The effect of percussion, diuresis and inversion therapy on RIRS success for lower renal pole stones.

Introduction: Inversion of the patient, forced diuresis after hydration, and mechanical percussion technique was developed for lower renal pole (LRP) stones with extracorporeal shock wave (ESWL). In this study, we aimed to analyze the effect of percussion, diuresis and inversion (PDI) therapy on the success rates of retrograde intrarenal surgery (RIRS) for the LRP stones. Material and methods: 114 patients who underwent RIRS for LRP stones <2cm were included in this study. Patients' demographic, clinical, radiological and anatomical features and success status were recorded prospectively. The patients were divided into two groups. One group received RIRS procedure only (non-PDI group) and the other group received PDI therapy after the RIRS procedure (PDI group). Results: PDI was performed to 60 (52.6%) patients, and not performed to 54 (47.4%) patients. The success rate (58.3%) for the PDI group was higher than the non-PDI group (25.9%), and this difference was statistically significant (p <0.001). In multivariate logistic regression analysis, stone size (OR = 1.306; 95% CI = 1.019-1.674; p <0.001), IU (OR = 1.702; 95% CI = 1.383-2.096; p <0.001) and not performing PDI therapy (p <0.001) OR = 9.455; 95% Cl = 2.426-10.853; p = 0.001) were revealed to be independent risk factors for failure. Conclusions: PDI therapy increases the success rates of RIRS performed for the LRP stones.

Predicting risk of erectile dysfunction in patients with nonalcoholic fatty liver disease.

Nonalcoholic fatty liver disease (NAFLD) is one of the risk factors for erectile dysfunction (ED). We aimed to predict the risk of ED in patients with NAFLD. The study included 146 male patients complaining impotence admitted to the urology outpatient clinic aged 24-80 years without a history of alcohol use who underwent abdominal ultrasonography between February 2018 and January 2019. 106 patients with NAFLD and 40 men without NAFLD were included in the study. Clinical and laboratory parameters, ED status according to International Index of Erectile Function-5 were compared between patients with and without NAFLD. The mean age of patients was 51.47 ± 10.34 years. NAFLD was detected in 72.6% of the patients. No statistically significant difference was found regarding mean age, BMI, IIEF-5 scores, DM status, serum glucose levels (p > .05). Fasting insulin levels, hypertension (HT), insulin resistance (IR) and ED status of the patients with NAFLD were significantly higher than patients without NAFLD (p < .05). NAFLD was found to be a significantly independent associated with ED. We also found that patients with NAFLD have risk of ED 2.92 times higher than without NAFLD (OR: 2.92). For the patients presenting with erectile dysfunction, hepatic steatosis should also be considered.

Triglyceride-Glucose Index (TyG) is associated with erectile dysfunction: A cross-sectional study.

BACKGROUND: Erectile dysfunction (ED) is often associated with endocrine metabolic diseases such as metabolic syndrome (MetS) and diabetes mellitus (DM), in which insulin resistance (IR) plays a decisive role in pathology. Triglyceride-glucose index (TyG), a simple, inexpensive and easily accessible IR marker, is calculated by fasting serum glucose and triglyceride values. OBJECTIVES: We aimed to reveal the relationship between TyG index and ED. MATERIALS AND METHODS: Of 152 male patients, aged between 24-80 years, admitted to the urology outpatient clinic with complaining erectile insufficiency were evaluated. Liver function tests, complete blood count, fasting serum triglyceride, serum testosterone, fasting glucose, fasting insulin, and hemoglobinA1c (HbA1c) were analyzed. TyG index was calculated. All patients were requested to fill in the validated Turkish version of the 5-item International Index of Erectile Function (IIEF-5) survey. RESULTS: A total of 142 patients were included the study. ED was detected in 91 (64.1%) of the patients. BMI, fasting insulin level, fasting glucose level, IR, GGT, HDL, HbA1c, Triglyceride, TyG, DM, HT, and MetS status of the patients in ED group were statistically significantly higher compared to non-ED group (all P < .05). It was found that the cutoff value of TyG index for ED was 8.88 (AUC = 0.739, sensitivity 67%, specificity = 68.6%). In multivariate logistic regression analysis, age (OR = 1.07, 95% CI = 1026-1115, P = .002) and TyG index above 8.88 (OR = 3.865, 95% CI = 1686-8859, P = .001) were found as independent predictors of ED after accounting for BMI, serum total T and IR. CONCLUSION: TyG index might be useful in the diagnosis and follow-up of ED.

