Comparison of Tumor Enucleation and Standard Partial Nephrectomy According to Trifecta Outcomes: A Multicenter Study by the Turkish Academy of Urology, Uro-Oncology Working Group.

INTRODUCTION: We aimed to evaluate the impact of the resection technique (tumor enucleation (TE) or standard partial nephrectomy (SPN)) on trifecta outcomes in patients having undergone partial nephrectomy (PN). MATERIALS AND METHODS: We retrospectively analyzed the clinical and pathologic parameters in patients with localized renal cell carcinoma (pT1-2N0M0) who had undergone PN between January 2001-December 2018 at one of 15 different tertiary referral centers. Multivariable logistic regression analysis was applied to investigate independent predictors of trifecta failure, decreased postoperative renal functions (decreased estimated glomerular filtration rate (eGFR) > 10%), perioperative complications (Clavien-Dindo > 1), and positive surgical margins. RESULTS: A total of 1070 patients with a mean age 56.11 ± 11.88 years were included in our study. PN was performed with TE in 848 (79.25%) and SPN in 222 (20.75%) patients. Trifecta failure rate was 56.2% for TE and 64.4% for SPN (p = 0.028). On multivariable analysis, TE was associated with less trifecta failure (p = 0.025) and eGFR decrease >10% rates (p = 0.024). On the other hand, there was no statistically significant difference between TE and SPN according to positive surgical margins (p = 0.450) and complication > Clavien-Dindo grade 1 (p = 0.888) rates. The only independent predictive factor for complications > Clavien-Dindo 1 was the Charlson comorbidity index (CCI) (p = 0.001). CONCLUSION: TE is associated with less trifecta failure than SPN. This result is mainly due to better preservation of renal function with TE.

Correlation of the Grade Group of Prostate Cancer according to the International Society of Urological Pathology (Isup) 2014 Classification between Prostate Biopsy and Radical Prostatectomy Specimens.

ABTRACTWe aimed to assess the correlation between ISUP 2014 grades of needle biopsy (NB) and radical prostatectomy (RP) specimens and the parameters effecting this correlation. A total of 353 patients, who underwent a radical prostatectomy with diagnose of prostate cancer, were included in the study. Especially, the maximum percentage of core involved by cancer (MPCI) of upgraded group was significantly higher than those of correlated group and downgraded group. MPCI might be used as a preoperative value to determine risk classification and to help counsel patients with regard to treatment decision and prognosis of disease.

Comparision of Brucella and Non-Brucella Epididymo-orchitis.

OBJECTIVE:  To find parameters for differential diagnosis between Brucella epididymo-orchitis (BEO) and non-brucella epididymo-orchitis (NBEO) cases with comparison of BEO and NBEO in terms of inflammatory markers, full urinalysis (FU) for pyuria, and abscess formation (AF). STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Agri State Hospital Urology and Infectious Disease Clinics, between January 2014 and  November 2017. METHODOLOGY: Data of the patients, who were diagnosed with epididymo-orchitis, were divided in BEO and NBEO groups on the basic of serum agglutination test. Parameters including age, white blood cell neutrophil, lymphocyte, monocyte, platelet, mean platelet volume, C-reactive protein (CRP), neutrophil/lymphocyte ratio, monocyte/lymphocyte ratio, platelet / lymphocyte ratio, and FU. The values were statistically compared. RESULTS: One hundred and thirty-eight (138) patients were found eligible for the study. Twenty-three (23) of these patients (16.66%) had BEO, and 115 (83.33%) had NBEO. BEO vs. NBEO cases were significantly different regarding mean age (26.17 ±8.15 vs. 48.53 ±21.78 years, p=0.0001) and frequency of pyuria (3,13.04%) vs. 89 (77.39%, p=0.001). However CRP values i.e. 6.07 ±6.59 vs. 6.07 ±5.85 mg/dl (p=0.999) was not significantly different. CONCLUSION: BEO cases are often younger and do not have pyuria or abscess formation. High frequency of pyuria was found in NBEO cases. CRP levels cannot be used in the differential diagnosis between BEO and NBEO cases. Key Words: Abscess formation, Brucella epididymo-orchitis, C-reactive protein, Orchiectomy, Pyuria.

Effects of methylphenidate on the lower urinary tract in patients with attention deficit hyperactivity disorder and without voiding dysfunction.

