Early outcomes of robotic retroperitoneal partial nephrectomy: evaluating surgical success with margin, ischemia, and complication score.

OBJECTIVE: The objective of this study was to evaluate the minimum number of required cases for successful robotic retroperitoneal partial nephrectomy for an experienced surgeon in transperitoneal robotic surgery. METHODS: Our prospectively collected clinic database was evaluated retrospectively, and 50 patients who underwent robotic retroperitoneal partial nephrectomy by a single experienced surgeon from January 2019 to February 2023 were included in this study. Demographic and perioperative data and R.E.N.A.L. nephrometry scores were noted. margin, ischemia, and complication score was used to predict surgical success. Receiver operating characteristic curve analysis was used to determine how many cases were required to achieve margin, ischemia, and complication score positivity and to apply the off-clamp technique. Also, the first 25 patients were assigned to Group 1 and the second 25 patients to Group 2, and the data were compared between the groups. RESULTS: The patients' demographic data and tumor characteristics were similar in the groups. The off-clamp technique and sutureless technique rates in Group 2 were significantly higher than that in Group 1. Margin, ischemia, and complication score positivity was observed in 60% (n=15) of Group 1 and 96% (n=24) of Group 2. At receiver operating characteristic curve analysis, the 25th and later cases were statistically significant in terms of margin, ischemia, and complication score positivity. In terms of performing surgery with the off-clamp technique, the 28th and subsequent cases were statistically significant. CONCLUSION: A total of 25 or more cases appear to be sufficient to provide optimal surgical results in robotic retroperitoneal partial nephrectomy for an experienced surgeon.

Successful Treatment of Detachment of the Incision after Al-Ghorab Procedure: A Case Report and Review of Literature.

Al-Ghorab procedure is known as open distal shunt for the treatment of ischemic priapism. In the literature, no information in terms of complications is available in three of fourteen studies. In the remaining eleven studies, complications occurred in five studies only. Here we present a case report describing successful treatment of detachment of the incision after Al-Ghorab procedure.

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

Background: Increased carotid artery intima-media thickness (CIMT) has been shown to be associated with erectile dysfunction (ED), but studies evaluating the efficacy of CIMT in predicting drug response are lacking in the literature. Aim: We aimed to evaluate the efficacy of CIMT in predicting the response to phosphodiesterase-5 inhibitors (PDE5-I). Methods: A total of 274 subjects were divided into two groups: ED patients (n = 150) and controls (n = 124). The patients in the ED group were further divided into the subgroups of severe, moderate, mild-moderate, and mild ED. Blood tests, carotid ultrasonography, and the International Index of Erectile Function-5 (IIEF-5) diagnostic tool were applied to all subjects. Tadalafil was administered to each patient. The patients were re-evaluated using the IIEF-5 questionnaire after 2 months of treatment. According to their response to medication, the patients were evaluated as responders or nonresponders. Outcomes: Increased CIMT was significantly associated with the failure of PDE5-I therapy, especially in patients with moderate/mild-moderate ED. Results: Fasting blood glucose, body mass index, and CIMT were significantly higher in the ED group compared to the control group (P = .021, P = .006, and P < .001, respectively). The IIEF-5 score was significantly lower in the ED group (P < .001). CIMT was significantly correlated with the IIEF-5 score. When the total patient group was evaluated, the CIMT value of the responders was significantly lower than that of the nonresponders (P = .001). CIMT was significantly higher among the nonresponders with moderate/mild-moderate ED compared to the responders (P = .004 and .008, respectively), while there was no significant difference in CIMT between the responders and nonresponders with severe or mild ED. A receiver operating characteristic (ROC) analysis of CIMT was performed for discrimination between nonresponders and responders with moderate/mild-moderate ED. The area under the ROC curve was 0.801 (0.682-0.921) (P = .001), and the cutoff value was determined to be 0.825 mm, at which CIMT predicted the response to treatment with 65% sensitivity and 89% specificity. Clinical Implications: Using a validated CIMT cutoff value can help the physician inform the patient about the possibility of drug failure and avoid attempting second-line therapy too soon. Strengths and Limitations: There are three main limitations to our study. First, the number of participants was low. Second, ultrasound is a relatively subjective method, and third, all measurements were made by the same radiologist. Conclusion: CIMT can be used as a predictor of response to PDE5-I therapies in patients with moderate/mild-moderate ED.