A novel urethra compression technique using Turkish continence device for male urinary incontinence

Background/aim: The male sling operation and artificial urinary sphincter implantation are common methods for treating urinary incontinence. However, there are some drawbacks to these methods such as infection, urethral erosion, pain, inefficiency, and the technical difficulty of the operations. Here we describe a new device we have named the Turkish Continence Device (TCD) which has advantages over these other methods. The aim of this study was perform experiments with the TCD prototype in vivo and ex vivo to determine efficiency, convenience of implantation, and negative effects. Materials and methods: We implanted the prototype device in male goats and sheep, compressing the posterior urethra, and then fixed it by sutures on the lateral sides of the cavernosal bodies, bilaterally. Then we recorded urodynamic findings and performed urinary imaging. Additionally we measured urethral closure pressure ex vivo. Results: The balloon volume for efficient urethral closure pressure using the new device was under 1 mL. It compressed the urethra towards the corpus cavernosum perfectly, because the wings of the prototype device are fixed near the tunica of the cavernosal bodies on each side. Conclusion: A smaller device with smaller arms/wings would be efficient for obtaining enough pressure on the urethra. Additionally, the technique for implanting the device is very simple and would likely be learned quickly.

Comparison of long-term kidney functions after radical nephrectomy and simple nephrectomy.

OBJECTIVE: To determine if there is a difference in proceeding to CKD between patients who had undergone radical nephrectomy (RN) and simple nephrectomy (SN) for different indications by comparing the short- and long-term renal function. MATERIALS AND METHODS: We retrospectively analyzed the records of all patients who underwent nephrectomy (either for malign or benign indications) in our clinic between January 2007 and September 2017. The patients were divided into 2 groups according the type of surgery: 1) Radical nephrectomy Group, 2) Simple Nephrectomy Group. Renal function was evaluated with Glomerular Filtration Rate (GFR) calculated using the MDRD formula. RESULTS: A total of 276 patients were included in the study. There were 202 patients in RN Group and 74 patients in SN Group. The mean age of the patients in RN Group and SN Group were age 59,2 ± 11,5 and 49,9 ± 15,1 years, respectively (p = 0.001). GFR levels of patients in RN Group versus SN Group were as follows: Preoperative period: 84.9 vs. 81 mL/min/1.73 m2; postoperative 1st day: 60.5 vs. 84.4 mL/min/1.73 m2, postoperative 1st month 58.9 vs. 76 mL/min/1.73 m2, postoperative 1st year: 59.5 vs. 74.1 mL/min/1.73 m2; at last control 60.3 and 76.1 mL/min/1.73 m2. While preoperative GFR was found to be similar in two groups (p = 0.26), postoperative GFR values were found to be significantly lower in Group RN (p < 0.001). In comparison of the decrease in GFR in two groups at last follow-up, significantly higher decrease was observed in RN Group, 29% vs. 6%, (p < 0.05). CONCLUSION: The decrease in GFR exists more common and intensive after RN compared to SN. In long-term, compensation mechanisms that develop after sudden nephron loss like radical nephrectomy deteriorates kidney function more than gradual nephron loss as in benign etiologies which indicates simple nephrectomy.

The effect of play distraction on anxiety before premedication administration: a randomized trial.