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is characterised by a range of symptoms, such as excessive mobility, difficulty in maintaining attention and inadequate impulse control. Methylphenidate (MPH) is widely prescribed as a treatment for ADHD. In the literature, studies investigating the effects of MPH on the lower urinary tract (LUT) are limited. OBJECTIVE: The aim of the study was to evaluate MPH-induced LUT symptoms (LUTSs) in patients with ADHD without a diagnosis of voiding dysfunction (VD). STUDY DESIGN: After ethical committee approval, volunteers aged 7-17 y were divided into two groups, with group 1 composed of individuals diagnosed with ADHD but not VD and group 2 (control) composed of healthy individuals. Lower urinary tract symptoms and quality of life, in addition to uroflowmetry test results and postvoiding residual volume (PVRV), were evaluated in both groups at baseline and again 4 wk later. The individuals in group 1 were treated with MPH after baseline screening. The dysfunctional voiding scoring system questionnaire was used for scoring LUTSs. Postvoiding residual volume was measured by ultrasound. Bladder capacity (BC) was calculated as the sum of voided volume (VV) and PVRV. The means of the maximum flow rate (Q max), mean flow rate (Q mean), VV, PVRV and BC were recorded. RESULTS: After exclusions, there were 43 participants in group 1 and 39 participants in group 2. There was no significant difference between the mean age of groups (p = 0.727). Compared with the baseline, VV and BC increased significantly in group 1 (p = 0.001 and p = 0.002, respectively) at the 4-wk follow-up. There was no significant difference in these parameters in group 2. DISCUSSION: This study demonstrated that VV and BC increased after MPH treatment in patients with ADHD without a diagnosis of VD. The mechanism underlying this effect is unclear, but it may be associated with dopaminergic and noradrenergic effects. CONCLUSION: The findings of the present study can inform further studies on the mechanism underlying the effect of MPH on the LUT. In a future study, the authors suggest evaluating the effects of MPH in a urodynamic study in patients with ADHD diagnosed with VD.

The association of let-7c, miR-21, miR-145, miR-182, and miR-221 with clinicopathologic parameters of prostate cancer in patients diagnosed with low-risk disease.

BACKGROUND: The diagnostic benefit of prostate specific antigen (PSA) is limited, owing to its lack of specificity, particularly in men with PSA levels of 4.0 to 10.0 ng/mL. Therefore, there is a need for more specific and sensitive biomarkers to improve diagnostic accuracy and to predict prostate cancer (PCa) progression. Assessing the expression levels of specific microRNAs (miRNAs) in patients with PCa may be helpful in detecting cancer and predicting the cancer prognosis and its evolution, and may serve as markers to decide the treatment. We examined the expression levels of five miRNAs (let-7c, miR-21, miR-145, miR-185, and miR-221) on patients with low-risk PCa who had been eligible for active surveillance but underwent radical prostatectomy. We investigated the correlation between the relative expression of miRNAs and clinicopathologic parameters to evaluate their clinical significance. MATERIALS AND METHODS: Total RNA was isolated from the tumor and the corresponding non-neoplastic prostate tissue of 45 patients who underwent radical prostatectomy. Quantitative reverse transcriptase-polymerase chain reaction was used to measure the levels of let-7c, miR-21, miR-145, miR-185, miR-221, and RNU6B expression, using TaqMan MicroRNA Assays. miRNA expression was examined in low-risk PCa, and miRNAs' association with Gleason upgraded (GU) and biochemical recurrent (BR) patients was evaluated. RESULTS: We observed that miR-21 and miR-182 were overexpressed; conversely, let-7c, miR-145, and miR-221 were underexpressed in patients with low-risk PCa. GU patients (n = 16) and non-upgraded patients (n = 28) were compared. miR-145 was downregulated significantly in the GU group (P = 0.03). Similarly, miR-221 was downregulated significantly in patients with BR (n = 14) compared with non-recurrent patients (n = 30) (P = 0.04). Receiver operator characteristics (ROC) curve analysis revealed that miR-221 levels were significantly associated with BR in patients with a cut-off <-1.666, a value at which sensitivity was 70% and specificity 71% (area under curve [AUC] = 0.705, P = 0.030). CONCLUSIONS: There is still a need for a tumor marker with higher sensitivity and specificity than that of PSA. Among the five miRNAs examined, miR-221 was most associated with biochemical recurrence in low-risk PCa.