Can atherogenic indices and the triglyceride-glucose index be used to predict erectile dysfunction?

Background: Atherosclerosis and insulin resistance play an important role in the development of erectile dysfunction (ED), and few studies have comprehensively evaluated more specific indicators like atherogenic indices and the triglyceride-glucose (TyG) index in the assessment of ED. Aim: This study aimed to reveal the role of atherogenic indices (atherogenic index of plasma [AIP], Castelli risk index-1/2 [CRI-1/2], and atherogenic coefficient [AC]) based on plasma lipid ratios, which have been used as more sensitive indicators of atherosclerosis in recent years, and the TyG index, a practical indicator of insulin resistance, in predicting vasculogenic ED. Methods: The study included a total of 199 patients who met the inclusion criteria and a total of 51 control subjects without ED complaints according to the International Index of Erectile Function (IIEF-5) scores (>21) between May 2021 and October 2022. For all participants, the demographic and biochemical parameters were evaluated, and atherogenic indices, namely CRI-1 (total cholesterol/high-density lipoprotein [HDL]), CRI-2 (LDL/HDL) AIP [log10(triglycerides/HDL)], and AC (non-HDL/HDL), as well as the TyG index [Ln {fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2}] were calculated. Outcomes: The TyG index, which is an indicator of insulin resistance, and atherogenic indices such as CRI-1, AIP, and AC were significantly associated with ED, and especially AIP and the TyG index seem to be more important in the evaluation of ED. Results: According to the univariate analysis, the patient group had significantly higher CRI-1 (5.3 ± 1.4 vs 4.7 ± 1.3; P = .005), AIP (0.31 ± 0.26 vs 0.13 ± 0.2; P < .001), AC (4.1 ± 1.4 vs 3.70 ± 1.2; P = .026), and TyG (9.16 ± 0.71 vs 8.77 ± 0.52; P < .001) values compared with the control group. In the correlation analysis, a significant negative correlation was found between the AIP and TyG index and the IIEF-5 scores (r2 = 0.120, P < .001 between AIP and IIEF-5; r2 = 0.091, P < .001 between TyG index and IIEF-5). The multivariate analysis revealed AIP and the TyG index as independent predictive factors for ED. Clinical Implications: The use of atherogenic indices and TyG index in daily urology practice can help physicians in the diagnosis and follow-up of ED. Strengths and Limitations: The lack of sex hormone-binding globulin and free testosterone levels represents a limitation of our study. Another limitation is that the severity of ED was determined using the IIEF-5 scores, rather than a more objective method, such as penile artery ultrasound. Conclusion: Atherogenic indices and the TyG index can be used as inexpensive and practical markers to predict the severity of arteriogenic ED.

Early outcomes of robotic retroperitoneal partial nephrectomy: evaluating surgical success with margin, ischemia, and complication score

SUMMARY OBJECTIVE: The objective of this study was to evaluate the minimum number of required cases for successful robotic retroperitoneal partial nephrectomy for an experienced surgeon in transperitoneal robotic surgery. METHODS: Our prospectively collected clinic database was evaluated retrospectively, and 50 patients who underwent robotic retroperitoneal partial nephrectomy by a single experienced surgeon from January 2019 to February 2023 were included in this study. Demographic and perioperative data and R.E.N.A.L. nephrometry scores were noted. margin, ischemia, and complication score was used to predict surgical success. Receiver operating characteristic curve analysis was used to determine how many cases were required to achieve margin, ischemia, and complication score positivity and to apply the off-clamp technique. Also, the first 25 patients were assigned to Group 1 and the second 25 patients to Group 2, and the data were compared between the groups. RESULTS: The patients' demographic data and tumor characteristics were similar in the groups. The off-clamp technique and sutureless technique rates in Group 2 were significantly higher than that in Group 1. Margin, ischemia, and complication score positivity was observed in 60% (n=15) of Group 1 and 96% (n=24) of Group 2. At receiver operating characteristic curve analysis, the 25th and later cases were statistically significant in terms of margin, ischemia, and complication score positivity. In terms of performing surgery with the off-clamp technique, the 28th and subsequent cases were statistically significant. CONCLUSION: A total of 25 or more cases appear to be sufficient to provide optimal surgical results in robotic retroperitoneal partial nephrectomy for an experienced surgeon.