STUDY OBJECTIVE: The majority of children scheduled to undergo surgery experience substantial anxiety in the preoperative holding area before induction of anesthesia. Pharmacological interventions aimed at reducing perioperative anxiety are paradoxically a source of stress for children themselves. Midazolam is frequently used as premedication, and the formula of this drug in Turkey is bitter. We aimed to assess the role of distraction in the form of playing with play dough (Play-Doh) on reducing premedication anxiety in children. DESIGN: Prospective randomized clinical trial. SETTING: Preoperative holding area. PATIENTS: One hundred four healthy children aged 3 to 7 years scheduled to undergo elective surgery were enrolled into the study. INTERVENTIONS: All children routinely receive sedative premedication (oral midazolam) before anesthesia. Children were randomized to 2 groups to receive either play dough (group PD) (n=52) or not (group C) (n=52) before administration of oral premedication. MEASUREMENTS: Children's premedication anxiety was determined by the modified Yale Preoperative Anxiety Scale (mYPAS). MAIN RESULTS: The difference in mYPAS scores between groups at T0 (immediately after entering the preoperative holding area) was not significant (P=.876). Compared with group C, group PD was associated with lower mYPAS scores at T1 and T2 (P<.001). In group PD, mYPAS scores were significantly lower at both T1 and T2 as compared with the scores at T0 (P<.001); they were similar between T1 and T2 (P>.001). CONCLUSION: This study showed that distraction in the form of playing with play dough facilitated administration of oral midazolam in young children.

Relationship between immunohistochemical staining extent of CD47 and histopathologic features of bladder tumor.

INTRODUCTION: It has been shown that CD47 is an important diagnostic and prognostic marker in many cancer types. However, the relationship between CD47 and bladder tumor stage has not been shown in previous studies. To the best of our knowledge, this is the first study investigating the association of CD47 with stages of bladder cancer. MATERIAL AND METHODS: Surgical specimens of 175 patients were included in the study. The CD47 staining assessment was performed in the following categories; none, focal, moderate and diffuse. The statistics of the study were tested using t-test and analysis of variance. RESULTS: We demonstrated much less CD47 staining extent in Ta tumor pathology compared to T1 and T1+T2+T3+T4 tumor pathology (p = 0.034 and p = 0.016, respectively). We also showed that the average value of CD47 staining extent with CIS+ was significantly higher compared to CIS- among NMIBC (p = 0.0248). However, no significant differences in CD47 staining pattern were observed in the following study groups: high vs. low-grade tumors in non-muscle invasive bladder cancer (NMIBC); MIBC (T2-T4) vs. NMIBC; lymph node involvement (N1-N3) vs. non-lymph node involvement (N0) in MIBC (T2-T4). CONCLUSIONS: Our study demonstrated that CD47 might have a critical role in the progression of Ta to T1 stage. Furthermore, we showed that CD47 is highly expressed in CIS+ NMIBC compared to CIS- NMIBC. Thus, differentiating stages with the help of this new potential marker may help clinicians treat bladder tumors better. Future studies to determine the role of CD47 on pathophysiology, diagnosis and prognosis of bladder tumor are warranted.

Is there any association between National Institute of Health category IV prostatitis and prostate-specific antigen levels in patients with low-risk localized prostate cancer?

PURPOSE: We investigated the association between National Institute of Health category IV prostatitis and prostate-specific antigen levels in patients with low-risk localized prostate cancer. MATERIALS AND METHODS: The data of 440 patients who had undergone prostate biopsies due to high PSA levels and suspicious digital rectal examination findings were reviewed retrospectively. The patients were divided into two groups based on the presence of accompanying NIH IV prostatitis. The exclusion criteria were as follows: Gleason score>6, PSA level>20ng/mL, >2 positive cores, >50% cancerous tissue per biopsy, urinary tract infection, urological interventions at least 1 week previously (cystoscopy, urethral catheterization, or similar procedure), history of prostate biopsy, and history of androgen or 5-alpha reductase use. All patient's age, total PSA and free PSA levels, ratio of free to total PSA, PSA density and prostate volume were recorded. RESULTS: In total, 101 patients were included in the study. Histopathological examination revealed only PCa in 78 (77.2%) patients and PCa+NIH IV prostatitis in 23 (22.7%) patients. The median total PSA level was 7.4 (3.5-20.0) ng/mL in the PCa+NIH IV prostatitis group and 6.5 (0.6-20.0) ng/mL in the PCa group (p=0.67). The PSA level was≤10ng/mL in 60 (76.9%) patients in the PCa group and in 16 (69.6%) patients in the PCa+NIH IV prostatitis group (p=0.32). CONCLUSIONS: Our study showed no statistically significant difference in PSA levels between patients with and without NIH IV prostatitis accompanying PCa.