Safety and efficacy of PNL vs RIRS in the management of stones located in horseshoe kidneys: A critical comparative evaluation.

AIM: To assess the efficacy and safety of two different techniques (Percutaneous nephrolithotomy (PNL) vs Retrograde intrarenal surgery (RIRS)) in the management of stones in patients with horseshoe kidneys (HSK). PATIENTS AND METHODS: Departmental files of 88 cases with radiopaque kidney stones in horseshoe kidneys undergoing two different approaches (PNL vs RIRS) were evaluated with respect to the success and complication rates of in a retrospective manner. In addition to the factors related with the procedures (success and complication rates, additional procedures), patient and stone characteristics were all well evaluated. Findings obtained in both groups were evaluated in a comparative manner with respect to the statistical significance. RESULTS: Stone free rates were comparable in both groups after 1-week period (81.6% PNL vs 80% RIRS). As well as 3 months evaluation (84.2% PNL and 82.0% RIRS). The percentage of the cases with residual fragments (> 4 mm) were similar in both groups and while all PNL procedures were completed in one session, mean number of RIRS sessions was higher (1.22 ± 0.05). Mean duration of the procedure was slightly higher in RIRS group and based on Clavien scoring system, despite a higher risk of Hb drop noted in patients treated with PNL, all complication rates were found to be similar in both groups. CONCLUSION: Our results demonstrate that of the available minimally invasive treatment alternatives, both PNL and RIRS could be safe and effective alternatives for renal stone removal in patients with HSK.

Our urethrocutaneous fistula repair results in adults after hypospadias surgery.

INTRODUCTION: Our aim was to evaluate and share our urethrocutaneus fistula repair results in adult patients who had been operated for hypospadias in their childhood. MATERIAL AND METHODS: The data of totally 48 patients who had been treated for urethrocutaneous fistula after hypospadias surgery in our department from May 2008 to January 2015 analyzed retrospectively. Patients' age at fistula repair, age at first hypospadias surgery, fistula size, localization and number, distal urethral obstruction status and surgical outcomes of fistula repairs were recorded. All patients were controlled three months after the repair for surgical outcomes. RESULTS: Fistula repair performed in 45 patients. Mean age was 21.46 (20-26). Nineteen patients (42.2%) underwent first hypospadias surgery under the age of 7 years; 8 patients (17.7%) between 7 and 15 years, 18 patients between 15 and 20 years. Tubularized incised plate urethroplasty (TIPU) was performed in 40 patients (88.9%), extragenital tissue was used in 5 patients (11.1%). Twenty two patients (48.9%) had 1 or 2 operations, 17 patients (37.8%) had 3-5 operations and 6 patients (13.3%) had 6 or more operations. Thirteen (28.9%) coronal, 24 (53.3%) subcoronal, 6 (13.3%) penile and 2 (4.4%) penoscrotal fistulas were observed. While a single fistula was observed in 35 patients, multiple fistulas were seen in 10 patients. A fistula diameter les than 5mm was detected in 37 patients, and larger than 5mm in 8 patients. Fistula recurrence was observed in 3 patients at follow-up examinations carried out at 3 months postoperatively. The number of operations was more than 5, the fistula diameter was larger than 5mm and the fistulas were coronal in all three recurrent fistulas. CONCLUSION: According to our results fistula size, previous surgery and well-vascularised, one or two layer tissue were the important factors in the success of fistula repair after hypospadias surgery.

Correlation Between Residual Volume of Male Patients After Uroflowmetry and Random Residual Volume.

OBJECTIVES: Our aim was to examine correlation between Post-void residual urine (PVR) after uroflowmetry and random PVR. METHODS: Male patients reporting to the Urology outpatient clinic with LUTS were selected. Patients' age, prostate volume, bladder capacity, voided volume, maximum flow rate, average flow rate, random PVR and PVR after uroflowmetry were recorded. We evaluated the correlations between these parameters. Also we assessed if there was a difference between random PVR and PVR after uroflowmetry. We divided PVR after uroflowmetry and random PVR into three groups: Group 1: 0-50 mL, Group 2: 51-100 mL and Group 3: >100 mL. Also we divided the patients into two groups according to bladder capacity as Group 1: ≤400 mL and Group 2: >400 mL. We compared these groups to determine whether a significant difference. RESULTS: Seventy-seven patients applying to the urology outpatient clinic were assessed between 2013 and 2014. PVR after uroflowmetry was significantly higher than random PVR (P < 0.001). When we divided PVR after uroflowmetry and random PVR into three groups there was a significant difference between the groups (P = 0.02). When we divided the patients into two groups according to bladder capacity as Group 1: ≤400 mL and Group 2: >400 mL, PVR after uroflowmetry was different, but random PVR was similar (P < 0.001, P = 0.72). CONCLUSIONS: PVR after uroflowmetry seems to be incorrectly high in patients whose bladder capacity is above 400 mL.