Assessing the nitric oxide and asymmetric dimethylarginine levels in lifelong premature ejaculation: A prospective study / Evaluación de los niveles de óxido nítrico y dimetilarginina asimétrica en la eyaculación precoz de por vida, un estudio prospectivo

Objective: To evaluate nitric oxide (NO) and asymmetric dimethylarginine (ADMA) levels in men with premature ejaculation (PE), which is a common condition that adversely affects quality of life. Material and method: Of the 20–50-year old men presenting to the urology clinic, who were married or had regular sexual intercourse, 40 that were diagnosed with lifelong PE according to the Premature Ejaculation Diagnostic Tool (PEDT) and intravaginal ejaculation latency time (IELT) measured by a stopwatch were included in the study. The results of the PE group were compared to those of the control group formed with 40 healthy hospital personnel. Venous blood samples were centrifuged and stored at −80°C. The NO and ADMA values were compared between the individuals with and without PE. Results: There was no statistically significant difference between the groups in terms of age, body mass index (BMI), and The International Erectile Dysfunction Index-5 (IIEF-5) questionnaire scores. The NO and ADMA values were significantly lower in the PE group than in the control group (29.76±13.26μmol/L vs. 48.27±22.71μmol/L; p<0.001 and 1.01±0.49nmol/ml vs. 1.83±1.06nmol/ml; p<0.001, respectively). There was a significant correlation between IELT and NO levels (r=0.407, p=0.001). Conclusion: Our study can contribute to the explanation of the pathophysiology of PE having unclear etiology and treatment. Further studies on these molecules with larger case series are required for the diagnosis and treatment of PE. (AU)

Objetivo: Evaluar los niveles de óxido nítrico (NO) y dimetilarginina asimétrica en hombres con eyaculación precoz (EP), que es una afección común que afecta negativamente la calidad de vida. Material y método: De los hombres de 20 a 50 años que acudieron a la clínica de urología, que estaban casados o tenían relaciones sexuales regulares, se incluyeron en el estudio 40 que fueron diagnosticados con EP de por vida según la Herramienta de Diagnóstico de la Eyaculación Precoz y el tiempo de latencia de la eyaculación intravaginal medidos por un cronómetro. Se compararon los resultados del grupo de EP con los del grupo control formado por 40 personas sanas del hospital. Las muestras de sangre venosa se centrifugaron y almacenaron a −80°C. Se compararon los valores de NO y dimetilarginina asimétrica entre los individuos con y sin EP. Resultados: No hubo diferencias estadísticamente significativas entre los grupos en términos de edad, índice de masa corporal y puntajes del cuestionario International Erectile Dysfunction Index-5. Los valores de NO y dimetilarginina asimétrica fueron significativamente más bajos en el grupo de EP que en el grupo control (29,76±13,26 frente a 48,27±22,71μmol/l [p<0,001] y 1,01±0,49 frente a 1,83±1,06nmol/ml [p<0,001], respectivamente). Hubo una correlación significativa entre los niveles de tiempo de latencia de la eyaculación intravaginal y NO (r=0,407, p=0,001). Conclusión: Nuestro estudio puede contribuir a la explicación de la fisiopatología de la EP de etiología y tratamiento poco claros. Se requieren más estudios sobre estas moléculas con series de casos más grandes para el diagnóstico y tratamiento de la EP. (AU)

Assessing the nitric oxide and asymmetric dimethylarginine levels in lifelong premature ejaculation: A prospective study.