Is there any association between National Institute of Health category IV prostatitis and prostate-specific antigen levels in patients with low-risk localized prostate cancer?

ABSTRACT Purpose We investigated the association between National Institute of Health category IV prostatitis and prostate-specific antigen levels in patients with low-risk localized prostate cancer. Materials and Methods The data of 440 patients who had undergone prostate biopsies due to high PSA levels and suspicious digital rectal examination findings were reviewed retrospectively. The patients were divided into two groups based on the presence of accompanying NIH IV prostatitis. The exclusion criteria were as follows: Gleason score>6, PSA level>20ng/mL, >2 positive cores, >50% cancerous tissue per biopsy, urinary tract infection, urological interventions at least 1 week previously (cystoscopy, urethral catheterization, or similar procedure), history of prostate biopsy, and history of androgen or 5-alpha reductase use. All patient's age, total PSA and free PSA levels, ratio of free to total PSA, PSA density and prostate volume were recorded. Results In total, 101 patients were included in the study. Histopathological examination revealed only PCa in 78 (77.2%) patients and PCa+NIH IV prostatitis in 23 (22.7%) patients. The median total PSA level was 7.4 (3.5–20.0) ng/mL in the PCa+NIH IV prostatitis group and 6.5 (0.6–20.0) ng/mL in the PCa group (p=0.67). The PSA level was≤10ng/mL in 60 (76.9%) patients in the PCa group and in 16 (69.6%) patients in the PCa+NIH IV prostatitis group (p=0.32). Conclusions Our study showed no statistically significant difference in PSA levels between patients with and without NIH IV prostatitis accompanying PCa.

Micropercutaneous nephrolithotripsy: initial experience.

INTRODUCTION: For small renal calculi (< 2 cm) the currently available treatment options include extracorporeal shockwave lithotripsy (ESWL), retrograde intrarenal surgery (RIRS) and standard/mini percutaneous nephrolithotomy (PNL). A new method, microperc, has therefore been developed, in which a smaller tract size and smaller instruments were used. AIM: To present our clinical experiences with micropercutaneous nephrolithotripsy (microperc) in the treatment of small renal calculi. MATERIAL AND METHODS: We retrospectively evaluated patients with small renal calculi who underwent microperc between February and June 2013. A 4.8 Fr 'all-seeing needle' was used to achieve percutaneous renal access with the C-arm fluoroscopy guidance in the prone position. Holmium: YAG laser 272 µm fiber was used for stone fragmentation. RESULTS: A total of 20 patients underwent the microperc procedure. The mean age of the patients was 46.5 ±13.8 years. The mean stone size was 13 ±3 mm. The stone-free rate (SFR) was 90% (18/20). Two patients had clinically significant residual fragments (≥ 4 mm). The mean operation and fluoroscopy times were 107.5 ±37 min and 45 ±40 s respectively. The mean postoperative drop in hemoglobin was 1.2 ±0.9 g/dl, and 1 patient required blood transfusion. The patients were discharged after an average hospitalization of 1.4 ±0.8 days. Two complications, urinary tract infection and blood loss requiring blood transfusion, were observed in 2 patients postoperatively. CONCLUSIONS: We suggest that microperc should be considered for the treatment of small renal stones.

Three different anesthesia techniques for a comfortable prostate biopsy.

AIM: In this paper, we aimed to compare the efficacy of three different anesthesia techniques applied in 90 cases of which transrectal ultrasound (TRUS) -guided prostate biopsies were taken. MATERIALS AND METHODS: Between February 2012 and July 2012, TRUS-guided 16 core biopsies were taken from 90 patients who comply the study criteria. Patients were randomly divided into three groups each of which consists of 30 individuals. Group 1: Was applied periprostatic block anesthesia; Group 2: Was administered intrarectal lidocaine gel; Group 3: Was applied pudendal block. Visual analog scale (VAS) of patients in groups was evaluated. RESULTS: There was no statistically significant difference between the mean ages, prostate-specific antigen values of three groups. Although pain ratings of Groups 2 and 3 were high, no significant difference was present between each other (P > 0.05). In Groups 1 and 2, the difference between VASs was significant. In the group where periprostatic block was applied, pain ratings were significantly low compared with the other two groups (P = 0.0001). DISCUSSION: Enabling pain and discomfort control in patients is very important during TRUS-guided prostate biopsy. In our study, we observed that the periprostatic block enables more comfortable compared with patient groups with intrarectal lidocaine gel and pudendal block and better reduction in pain scores.