Comparison of two different doses of lidocaine on the pain sensation during transrectal ultrasound-guided prostate biopsy.

OBJECTIVE: To compare two different doses of lidocaine used for periprostatic nerve block on pain perception during transrectal ultrasound (TRUS) guided prostate biopsy. MATERIAL AND METHODS: A total of 288 patients with elevated prostate specific antigen (PSA) levels and/or abnormal digital rectal examination who underwent TRUS-guided prostate biopsy were included in the study. The patients were divided into 3 groups: Group 1 (n=103) prostate biopsy were performed after administering perianal intrarectal application of 10 mL 2% lidocaine gel, Group 2 (n=98) 2 mL of 2% lidocaine injection on each side following rectal installation of lidocaine gel and Group 3 (n=87) 4 mL of 2% lidocaine injection on each side after rectal instillation of lidocaine gel. Patients' pain scores during biopsy procedure were reported using visual analogue score (VAS). Independent sample t test, ANOVA test and Tukey test were used for statistical evaluation. RESULTS: The mean age, prostate volume and PSA level were 65.6±8.4 years, 58.2±34.8 mL, and 11.8±3.4 ng/mL respectively. There were no statistically significant differences in baseline characteristics between the groups. The mean VAS scores were 2.4±1.8 in Group 1, 2.5±1.9 in Group 2 and 1.6±1.6 in Group 3. Patients in Group 3, reported significant pain reduction compared with patients in Groups 1 and 2 (p=0.002, and 0.001, respectively). However, there was no statistically significant difference in VAS scores between Groups 1 and 2 (p=0.815). CONCLUSION: According to our results we recommend the use of perianal intrarectal lidocain gel application, and periprostatic nerve block with injection of 4 ml 2% lidocaine per side combination in TRUS-guided prostate biopsies. Further large-scale randomized control studies are needed to validate these finding.

Does an asymmetric lobe in digital rectal examination include any risk for prostate cancer? results of 1495 biopsies.

INTRODUCTION: Despite the well-known findings related to malignity in DRE such as nodule and induration, asymmetry of prostatic lobes, seen relatively, were investigated in a few studies as a predictor of prostate cancer so that there is no universally expected conclusion about asymmetry. We aimed to compare cancer detection rate of normal, asymmetric or suspicious findings in DRE by using biopsy results. MATERIALS AND METHODS: Data of 1495 patients underwent prostate biopsy between 2006-2014 were searched retrospectively. Biopsy indications were abnormal DRE and or elevated PSA level( >4ng/mL). DRE findings were recorded as Group 1: Benign DRE, Group 2: Asymmetry and Group 3: Nodule/induration. Age, prostatic volume , biopsy results and PSA levels were recorded. RESULTS: Mean age, prostate volume and PSA level were 66.72, 55.98 cc and 18.61ng/ mL respectively. Overall cancer detection rate was 38.66 % (575 of 1495). PSA levels were similar in group 1 and 2 but significantly higher in group 3. Prostatic volume was similar in group 1 and 2 and significantly lower in Group 3. Malignity detection rate of group 1,2 and 3 were 28.93%, 34.89% and 55.99% respectively. Group 1 and 2 were similar (p=0.105) but 3 had more chance for cancer detection. CONCLUSION: Nodule is the most important finding in DRE for cancer detection. Only na asymmetric prostate itself does not mean malignity.