OBJECTIVE: To evaluate nitric oxide (NO) and asymmetric dimethylarginine (ADMA) levels in men with premature ejaculation (PE), which is a common condition that adversely affects quality of life. MATERIAL AND METHOD: Of the 20-50-year old men presenting to the urology clinic, who were married or had regular sexual intercourse, 40 that were diagnosed with lifelong PE according to the Premature Ejaculation Diagnostic Tool (PEDT) and intravaginal ejaculation latency time (IELT) measured by a stopwatch were included in the study. The results of the PE group were compared to those of the control group formed with 40 healthy hospital personnel. Venous blood samples were centrifuged and stored at -80°C. The NO and ADMA values were compared between the individuals with and without PE. RESULTS: There was no statistically significant difference between the groups in terms of age, body mass index (BMI), and The International Erectile Dysfunction Index-5 (IIEF-5) questionnaire scores. The NO and ADMA values were significantly lower in the PE group than in the control group (29.76±13.26µmol/L vs. 48.27±22.71µmol/L; p<0.001 and 1.01±0.49nmol/ml vs. 1.83±1.06nmol/ml; p<0.001, respectively). There was a significant correlation between IELT and NO levels (r=0.407, p=0.001). CONCLUSION: Our study can contribute to the explanation of the pathophysiology of PE having unclear etiology and treatment. Further studies on these molecules with larger case series are required for the diagnosis and treatment of PE.

Red blood cell distribution width values in erectile dysfunction.

PURPOSE: Erectile dysfunction (ED) has increased prevalence by age and significantly affects the quality of life of men and their partners. To investigate the relationship between ED and red blood cell distribution width (RDW) values. MATERIALS AND METHOD: Between September 2019 and December 2019, a total of 192 individuals comprising those that were admitted to the urology outpatient clinic with ED complaints and healthy volunteers from among hospital staff were prospectively included in the study. The participants were divided into two groups according to the international erectile function index (IIEF-5) as ED group (n=148) and control group (n=44). RESULTS: There was no statistically significant difference between the two groups in terms of age, smoking status, presence of hypertension, triglyceride, low-density lipoprotein, high-density lipoprotein, total cholesterol, total prostate-specific antigen and haematocrit values. Body mass index, fasting blood sugar, neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) were significantly higher in the ED group (28.5±27.4kg/m2 vs 26.8±26.5kg/m2, p=.021, 109.05±49.7mg/dl vs 93.39±10.2mg/dl, p<.001, 2.18±1.3 vs 1.74±0.3, p=.031, and 113.7±47 vs 92.4±24.1, p=.004, respectively). The mean RDW values were 13.7±1.1 in the ED group and 13±0.5 in the control group (p<.001). The multivariate analysis revealed PLR [1.02 OR (1-1.04), p=.007] and RDW [2.75 OR (1.56-4.85), p<.001] as independent predictors for an ED diagnosis. CONCLUSION: Based on the strong relationship between RDW and ED, we consider that RDW may be a new indicator in the diagnosis of ED.

Development of a Novel Nomogram and a Simple Scoring System Using Ureteral Jet Flow to Predict Impacted Ureteral Stone.

Purpose: To examine the efficacy of ureteral jet flow measured by Doppler ultrasonography (USG) together with radiological parameters obtained by noncontrast enhanced CT in predicting whether a ureteral stone is impacted. Materials and Methods: A total of 178 patients that met the criteria were included in the study. Stone size, location, grade of hydronephrosis, HU values of the stone and the proximal and distal parts of the stone, and ureteral wall thickness (UWT) were obtained from noncontrast enhanced abdominal CT images. Ureteral jet flows (Vmax) were measured and recorded by Doppler USG. Thirty-eight cases in whom the guidewire or opaque contrast material could not pass beyond the stone were included in the impacted ureteral stone (IUS) group, whereas the remaining 140 patients constituted the non-IUS (non-IUS) group. Results: Significant independent predictors of IUS were determined as stone size (odds ratio [OR]: 2.23, p = 0.020), ureteral HU value under the stone (OR: 1.11, p = 0.014), UWT (OR: 5.66, p = 0.009), anteroposterior diameter (OR: 1.23, p = 0.033), and the Vmax value of the stone side (OR: 0.76, p = 0.011). The proposed scoring system predicted IUS with 89% sensitivity and 91% specificity at a cutoff value of 11.5. Conclusion: Determining whether a ureteral stone is impacted is important in deciding on the optimal treatment modality. The nomogram and scoring system that we created based on the data that were obtained with noninvasive methods can predict IUS with high sensitivity and specificity.

Vitamin D and thiol-disulfide homeostasis levels in postmenopausal women with overactive bladder syndrome.

