The best method for erection function in urethroplasty; is excision and primary anastomosis or buccal mucosal graft urethroplasty?

INTRODUCTION: The aim of this study is to evaluate and compare erection function (EF) after Excision and Primary Anastomosis Urethroplasty (EPAU) and Buccal Mucosal Graft Urethroplasty (BMGU) in bulbar urethral stricture. METHODS: Patients who underwent urethroplasty were identified retrospectively. The criteria for inclusion in the study were determined as being over 18 years old and under 70 years old, being sexually active. Exclusion criteria are; preoperative severe erectile dysfunction, stricture outside the bulbar urethra, psychosocial incompatibility, urethral stricture related to pelvic fracture, follow-up time less than a year. As the primary endpoint, the International Index of Erectile Function-5 (IIEF-5) was determined as a comparison of EF in the preoperative and third, sixth and twelfth months after surgery. The secondary endpoint was the evaluation of the effects of demographic data, stricture and treatment characteristics on EF. RESULTS: Fifty patients were identified considering the inclusion/exclusion criteria. It was observed that there were 30 patients who underwent EPAU and 20 patients who underwent BMGU. At the third month after surgery, EF showed a statistically significant decrease in the EPAU group. In both patient groups, it was observed that the early negative effects after the operation in EF started to improve in the sixth month and returned to the baseline level by the first year. CONCLUSION: EPAU and BMGU techniques have a similar effect on EF in the medium and long term. Both methods can be used safely and effectively in the appropriate patient group.

Could Prognostic Nutritional Index be a new criteria for active surveillance of prostate cancer?

OBJECTIVE: To evaluate the importance of the Prognotic Nutritional Index(PNI) value for patient selection of active surveillance(AS) in prostate cancer. METHODS: Between September 2020 and June 2022, the data of 125-patients who underwent Robot-Assisted-Laparoscopic-Prostatectomy(RALP) were retrospectively analyzed. All patients were suitable for AS preoperatively. Using the pathological results of RALP, patients have been divided two groups. Patients who met the criteria for AS were defined as the first group, others were defined second. Demographic datas, PNI values and hematological parameters of the groups were compared. RESULTS: 38% (n:48) patients were found suitable for the group1, and 62%(n:77) were found suitable for the group 2. Upgrading and upstaging were found at 76 patients (61%) and 26(21%), respectively. There is no significant difference between groups on age, BMI, PSA, PSA-density, prostate volume, and PIRADS. PNI value was found higher at first group. The value of 49.45 was calculated by ROC analysis as the ideal PNI cut-off value for predicting upgrading and upstaging of prostate cancer (P < ,001). According to the both univariate and multivariate regression analysis, PNI was found a predictor for exclusion from AS (P < ,001). CONCLUSION: Upgrading and upstaging are detected at a higher rate in patients with low PNI values. The use of PNI value in the selection of patients to AS will increase the success rate of ideal patient selection.