Does an asymmetric lobe in digital rectal examination include any risk for prostate cancer? results of 1495 biopsies

ABSTRACT Introduction: Despite the well-known findings related to malignity in DRE such as nodule and induration, asymmetry of prostatic lobes, seen relatively, were investigated in a few studies as a predictor of prostate cancer so that there is no universally expected conclusion about asymmetry. We aimed to compare cancer detection rate of normal, asymmetric or suspicious findings in DRE by using biopsy results. Materials and Methods: Data of 1495 patients underwent prostate biopsy between 2006-2014 were searched retrospectively. Biopsy indications were abnormal DRE and or elevated PSA level(>4ng/mL). DRE findings were recorded as Group 1: Benign DRE, Group 2: Asymmetry and Group 3: Nodule/induration. Age, prostatic volume, biopsy results and PSA levels were recorded. Results: Mean age, prostate volume and PSA level were 66.72, 55.98 cc and 18.61ng/ mL respectively. Overall cancer detection rate was 38.66 % (575 of 1495). PSA levels were similar in group 1 and 2 but significantly higher in group 3. Prostatic volume was similar in group 1 and 2 and significantly lower in Group 3. Malignity detection rate of group 1,2 and 3 were 28.93%, 34.89% and 55.99% respectively. Group 1 and 2 were similar (p=0.105) but 3 had more chance for cancer detection. Conclusion: Nodule is the most important finding in DRE for cancer detection. Only an asymmetric prostate itself does not mean malignity.

Evaluation of PCA3 and multiparametric MRI's: collective benefits before deciding initial prostate biopsy for patients with PSA level between 3-10ng/mL.

OBJECTIVE: To analyze the contribution of multiparametric MRI and PCA3 assay, predecision of initial biopsy in PSA level between 3-10 ng/mL patients with normal digital rectal examination(DRE). MATERIALS AND METHODS: PSA level 3-10 ng/mL, patients, with normal DRE results and no previous prostate biopsy history, were included in this study. Each patient underwent multiparametric MRI one week before biopsy. Urine sample taking for PCA3 examination preceded the biopsy. Systematic and targeted biopsies were conducted. Patients with high PSA levels were seperated into two groups as: high PCA3 scored and low PCA3 scored. Then each group was divided into two sub-groups as: MRI lesion positive and negative. Tumor incidence, positive predictive values(PPV) and negative predictive values(NPV) were calculated. RESULTS: 53 patients were included between February 2013 and March 2014. Mean age 61.22 ± 1.06. Mean PSA value 5.13 ± 0.19 ng / mL. Mean PCA3 score 98.01 ± 23.13 and mean prostate size was 48.96 ± 2.67 grams. Fourty nine patients had both PCA3 score and multiparametric MRI. The PCA3's PPV value was 58.33%. If multiparametric MRI lesions are added to high PCA3 scores , the PPV appears to elevate to 91.66%. NPV of PCA3 was 96%. NPV was 95% when there was no lesion in the multiparametric MRI with low PCA3 scores. Sensitivity was 91.66% , specificity was 95% respectively. CONCLUSION: Adding multimetric MRI can also support biopsy decision for patients with high PCA3 value. When PCA3 value is low, patients can be survailled without any need to take a MRI.

TMPRSS2-ERG gene fusion in Turkish patients with localized prostate cancer: results of radical prostatectomy specimens.

OBJECTIVE: Our aim was to evaluate and determine the frequency of Transmembrane protease, serine 2 (TMPRSS2)-ERG fusion in Turkish patients with clinically localized prostate cancer by using immunohistochemistry and reveal its relationship with clinicopathologic variables. MATERIAL AND METHODS: Radical prostatectomy specimens of 99 patients, who underwent radical retropubic prostatectomy for localized cancer, between January 2002 and December 2011 were analyzed in the study. To detect ERG fusions, monoclonal ERG antibodyclone ID: EPR3864 (Epitomics, San Diego, CA, USA) and monoclonal anti-ERG antibody (9FY) (BiocareMedical, LLC, USA) were used. The immunistochemical expression of ERG protein was assessed as positive or negative regardless of stain intensity. Patients' age, total and primary Gleason scores, PSA levels, prostate volumes, tumor volumes, tumor stages and perineural invasion status were analysed retrospectively. Total fusion rate and correlation between the variables and fusion were evaluated. RESULTS: Mean age, prostate volume, tumor volume, PSA value of 99 patients were 62.02 years (±5.93), 50.02 cc (±20.67), 3.19 cc (±4.16), and 9.34 ng/mL (±3.37) respectively. TMPRSS2-ERG fusion was seen in 46 (46.5%) of 99 patients. When the variables analysed with independent samples t test to predict fusion (+) status, none of them was found to be statistically significant. When evaluated by logistic regression analysis for (+) or (-) status, only tumor stage was found to be statistically significantly correlated with fusion (p=0.049). CONCLUSION: The incidence of TMPRSS-ERG fusion in patients with localised prostate cancer in our study with Turkish population was found as 46.5%. Only tumor stage correlated with TMPRSS2-ERG fusion.

