in pregnant women who do not respond to conservative treatment and have impaired renal function and grade 3-4 hydronephrosis. Early surgical intervention is necessary in patients with a renal pelvis AP diameter of >16.5 mm in the first 2 trimesters and >27.5 in the third trimester.

Urolithiasis and Its Treatment in Pregnant Women: 10-Year Clinical Experience From a Single Centre.

INTRODUCTION: Urolithiasis during pregnancy is an important health concern that can affect maternal and foetal health. If left untreated, it can cause obstetric complications, such as spontaneous abortion and preterm delivery. In this study, we aimed to evaluate urolithiasis and its treatment in pregnant women. METHODS: We analysed data of 57 patients diagnosed with urolithiasis during pregnancy between January 2010 and December 2020. Patients' age, gestational age, urolithiasis history, physical examination findings, laboratory findings, location and size of the stone and applied treatment methods were examined. The effectiveness and complications of the applied treatment methods were evaluated. RESULTS: The mean age of 57 patients included in our study was 27 (27.8 ± 5.6) years and their mean gestational age was 20 (20.3 ± 9.2) weeks. The mean stone size was 9 mm (9.09 ± 4.37). The most common symptom at the time of presentation to the hospital was flank pain (93%). Kidney stones were detected in 34 patients and ureteral stones in 23 patients. Although conservative treatment was sufficient in 26 (45.6%) patients, 31 (54.4%) patients required surgical intervention. Major obstetric complications, such as preterm delivery and abortion, did not occur in any of the patients. CONCLUSION: The diagnosis and treatment of pregnant women with urolithiasis should be managed in a multidisciplinary manner. While determining the treatment options, foetal and maternal health should be considered.

A different look at genetic factors in individuals with non-obstructive azoospermia or oligospermia in our research study: To whom, which threshold, when, in what way? / Diferente perspectiva de los factores genéticos en individuos con azoospermia no obstructiva u oligospermia en nuestro estudio: ¿a quién realizarlo?; ¿con qué umbral?; ¿en qué momento?; ¿de qué modo?

INTRODUCTION: In our study, we sought answers to many questions about male infertility from a different perspective. The first step in male infertility is anamnesis, physical examination and sperm count. The European Academy of Andrology recommends examination of genetic causes in individuals with fewer than 5million/ml semen counts. The American Urological Association and American Society for Reproductive Medicine have guidelines recommending performing karyotype and AZF subgroup deletion testing in azoospermia and fewer than 5 million sperm total count. Klinefelter syndrome and Y chromosome microdeletions are still very important in male infertility. Based on patients with Klinefelter syndrome or Y microdeletion, we sought answers to many questions in male infertility. MATERIALS AND METHODS: In the presented study 327 male patients with having fewer than 15millionsperm/ml detected in at least two consecutive sperm analysis were examined. Patients were divided into sub-groups according to the presence of semen count, chromosomal anomaly and Y microdeletion. In addition, FSH, LH and testosterone levels were analyzed. RESULTS: Numerical chromosomal anomalies were observed in 34 (10.4%) of 327 patients, and all of these anomalies were found as 47, XXY. Individuals with no AZF microdeletion constituted 95.1% (n=311) of the study group. The overall frequency of AZF microdeletions was 4.9% (16/327). No AZF microdeletions were detected for the patients who have sperm counts above 2million/ml. FSH, LH and testosterone levels were found significantly different between the groups. DISCUSSION: The results of our study provide another layer of evidence to demonstrate the controversial threshold value of the EAA. In light of our data and current literature, we recommend to set the threshold value at 2million/ml for semen analysis. Further studies conducted in different ethnic groups and larger patient groups would contribute to clarify what exact value should be used to apply genetic tests