Importance of the neutrophil-to-lymphocyte ratio in muscle-invasive and non-muscle invasive bladder tumors.

INTRODUCTION: To research the importance of the neutrophil-to-lymphocyte ratio (NLR) in muscle-invasive bladder cancers (MIBC) and non-muscle invasive bladder cancer (NMIBC). METHODS: Data of 198 patients who underwent TUR-TM in our clinic were retrospectively evaluated. Patients were divided into two groups: group-I (MIBC) and group-II (NMIBC). The neutrophil and lymphocyte counts, NLR, hemoglobin and hematocrit values, tumor numbers, sizes and degrees of patients were recorded. Within the inter-group comparison, Mann-Whitney U test was used for the values stated with measuring, whereas a Chi-square test was used for the values stated with counting. The cut-off value for the NLR was determined with ROC curve. RESULTS: The NLR values of group-I and group-II were found as 4.14 ± 2.76 and 3.36 ± 2.88, respectively (p = 0.03). Whether the NLR carries a differential property was evaluated with ROC curve. The cut-off value was estimated as 3.96 according to the Youden index. With this value, sensitivity was found as 50%, specificity was 22.8% and AUC was 0.615 (p = 0.03). DISCUSSION: According to the data in this study, it can be said that Ta-T1 tumors are likely to be invasive by 50% if the NLR value is greater than 3.96.

[Giant renal cystic echinococcosis: case report]. / Dev Böbrek Kistik Ekinokok Hastaligi: Olgu Sunumu.

Echinococcosis is endemic in many parts of the world. Although echinococcosis can be present in all parts of the human body, urinary tract involvement develops in only 2-4% of all cases, and isolated renal cysts are extremely rare. There are no specific clinical symptoms or signs that will reliably confirm the diagnosis of renal echinococcosis. Routine blood tests are generally normal except for eosinophilia, which is found in only 20% of the cases. Radiological studies have a more important place in the preoperative diagnosis of renal hydatic disease. However, there is no specific sign on plain urography or intravenous urography, and ultrasound or computed tomography cannot always show a echinococcosis as a specific lesion. Echinococcosis should be included in the differential diagnosis of cystic lesions in solid organs or other anatomic sites, especially in endemic countries. We presented a patient with isolated giant renal cystic echinococcosis mimicking a complicated cyst who was treated successfully with nephrectomy.

Scintigraphic comparison of renal ischemia-reperfusion injury models in rats: correlations with biochemical and histopathological findings.

OBJECTIVE: This study aimed to compare the effect on renal functions of ischemia-reperfusion (I-R) injury models by renal scintigraphy and to investigate possible correlations among scintigraphic, biochemical and pathological findings. METHODS: An experimental I-R injury was performed on the left kidneys of 40 Wistar rats: pedincular continuous clamping in Group 1 (n = 10), pedincular cyclic clamping in Group 2 (n = 10), arterial continuous clamping in Group 3 (n = 10) and arterial cyclic clamping in Group 4 (n = 10). A functional and morphological assessment was made by (99m)Tc-MAG3 scintigraphy, biochemical tests and histopathological examination in the late period of I-R injury. Data were analyzed statistically. RESULTS: Statistically significant differences were found in the peak counting (C max), normalized residual activity (NORA), renal retention (RR), split renal function (SRF) and the time to the C max (T max) parameters between the right and left kidneys in each group (p < 0.001). In multiple group comparisons for the left kidney statistically significant differences were determined for C max (F = 4.75, df = 3, p < 0.05), NORA (F = 4.362, df = 3, p < 0.05), RR (F = 10.49, df = 3, p < 0.001) and SRF (F = 4.17, df = 3, p < 0.05) but not T max (F = 1.13, df = 3, p > 0.05). The total scores of Groups 1, 2, 3, and 4 were, respectively, found to be 18, 30, 20 and 24 by grading of renogram curves and 22, 28, 23 and 25 by pathological scoring system. There was a significant correlation among the two score data (r = 0.867, p < 0.001). CONCLUSIONS: (99m)Tc-MAG3 scintigraphy was a reliable method to evaluate renal dysfunction in the late period of I-R injury. Cyclic clamping, especially pedincular type was compatible with higher tubular dysfunction and structural damage.