BACKGROUND: This study aimed to find a relationship between vitamin D concentration and thiol-disulfide homeostasis in the pathophysiology of overactive bladder (OAB) syndrome in postmenopausal women. METHODS: A total of 76 postmenopausal women, referred for routine controls, were recruited between January and March 2018 to participate in this study. Participants with an overactive bladder questionnaire (OAB-q) score of >11 (n = 34) were included in the OAB syndrome group, while those with a score of <5 (n = 42) were included in the control group. Serum total antioxidant capacity, ischemia-modified albumin, C-reactive protein, 25-hydroxy vitamin D levels, and thiol-disulfide homeostasis were measured. RESULTS: Patients with OAB syndrome had waist circumferences of 106 ± 11 cm, and their body mass indexes (BMIs) were 30.8 ± 4.8 kg/m2. The control groups' waist circumferences were 102 ± 11 cm and their BMIs were 28.9 ± 4.3 kg/m2 (p = 0.069 and p = 0.098, respectively). The level of vitamin D in the control group was 33.7 (IQR: 30.7) nmol/L and 27.0 (IQR: 27.5) nmol/L (p = 0.081) in the OAB syndrome group. CONCLUSIONS: We were not able to demonstrate with certainty any significant relationships between serum 25-hydroxy vitamin D levels and thiol-disulfide homeostasis parameters and OAB syndrome.

Free prostate-specific antigen outperforms total prostate-specific antigen as a predictor of prostate volume in patients without prostate cancer.

OBJECTIVE: In the management of benign prostatic hyperplasia (BPH), urology guide- lines recommend medical or surgical treatments according to different prostate volumes (PV). The aim of this study was to analyze the relationships between PV and age, total and free prostate specific antigen (tPSA, fPSA) and fPSA/tPSA ratio in patients without histologically proven prostate cancer. MATERIALS AND METHODS: A retrospective analysis was made of the data of 1334 patients who underwent transrectal ultra- sound (TRUS)-guided prostate biopsy between January 2016 and October 2018. A total of 438 patients with available data for age, tPSA and fPSA levels and PV calculated by TRUS were enrolled in the study. Patients with chronic prostatitis pathology in addition to BPH were also noted and evaluated as a separate group. RESULTS: There were significant correlations between PV and age, tPSA, fPSA, fPSA/tPSA ratio (r = 0.210, r = 0.338, r = 0.548, r = 0.363 respectively). In multivariate linear regression analysis, fPSA was found to be the only predictor for PV (p < 0.001) when compared to age (p = 0.097), tPSA (p = 0.979) and fPSA/tPSA ratio (p = 0.425). In patients with chronic prostatitis pathology there were significant correla- tions between PV and age, tPSA, fPSA, fPSA/tPSA ratio (r = 0.279, r = 0.379, r = 0.592, r = 0.359, respectively). The multivariate linear regression analysis showed a signifi- cant correlation only between PV and tPSA and fPSA/tPSA ratio but not with fPSA and age (p = 0.008, p = 0.015, p = 0.430, p = 0.484, respectively). In men with only BPH pathology there were significant correlations between PV and age, tPSA, fPSA, fPSA/tPSA ratio (r = 0.223, r = 0.385, r = 0.520, r = 0.287, respectively) In multivariate linear regression model the significant correlation was shown only between PV and fPSA (p < 0.001). CONCLUSIONS: Although tPSA was significantly correlated with PV in patients without prostate cancer, the correlation between fPSA and PV was much stronger. However, it should be kept in mind that the efficacy of fPSA may be limited in patients with clinically unknown prostatic inflammation.

Percutaneous Nephrolithotomy via a Middle Calyx Access Is Effective in the Treatment of Lower Pole Kidney Stones: A Single-Center Study.