INTRODUCCIÓN: En nuestro estudio, buscamos respuestas a muchas preguntas relativas a la infertilidad masculina, desde una perspectiva diferente. El primer paso en la infertilidad masculina es la anamnesis, el examen físico y el recuento seminal. La Academia Europea de Andrología recomienda el examen de las causas genéticas en individuos con menos de 5millones/ml de recuento seminal. La Asociación Americana de Urología y la Sociedad Americana de Medicina Reproductiva cuentan con directrices que recomiendan la realización de pruebas de cariotipos y deleción del subgrupo AZF en los casos de azoospermia y un recuento seminal total inferior a 5millones/ml. El síndrome de Klinefelter y las micro-deleciones del cromosoma Y siguen siendo muy importantes en la infertilidad masculina. Basándonos en los pacientes con síndrome de Klinefelter o micro-deleción del cromosoma Y, buscamos respuestas a muchas cuestiones de la infertilidad masculina. MATERIALES Y MÉTODOS: En el presente estudio examinamos 327 varones con valores inferiores a 15 millones de esperma/ml detectados en al menos 2 análisis seminales consecutivos. Dividimos a los pacientes en subgrupos con arreglo a la presencia de recuento seminal, anomalía cromosómica y micro-deleción del cromosoma Y. Además, analizamos los niveles de FSH, LH y testosterona. RESULTADOS: Se observaron anomalías cromosómicas numéricas en 34 (10,4%) de los 327 pacientes, encontrándose dichas anomalías como 47, XXY. Los individuos sin micro-deleción AZF constituyeron el 95,1% (n=311) del grupo de estudio. La frecuencia general de las micro-deleciones AZF fue del 4,9% (16/327). No se detectaron micro-deleciones AZF para los pacientes con recuentos seminales superiores a 2millones/ml. Los niveles de FSH, LH y testosterona fueron significativamente diferentes entre los grupos. DISCUSIÓN: Los resultados de nuestro estudio aportan otra evidencia para demostrar el controvertido valor umbral de EAA. A la luz de nuestros datos y de la literatura actual, recomendamos establecer el valor umbral en 2millones/ml para el análisis seminal. Los futuros estudios a realizar en diferentes grupos étnicos y muestras de mayor tamaño de pacientes contribuirían a clarificar qué valor exacto debería utilizarse para solicitar pruebas genéticas

A different look at genetic factors in individuals with non-obstructive azoospermia or oligospermia in our research study: To whom, which threshold, when, in what way?

INTRODUCTION: In our study, we sought answers to many questions about male infertility from a different perspective. The first step in male infertility is anamnesis, physical examination and sperm count. The European Academy of Andrology recommends examination of genetic causes in individuals with fewer than 5million/ml semen counts. The American Urological Association and American Society for Reproductive Medicine have guidelines recommending performing karyotype and AZF subgroup deletion testing in azoospermia and fewer than 5 million sperm total count. Klinefelter syndrome and Y chromosome microdeletions are still very important in male infertility. Based on patients with Klinefelter syndrome or Y microdeletion, we sought answers to many questions in male infertility. MATERIALS AND METHODS: In the presented study 327 male patients with having fewer than 15millionsperm/ml detected in at least two consecutive sperm analysis were examined. Patients were divided into sub-groups according to the presence of semen count, chromosomal anomaly and Y microdeletion. In addition, FSH, LH and testosterone levels were analyzed. RESULTS: Numerical chromosomal anomalies were observed in 34 (10.4%) of 327 patients, and all of these anomalies were found as 47, XXY. Individuals with no AZF microdeletion constituted 95.1% (n=311) of the study group. The overall frequency of AZF microdeletions was 4.9% (16/327). No AZF microdeletions were detected for the patients who have sperm counts above 2million/ml. FSH, LH and testosterone levels were found significantly different between the groups. DISCUSSION: The results of our study provide another layer of evidence to demonstrate the controversial threshold value of the EAA. In light of our data and current literature, we recommend to set the threshold value at 2million/ml for semen analysis. Further studies conducted in different ethnic groups and larger patient groups would contribute to clarify what exact value should be used to apply genetic tests.

Usability of shear wave elastography to predict the success of extracorporeal shock-wave lithotripsy: prospective pilot study.

The present study is intended to investigate the usability of shear wave elastography (SWE) in predicting the success of extracorporeal shock-wave lithotripsy (ESWL) used in kidney stone treatment. ESWL was performed on a total number of 52 patients diagnosed with kidney stones between May 2019 and July 2020. The presence of a residual stone greater than 4 mm was accepted as failure. The patients were divided into two groups as ESWL success and ESWL failure. SWE and Hounsfield unit (HU) measurements of stones were performed in all patients before ESWL. The two groups were compared in terms of age, gender, stone localisation, stone size, body mass index (BMI), skin-to-stone distance, HU, and SWE values of the stones. ESWL was successful in 30 of the 52 patients included in the study, while it failed in 22 of them. While the mean SWE value was 7.3 (7.9 ± 2.2) kPa in patients with success in ESWL, it was 14.6 (17.9 ± 10.2) kPa in those with failed ESWL. The mean HU was 883.5 (841.4 ± 191.1) in patients with success in ESWL and 1078 (1115.5 ± 183) in those with failed ESWL. Both SWE and HU values of the stones were found to be statistically significantly lower in the successful group (p < 0.05). It was seen that SWE and HU values were correlated to each other. The groups of successful and failed ESWL did not differ significantly in terms of age, gender distribution, stone size, BMI, and skin-to-stone distance (p > 0.05). With SWE, the hardness of the stone can be measured and its suitability for ESWL can be evaluated. It can be used as an alternative parameter to HU before ESWL treatment, since it has a lower cost compared to computed tomography (CT) and does not contain radiation.