Recurrent pancreatic fistula occurring after nephrectomy in patients with a renal hydatid cyst: a case report.

Pancreatic fistula (PF) is an important complication that may develop during intra-abdominal surgeries and following distal pancreas trauma. In the early period, drainage from the surgical site and increased amylase production based on the biochemical examination of the drainage fluid are the factors for diagnosis. In contrast, in association with fluid collected from the surgical site, intra-abdominal abscess and high fever may lead to the diagnosis in the late period. Endoscopic retrograde cholangiopancreatography (ERCP) for the treatment of intra-abdominal fluid collection after PF and intra-abdominal percutaneous stent placement as well as the placement of a pancreatic stent in the pancreatic channel may be alternative methods to stop drainage. However, the complete resolution of fluid drainage may take months. In our case, drainage from the pancreatic fistula area took longer to resolve than the periods previously reported in the English literature. The tail of the pancreas can be injured during the extraction of especially aggressive and metastatic masses from organs near to the distal pancreas. Injury to the tail of the pancreas can also occur during the extraction of benign-like renal hydatid cysts and/or malignant left kidney masses. However, PF can be treated with noninvasive methods, such as percutaneous treatment and ERCP.

[Evaluation of urogenital injuries in patients with trauma in the emergency department]. / Acil servise basvuran travmali olgularda Urogenital yaralanmalarin degerlendirilmesi.

BACKGROUND: The aim of this study was to investigate the characteristics of the patients admitted to the Emergency Department with urogenital system trauma and the factors affecting morbidity and mortality. METHODS: In this prospective, cross-sectional descriptive study, the demographic characteristics, trauma types, laboratory and radiologic results, hospitalization states, and the outcomes of patients with urogenital trauma were investigated. A total of 153 patients [108 (70.6%) male; 45 (29,4%) female] with major trauma were included in this study. RESULTS: Twenty-three (15.03%) had penetrating trauma and 130 (84.96%) blunt trauma. Seventy-nine presented with motor vehicle accidents, 42 with falls, 10 with gunshot wounds, and 10 with stab wounds. There were pelvic fractures in 60 patients, renal injuries in 35 patients, and bladder injuries in 4 patients. Twenty-one of the patients underwent surgery for any reason and 17 patients died. There was a significant relationship between hematuria and renal injury. CONCLUSION: Urogenital injuries are frequently seen with other system injuries, and deaths generally occur due to the other system injuries. The timely identification and management of genitourinary injuries with an in-depth clinical evaluation are important for preventing deaths due to urogenital region trauma.

Predicting the outcome in children with head trauma: comparison of FOUR score and Glasgow Coma Scale.

BACKGROUND: Because of the limitations of the Glasgow Coma Scale (GCS), many scoring systems have emerged and been compared with GCS. Herein, we investigated whether the Full Outline of Unresponsiveness (FOUR) score is better than GCS in predicting morbidity and mortality in children with head trauma. METHODS: Patients 2-17 years of age who admitted to the emergency department with head trauma and presented with altered level of consciousness were included in this study. In-hospital mortality, hospitalization of more than three days, and Glasgow Outcome Score (GOS) at discharge and after three months were used as the primary outcome measures. RESULTS: A total of 100 children were included in the study. The median age was 6 years, and 69% were male. The in-hospital mortality rate was 10%. The cut-off values for predicting in-hospital mortality were 9 for FOUR score and 7 for GCS. Area under the curve (AUC) values in predicting in-hospital mortality, poor GOS (score of 1-3) at discharge, and poor GOS after three months were similar for GCS and FOUR score. CONCLUSION: FOUR score provides no significant advantage over GCS in predicting morbidity and mortality in children with head trauma.