PURPOSE: To compare the efficacy of the middle calyx access (MCA) and lower calyx access (LCA) in the treatment of lower pole kidney stones. MATERIALS AND METHODS: The data of patients with isolated lower pole kidney stones who underwent percutaneous nephrolithotomy via MCA or LCA between 2009 and 2019 were evaluated retrospectively. Pre-, peri-, and postoperative parameters of the groups (LCA group and MCA group) were compared. A value of p < 0.05 was considered significant. RESULTS: A total of 601 patients with lower pole kidney stones were included in the study. LCA was performed for the initial tract in 400 patients, and MCA was performed in 201 patients. There were no significant differences in terms of age, gender, laterality, body mass index, previous operation history, stone burden, duration of fluoroscopy, and stone-free rate between the groups. Operation time was significantly longer in the LCA group (p = 0.041). In the LCA group, additional access was required in 50 cases, which was significantly higher than in the MCA group (p = 0.013). Clinically insignificant residual fragments (CIRF) were present in 28 patients (7%) in the first group (significantly higher vs. MCA: p = 0.044). There were no statistically significant differences in terms of overall complication and transfusion rates. CONCLUSIONS: MCA had superior outcomes in terms of operation time, CIRF rate, hemoglobin drop, and requirement of an additional tract compared to LCA. Further studies evaluating the efficacy of MCA in lower pole kidney stones should be performed to verify our results.

Importance of the Hounsfield Unit Value Measured by Computed Tomography in the Differentiation of Hydronephrosis and Pyonephrosis.

Objectives To evaluate the efficacy of the non-contrast-enhanced computed tomography (NCECT) renal pelvis Hounsfield unit (HU) values in differentiating between the hydronephrosis and pyonephrosis in dilated urinary systems. Materials and methods Patients who underwent percutaneous nephrostomy (PN) due to urinary system obstruction in the last three years were retrospectively evaluated. Pyonephrosis and hydronephrosis groups were differentiated according to the clarity of percutaneous needle aspiration. The patients' renal pelvic anteroposterior (AP) diameter, renal pelvic area, and mean HU values were measured on NCECT and compared between two groups. Results PN was performed on a total of 523 patients. The study included 159 patients and 214 renal units. Hydronephrosis was detected in 176 renal units and pyonephrosis in 38 renal units. No statistically significant difference was observed between the measured AP diameter and renal pelvic area in the two groups (28.45 ± 10.1 mm vs. 31.13 ± 14.4 mm, p = 0.36 and 658.51 ± 433.1 mm2 vs. 755.14 ± 470.6 mm2, p = 0.22, respectively). The mean HU value of the pyonephrosis group was significantly higher (2.30 ± 5.02 vs. 10.97 ± 6.68, p < 0.001). At the cut-off value of 8.46, HU had a sensitivity of 68.4% and specificity of 92.6% in the diagnosis of pyonephrosis. Conclusions It is possible to determine differential diagnosis between pyonephrosis and hydronephrosis easily and without additional cost by performing dilated renal pelvis HU measurements on NCECT.

Comparison of the levels of the serotonin metabolite, 5-hydroxyindole acetic acid, in cerebrospinal fluid from patients with and without premature ejaculation / Comparación de los niveles de ácido 5-hidroxindolacético, metabolito de la serotonina, en el líquido cefalorraquídeo de pacientes con y sin eyaculación precoz

Introduction: Premature ejaculation (PE) is a significant problem as it can cause a loss of sexual self-confidence and a significant deterioration in quality of life. The frequency of PE varies between 9% and 27%. In the current study, we aimed to compare the levels of the serotonin metabolite 5HIAA (5 hydroxyindole acetic acid) in the cerebrospinal fluid (CSF) of patients with and without PE according to IELT (intravaginal ejaculation latency time) in order to investigate the relationship of PE with CSF 5HIAA levels. Materials and methods: A total of 60 male patients were included in the study who were planning to undergo surgery under spinal anesthesia, 30 in the patient (PE) group (all of the included patients had an IELT of <1min) and 30 in the control group (patients had an IELT of > 1 min). Levels of CSF 5HIAA were measured. Results: There was a significant negative correlation between IELT and the 5HIAA variables in all patients (r = -0.322, p = 0.012). Although the average 5HIAA levels (nmol/L) were higher in the patient group (86.80 ± 28.33) than in the control group (76.44 ± 35.91), this difference was not significant (p = 0.22). Discussion: Results of the current study bring new and different perspectives to the explanation of PE pathophysiology. There is a need for more specific and genetic studies to determine the best treatment for this common disorder