Penile fracture and investigation of early surgical repair effects on erectile dysfunction.

OBJECTIVES: Penile fracture is one of the urological emergencies caused by direct trauma to an erect penis during sexual intercourse, which results in a tear in the tunica albuginea within the corpus cavernosum. Serious complications such as penile curvature and erectile dysfunction may develop due to inappropriate and/or late surgical repair. This study aims to evaluate patients with penile fracture and to describe their demographics, surgical repairs, and long-term outcomes. MATERIALS AND METHODS: A total of 56 patients who were diagnosed with penile fracture between January 2012 and June 2017 were reviewed. Clinical features, pre-operative assessment, time from injury to surgery, tunica defect properties, and presence of urethral injury were assessed. Early surgical management was performed. Outcomes, including International Index of Erectile Function 5 pre-operation and after 6 months, were evaluated. RESULTS: The mean age was 30.2 (18-57) years. In etiological questionnaires, 32 (57.2%) patients reported direct trauma to an erect penis during intercourse. The mean size of tunica defects was 1.61 ± 0.42 (0.3-3.6) cm of the nine (16%) patients, and penile fracture was associated with urethral injury. There was no significant difference in International Index of Erectile Function 5 scores before the surgery and 6 months after surgery. Penile skin necrosis developed in one patient 10 days post-operation. CONCLUSION: Early surgical repair could be an effective method of achieving post-operative erection success in patients with penile fracture due to direct trauma during intercourse.

Carotid artery intima-media thickness can predict the response of patients with erectile dysfunction to phosphodiesterase 5 inhibitors.

This study investigated the role of carotid artery intima-media thickness (IMT) as a morphological marker of the response of vasculogenic erectile dysfunction (ED) patients to tadalafil, one of the phosphodiesterase 5 inhibitor (PDE5-I). Through March-December 2016, 51 men with vasculogenic ED aged over 30 years were enrolled in this prospective study. Vasculogenic ED was accepted as a normal testosterone level, with penile colour Doppler ultrasonography showing arteriogenic ED, venogenic ED or mixed arteriogenic and venogenic ED. All patients underwent biochemical and hormonal blood tests, ultrasonographic evaluation of the common carotid artery (CCA) IMT and penile colour Doppler ultrasonography. On-demand tadalafil (10 mg or 20 mg in cases of a non-response to 10 mg) was administered to each patient for 2 months. ED was assessed using the short form of International Index of Erectile Function (IIEF-5) before and after the drug therapy. According to the patients' responses to the medication, they were grouped as non-responders or responders. Thirty-one of the 51 patients responded to tadalafil. The mean CCA IMT of the non-responders and responders was 0.9 ± 0.2 mm and 0.6 ± 0.2 mm, respectively (P = 0.000). The IMT of 90% of the non-responders was >0.67 mm, whereas it was >0.67 mm in 40% of the responders. The data were analysed using the Kolmogorov-Smirnov test, Chi-square test, t-test, Mann-Whitney U test and receiver operator characteristic (ROC) curves. Measurement of CCA IMT may offer an alternative and simple method to predict the response of vasculogenic ED patients to PDE5-Is.

Percutaneous Nephrolithotomy with Different Temperature Irrigation and Effects on Surgical Complications and Anesthesiology Applications.

OBJECTIVE: Percutaneous nephrolithotomy (PCNL) is a widely accepted and frequently performed operation for large kidney stones. However, there is not much information about the effects of irrigation fluid temperature as well as many other factors that affect success and complications during the operation. In this study, we aimed to investigate the surgical and anesthesiological effects of irrigation fluid used in body temperature and room temperature during and after PCNL. MATERIAL AND METHODS: A total of 108 PCNL patients were performed between June 2016 and April 2018. The half of these patients (54) were performed with body temperature (37°C) irrigation fluid, hence known as body temperature group (BTG), and the other half with room temperature (22°C) irrigation fluid, called as room temperature group (RTG). For the study, we recorded the body temperature of the patients during and after the operation, the amount of irrigation fluid used, the size and location of the kidney stones, the duration of the operation, postoperative shivering time during the patient's wake-up period, pre- and postoperative hemoglobin value, additional blood requirements, postoperative analgesic requirements, and postoperative urinary tract infections. RESULTS: The age of patients, gender distribution, height, weight, body mass index, stone size, and postoperative analgesic requirement showed no significant differences in two groups. The postoperative body heat was significantly higher in the BTG than the RTG. The duration of waking was significantly higher in the RTG than the BTG. The amount of hemorrhage was significantly less in the patients who were irrigated in the RTG. CONCLUSION: The temperature of the irrigation fluid can affect many parameters in the PCNL. We recommend using irrigation in room temperature especially with patients having bleeding risks and irrigation fluid in body temperature especially with patients having anesthetic risks for easier waking process.