Clinical and histopathological results of the adult patients with unilateral cryptorchidism.

OBJECTIVE: To evaluate the clinical and histopathological results of adult unilateral cryptorchidism patients. MATERIAL AND METHODS: Data from adult unilateral cryptorchidism patients that underwent orchiectomy in our clinic between between January 2004 and March 2013 were retrospectively evaluated. Patients were divided into three groups as intra-abdominal, inguinal canal and superficial inguinal region according to the location of the undescended testes. Patients were also grouped according to their testicular volume (<4 cc, 4.1-12 cc, and >12 cc). Histopathology results of orchiectomy specimens were classified as follows: 1. Sertoli cells only, testicular atrophy and vanished testis (anorchia) 2. Hypospermatogenesis, and 3. Maturation arrest. Patients were grouped as normospermia, azoospermia and oligo/astheno/teratospermia groups according to semen analysis results. Correlations between testicular localization, testicular size, semen analysis and pathology results were evaluated. Incidental tumor detection rates were also calculated. RESULTS: Two hundred and forty-four adult unilateral cryptorchidism patients underwent orchiectomy in our clinic. There was no a significant relationship between location of the testis and testicular pathology results (p=0.707). Most common semen analysis results was normospermia in patients with high testicular volume group however azoospermia and oligoasthenospermia observed commonly in patients with low testicular volume group. There was a significant relationship between testicular volume and semen analysis results (p=0.023). No significant relationship was observed between semen analysis and pathological results (p=0.929). After an evaluation of all factors with possible effects on the semen analysis results, only testicular volume (p=0.036) was found to have a significant impact. Only one case (0.4%) was incidentally diagnosed seminoma after a review of 233 patients with available histopathological results on record. CONCLUSION: Adult unilateral cryptorchidism has a minimal effect on male fertility or even this effect can be overlooked. Low detection rates of incidental germ cell tumors also make an orchiectomy decision questionable in such cases.

Evaluation of PCA3 and multiparametric MRI's: collective benefits before deciding initial prostate biopsy for patients with PSA level between 3-10ng/mL

ABSTRACT Objective To analyze the contribution of multiparametric MRI and PCA3 assay, pre- decision of initial biopsy in PSA level between 3-10 ng/mL patients with normal digital rectal examination(DRE). Materials and Methods PSA level 3-10 ng/mL ,patients, with normal DRE results and no previous prostate biopsy history, were included in this study. Each patient underwent multiparametric MRI one week before biopsy. Urine sample taking for PCA3 examination preceded the biopsy. Systematic and targeted biopsies were conducted. Patients with high PSA levels were seperated into two groups as: high PCA3 scored and low PCA3 scored. Then each group was divided into two sub-groups as: MRI lesion positive and negative. Tumor incidence, positive predictive values(PPV) and negative predictive values(NPV) were calculated. Results 53 patients were included between February 2013 and March 2014.Mean age 61.22 ± 1.06. Mean PSA value 5.13 ± 0.19 ng / mL. Mean PCA3 score 98.01 ± 23.13 and mean prostate size was 48.96 ± 2.67 grams. Fourty nine patients had both PCA3 score and multiparametric MRI. The PCA3’s PPV value was 58.33%. If multiparametric MRI lesions are added to high PCA3 scores , the PPV appears to elevate to 91.66%. NPV of PCA3 was 96%. NPV was 95% when there was no lesion in the multiparametric MRI with low PCA3 scores. Sensitivity was 91.66% , specificity was 95% respectively. Conclusion Adding multimetric MRI can also support biopsy decision for patients with high PCA3 value. When PCA3 value is low, patients can be survailled without any need to take a MRI.

The nomogram conundrum: a demonstration of why a prostate cancer risk model in Turkish men underestimates prostate cancer risk in the USA.