Introducción: La eyaculación precoz (EP) es un problema importante, ya que puede provocar una pérdida de confianza sexual en uno mismo y un deterioro considerable de la calidad de vida. La frecuencia de EP varía entre el 9 y el 27%. En este estudio, nuestro objetivo fue comparar los niveles del ácido 5-hidroxindolacético (5-HIAA), metabolito de la serotonina, en el líquido cefalorraquídeo (LCR) de pacientes con y sin EP según el tiempo de latencia eyaculatoria intravaginal (TLEI) para analizar la relación de la EP con los niveles de 5-HIAA en el LCR. Materiales y métodos: Se incluyeron en el estudio un total de 60 pacientes de sexo masculino que tenían prevista cirugía con anestesia intradural, 30 en el grupo de pacientes con EP (todos los pacientes incluidos tenían un TLEI < 1 min) y 30 en el grupo de control (los pacientes tenían un TLEI > 1 min). Se midieron los niveles de 5-HIAA en el LCR. Resultados: Hubo una correlación negativa importante entre las variables TLEI y 5-HIAA en todos los pacientes (r = -0,322; p = 0,012). Aunque los niveles medios de 5-HIAA (nmol/l) fueron más elevados en el grupo de pacientes (86,80 ± 28,33) que en el grupo de control (76,44 ± 35,91), esta diferencia no fue considerable (p = 0,22). Discusión: Los resultados del presente estudio aportaron nuevas y diferentes perspectivas a la explicación de la fisiopatología de la EP. Es necesario realizar más estudios específicos y genéticos para establecer el mejor tratamiento de este trastorno frecuente

Comparison of Guy's Stone Score and clinical research of the endourological society nomogram for predicting surgical outcomes after pediatric percutaneous nephrolithotomy: a single center study.

BACKGROUND: The aim of this study was to compare the efficacy of Guy's Stone Score (GSS) and Clinical Research of the Endourological Society (CROES) Nomogram in predicting PCNL outcomes in the pediatric patients with kidney stone. METHODS: A retrospective review of the clinical data of 120 pediatric patients who underwent PCNL between August 2004 and February 2016 was performed. Patients were grouped according to stone-free (SF) status and complication status. The patients whose history, preoperative physical examination records, biochemical analysis, imaging records were available and who did not neglect the follow-up, were included in the study. The stone size measurement and the scoring system calculation were always performed by the same surgeon. Multivariate logistic regression analysis were performed to identify the factors associated with SF status and complication status. RESULTS: CROES score was significantly higher in SF patients compared to the patients with residual stones (P=0.009), while stone burden and GSS were significantly lower (P=0.023 and P=0.025). Median hospitalization day of patients with complications was significantly higher compared to the patients without complication (P=0.005). To have stones located in multiple calyces was the only statistically significant condition when two groups were compared (P=0.014). In multivariate analysis, CROES score was the independent factor associated with SF status (OR:0.984 95% CI: 0.959-1.010 P=0.017) and to have stones located in multiple calyces was the independent factor associated with complication status (OR:0.265 95% CI:0.087-0.808 P=0.02). CONCLUSIONS: CROES nomogram is associated with the SFR while GSS is not. Both scoring systems do not have predictive accuracy on complication status. Further studies are required to make modifications in the scoring systems in the pediatric population.

Comparison of the levels of the serotonin metabolite, 5-hydroxyindole acetic acid, in cerebrospinal fluid from patients with and without premature ejaculation.

INTRODUCTION: Premature ejaculation (PE) is a significant problem as it can cause a loss of sexual self-confidence and a significant deterioration in quality of life. The frequency of PE varies between 9% and 27%. In the current study, we aimed to compare the levels of the serotonin metabolite 5HIAA (5 hydroxyindole acetic acid) in the cerebrospinal fluid (CSF) of patients with and without PE according to IELT (intravaginal ejaculation latency time) in order to investigate the relationship of PE with CSF 5HIAA levels. MATERIALS AND METHODS: A total of 60 male patients were included in the study who were planning to undergo surgery under spinal anesthesia, 30 in the patient (PE) group (all of the included patients had an IELT of <1min) and 30 in the control group (patients had an IELT of >1min). Levels of CSF 5HIAA were measured. RESULTS: There was a significant negative correlation between IELT and the 5HIAA variables in all patients (r=-0.322, p=0.012). Although the average 5HIAA levels (nmol/L) were higher in the patient group (86.80±28.33) than in the control group (76.44±35.91), this difference was not significant (p=0.22). DISCUSSION: Results of the current study bring new and different perspectives to the explanation of PE pathophysiology. There is a need for more specific and genetic studies to determine the best treatment for this common disorder.