Do dental calculi predict the presence of renal stones?

OBJECTIVE: Pathological calcifications that occur in various parts of the body may cause stone formation over time. The structure of these stones is similar in many regions of the body. We have studied the relationship between dental calculi and kidney stones. MATERIAL AND METHODS: A total of 183 patients with dental stone complaints or dental calculi were included between April and August 2016 in the Cagri Dental Hospital, Elazig, Turkey. Patients were evaluated with regard to a urinary tract ultrasonography, urinalysis, oral hygiene, and stone and surgical disease history. All information was statistically investigated. RESULTS: The age of the patients in the kidney stones group was significantly higher than the non-kidney stone patients (p < 0.05). In the group with kidney stones, the percentage of dental calculus formation was significantly higher than the group without stones (p < 0.05). In the groups with and without kidney stones, dental stone recurrence rates did not differ significantly (p < 0.05). Urinary pH was significantly lower in the group with stones than the group without stones (p < 0.05). CONCLUSIONS: During a physical examination, the formation of a visible stone, such as a dental calculus, may be an indicator of other types of stones, such as kidney stones, and this should be further investigated.

Mini-laparoscopic pyeloplasty in adults: Functional and cosmetic results.

PURPOSE: The study objective was to evaluate the safety and efficacy of mini-laparoscopic pyeloplasty (mLP) in an adult population and to demonstrate the functional and cosmetic results. METHODS: Data for 29 patients (19 men and 10 women) undergoing mLP for ureteropelvic junction obstruction (UPJO) from May 2014 to December 2016 in Turkey were collected in this prospective study. Inclusion criteria were age ? 18 years, body mass index (BMI) ? 30 kg/m2 and primary UPJO, and no previous surgery on the affected kidney or previous abdominal surgery. Postoperative Visual Analogue Scale scores and the Patient Scar Assessment Questionnaire (PSAQ) were used. Demographic data, perioperative parameters, complications, and postoperative functional and cosmetic results were recorded. All statistical analyses were done by SPSS software. P value of <05 was considered statistically significant. RESULTS: Twenty-nine adults with a mean age of 29.4 ± 10.2 years (19-38 years) were included. The patients' mean BMI was 22.4 ± 4.3 kg/m2 (a range of 16-29 kg/m2). The procedures were performed using three ports (one 5 mm port for the camera and two 3 mm ports). Mean operative time was 119 ± 28.5 minutes (85-144 minutes). Major complications were not observed, as per the Clavien-Dindo classification of surgical complications (grades IV-V). The mean VAS score was 1.2 ± 0.2 points. Functional obstruction was reported in one patient on renal scintigraphy at 12 months postoperatively. The success rate of mLP was 97%. The minimum and maximum PSAQ scores at month 3 postoperatively were 24 and 86, respectively. All the patients were satisfied with the intervention and with their cosmetic results. CONCLUSION: mLP is a safe, effective and feasible treatment method for UPJO in adult patients. This treatment modality offers excellent cosmetic and functional results following treatment for UPJO.

Evaluation of dapoxetine treatment success in lifelong premature ejaculation patients with penile sympathetic skin response.

Hyperactivity of the sympathetic nervous system may play an important role in primary premature ejaculation (PPE), and dapoxetine, a selective serotonin reuptake inhibitor, plays a role in its treatment. We evaluated the success of dapoxetine treatment in PPE patients with a penile sympathetic skin response (PSSR). Of 63 patients who were admitted to our outpatient clinic between March 2017 and December 2017 with a complaint of premature ejaculation and diagnosed with PPE, 56 completed treatment (minimum 12 tablets) with on-demand use 30 mg of dapoxetine and returned for a follow-up appointment. Before and after treatment, the International Index of Erectile Function (IIEF-5) and Arabic index PE (AIPE) scores, intravaginal ejaculation latency time (IELT), testosterone values and PSSR values were compared. The IELT and AIPE values increased significantly in the 56 patients who were re-evaluated after dapoxetine treatment. No significant changes were observed in testosterone levels and IIEF-5. In the PSSR measurement, while the amplitude decreased, the latency was prolonged significantly. PSSR may be an important determinant in the measurement of dapoxetine treatment success for PPE patients, but additional studies are needed.