PURPOSE: The utility of a nomogram is based on the patient population it is designed for-and their inherent properties and biases. Our aim was to demonstrate the variability in predictive model accuracy and utility between different populations. METHODS: Our model is based on 761 men who underwent initial TRUS biopsy at a single institution in Turkey. Patients were included if they had at least 10 cores on biopsy and PSA level <20 ng/ml. Multivariable logistic regression models were used to develop a new nomogram. External validity was tested with two different cohorts one from another institution in Turkey (N = 136) and cohort from USA (N = 2242). RESULTS: Prostate cancer (PCa) and high-grade PCa was diagnosed in 249/761 (32.7 %) and 101/761 (13.3 %) patients from Ankara, Turkey, respectively. Predictors of PCa were age (p < 0.0001, OR 2.11), PSA (p = 0.044, OR 1.44), PV (p < 0.0001, OR 0.38), %fPSA (p = 0.016, OR 0.72), and abnormal DRE (p < 0.0001, OR 2.05). The predictive accuracy (c-index) of our nomogram was 73 %. C-indices of 71 and 70 % were recorded in external validation cohorts from Turkey and the USA, respectively. Virtually ideal calibration was recorded for the internal validated predictive model, and good calibration was recorded when applied to the Istanbul cohort. However, the model/nomogram underestimates PCa risk in the US cohort. CONCLUSION: This is the first nomogram predicting the risk of PCa at initial biopsy in a Turkish population and provides a good risk estimation tool with good predictive accuracy and calibration in the Turkish populations. However, our study demonstrates the poor transferability of predictive tools to widely different populations.

Medical ozone therapy reduces shock wave therapy-induced renal injury.

OBJECTIVES: Extracorporeal shock wave (ESW) lithotripsy is the preferred treatment modality for uncomplicated kidney stones. More recently free oxygen radical production following ESW application has been considered to be crucial in shock wave-induced renal damage. It has been shown that ozone therapy (OT) has ameliorative and preventive effects against various pathological conditions due to increased nitro-oxidative stress. In current study, we aimed to evaluate the efficacy of OT against ESW-induced renal injury. METHODS: Twenty-four male Sprague-Dawley rats were divided into three groups: sham-operated, ESW, and ESW + OT groups. All groups except sham-operated group were subjected to ESW procedure. ESW + OT group received 1 mg/kg/day of oxygen/ozone mixture intraperitoneally at 2 h before ESW, and OT was continued once a day for consecutive three days. The animals were killed at the 4th day, and kidney tissue and blood samples were harvested for biochemical and histopathologic analysis. RESULTS: Serum ALT and AST levels, serum neopterin, tissue nitrite/nitrate levels, and tissue oxidative stress parameters were increased in the ESW group and almost came close to control values in the treatment group (p < 0.05, ESW vs. ESW + OT). Histopathological injury scores were significantly lower in treatment group than the ESW group (p < 0.05, ESW vs. ESW + OT). Immunohistochemical iNOS staining scores in ESW group were higher than those of sham-operated group (p < 0.05, ESW vs. sham-operated), iNOS staining scores in OT group were significantly lower than the ESW group (p < 0.05, ESW + OT vs. ESW). CONCLUSION: OT ameliorates nitro-oxidative stress and reduces the severity of pathological changes in the experimental ESW-induced renal injury of rat model.

Management behaviors of the urology practitioners to the small lower calyceal stones: the results of a web-based survey.

Lower pole calyceal stones (LPS) represent lower spontaneous passage rates and, therefore, require several interventional treatment approaches. The aim of this survey study was to investigate the attitudes of the urology practitioners and the factors affecting their decision making in the management of small asymptomatic LPS. A total of 149 urologists participated to the study via email through the internet-based website. Participating urologists were asked to complete a 29-question survey including personal and academic data, level of surgical experience, available equipment for interventional approaches, which treatment do they prefer for small LPS (≥5 mm and <1 cm), and factors affecting their treatment decision. All data were analyzed to make inferences related with treatment decision and factors affecting decision-making. Mean participant age was 41.57 (26-62) years. The most preferred approach was observation/medical treatment option (52.3 %), subsequently SWL (25.5 %), RIRS (16.1 %), miniPNL (5.4 %) and standard PNL (0.7 %) were chosen by the participants. On the other side, SWL and medical treatment were at the forefront (52 and 16.1 %) among children. In the multivariate analysis of participants' age, academic status, surgical experience and institution, none was significantly associated with treatment decision-making (p > 0.05). The most important factors associated with decision making were calyceal dilatation (85.9 %) and patient preferences (81.2 %). The other factors effecting treatment decision were reported to be recurrent disease (70.5 %), the duration of the stone (74.5 %), patient age (95.3 %), current guidelines (87.9 %), stone density (50.3 %), body mass index (BMI) (73.8 %) and other morbid diseases (91.9 %). Our surveys' greatest value is in demonstrating the preferred treatment options and factors effecting decision-making in the treatment of LPS. The most preferred option in our population was follow-up and medical treatment. The most influencing factors on decision-making were age, patients' preferences, presence of calyceal dilatation, body mass index, comorbid conditions, available options for stone treatment and the surgeon's experience on the existing opportunities.