Lymphocyte-to-monocyte ratio is a valuable marker to predict prostate cancer in patients with prostate specific antigen between 4 and 10 ng/dl.

OBJECTIVE: To evaluate the diagnostic value of serum inflammation markers derived from complete blood count in diagnosis of prostate cancer (PCa). METHODS: We retrospectively analyzed the data of 621 patients who underwent prostate biopsy between March 2013 and April 2018. Age, prostate specific antigen (PSA), free PSA, platelet count, neutrophil count, lymphocyte count, monocyte count, prostate volume (PV) and pathology result of the patients were recorded. Patients were grouped as benign prostatic hyperplasia (BPH), prostatitis and PCa. Patients were also grouped according to PSA values, as PSA < 4 , PSA 4-10 and PSA > 10 ng/dl. RESULTS: The mean lymphocyte-to-monocyte ratio (LMR) value of the patients with PCa was significantly lower in the entire cohort (p = 0.047). In the PSA 4-10 ng/dl range, LMR value wassignificantly lower in patients with PCa than those with BPH or prostatitis (p = 0.012). In this PSA range, free/total PSA ratio and LMR were significant factors to predict PCa. The cut-off values of LMR, free/total PSA were 3.05 and 0.15 respectively. The sensitivities, spesificities, positive predictive values (PPV) and negative predictive values using LMR cut-off, free/total PSA cut-off and their combination were assessed. Specificity and PPV of the combination group were higher (97.2%, 83.3% respectively) compared to free/total PSA cut-off group (91.6%, 76.6%) and LMR cut-off group (67.8%, 43.7%). CONCLUSIONS: LMR is a useful tool at detecting PCa especially in patients with PSA value between 4 and 10 ng/dl. The combination of free/total PSA ratio and LMR improves the diagnostic accuracy more than the use of free/total PSA ratio alone.

Relationship between erectile dysfunction and the neutrophil to lymphocyte and platelet to lymphocyte ratios.

The most important cause of erectile dysfunction (ED) among aging men is organic disease due to vascular disturbance that is often caused by atherosclerosis. Recently, studies have shown that atherosclerosis can manifest as an active inflammatory process rather than as passive vascular injury caused by lipid infiltration. Our study aimed to examine the association of ED with the neutrophil/lymphocyte ratio (NLR) and the platelet/lymphocyte ratio (PLR), both of which are markers of inflammation. Between December 2014 and May 2015, 101 male patients aged 40-70 years who were seen at our institute due to ED were included in this study. Thirty-one sexually active men with similar clinical and demographic characteristics without ED were included in our study as a control group. The control and patient groups were compared with respect to their NLR and PLR values as well as other hormonal, biochemical, hematological parameters. The median ages of the patient and control groups were 49 (40-69) and 48 (43-65) years old, respectively. Comorbidities such as hypertension, diabetes, chronic obstructive pulmonary disease (COPD), and coronary artery disease were not significantly different between the groups (p > 0.05). The neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios were significantly higher in the patient group than in the control group (p < 0.05). Furthermore, the detected CRP levels were also significantly higher in the patient group than in the control group (p < 0.001). In the correlation analysis, the NLR, PLR, and CRP levels were negatively correlated with the IIEF-5 scores. A multivariate analysis was performed to determine the independent predictors of ED. PLR was identified as an independent predictor for ED. The neutrophil-to-lymphocyte and especially platelet-to-lymphocyte ratios are correlated with a diagnosis of ED, and these ratios could serve as practical parameters that will not elicit additional costs.

Liposarcoma of the spermatic cord: A case report.

Spermatic cord liposarcoma is very rare and characterized by a painless inguinal or scrotal mass. This is a case report of a 66-year-old man presenting with a mass in his left scrotum. Inguinal orchiectomy was performed and the histopathological examination revealed a liposarcoma of the spermatic cord.