Testis-Sparing Surgery in Small Testicular Masses Not Suspected to Be Malignant.

UNLABELLED: Fifteen patients with small testicular masses not suspected to be malignant were included in the study, and permanent and frozen section analyses were evaluated. As a result frozen analysis, preoperative externalization of the suspected malignancy with a physical examination, ultrasonographic evaluation, and serum tumor marker analysis were concluded as key points for accurate decision making between TSS and radical orchiectomy. BACKGROUND: We aimed to determine the safety, efficacy, and the concordance of permanent and frozen section analysis (FSA) of testis-sparing surgery (TSS) in patients who had small testicular masses that were not suspected to be malignant. PATIENTS AND METHODS: Fifteen patients who underwent TSS were included in the study. TSS was performed for the patients who had testicular lesions <25 mm and testicular lesion volume <30% of the whole testis. All patients had normal serum tumor marker levels and ultrasonographic evaluation did not indicate malignancy. Surgery was performed via an inguinal approach with temporary cord occlusion and FSA of the lesions. Benign findings allowed for TSS, and cancer prompted total orchiectomy. RESULTS: The mean patient age was 25.33 (range, 20-36) years. The predominant complaint was swelling (9 patients). The mean lesion diameter was 16 mm (range, 5-26 mm). Fourteen of all cases (93%) had benign pathology and underwent TSS. Only 1 patient, whose FSA revealed malignant formation, underwent radical orchiectomy. Final pathology of this patient was seminoma. Complete histopathologic concordance was observed between the results of frozen and permanent sections. TSS was performed with no intra- or postoperative complications. After a mean follow-up of 23 months (range, 6-44 months) all patients, except 3 who were lost to follow-up, were free of disease. CONCLUSION: The main key points for accurate decision-making between TSS and radical orchiectomy are intraoperative FSA and preoperative externalization of possible suspected malignancy with physical examination, ultrasonographic evaluation, and serum tumor marker analysis.

Erectile dysfunction after radical prostatectomy: effect of quality of life and psychology / Disfunción eréctil después de prostatectomía radical: efecto en la calidad de vida y psicología

Objective. Radical prostatectomy may have a significant impact on quality of life (QoL) because of erectile dysfunction, depression and incontinence. In this study, the mood and QoL of patients who underwent radical prostatectomy due to localized prostate Ca and were non-relapsed at least 12 months after operation were evaluated. Materials and methods. We evaluated 35 patients who underwent radical prostatectomy operation between 2000 and 2011 and showed no reduction during 12 months observation. IIEF, Beck Depression test, and EORTC 3.0 quality of life were given and scored. In this study, the effects of erectile dysfunction according to Beck depression test and QoL scores and correlation between the mood and QoL are evaluated. Results. In our study, ED groups categorized as mild, moderate and severe had no correlation with Beck depression scores (p = 0.874). But only the patients with severe and moderate erectile dysfunction had moderate and severe depression scores. Negative correlation was determined (p = 0.013) when Beck Depression scores with IIEF scores without categorizing ED groups. Correspondingly, negative correlation was determined (p = 0.048) between QoL and IIEF scores, whereas positive correlation was determined (r = 0.756 and p < 0.001) between QoL and Beck Depression scores. Conclusions. We observed that an increase of erectile dysfunction elevated depression symptoms and resulted in bad quality of life. During tumor control, it is important to use methods that do not affect QoL (AU)

Objetivo. La prostatectomía radical podría impactar de manera significativa en la calidad de vida (QoL) debido a la disfunción eréctil, la depresión y la incontinencia. En este ensayo se analiza el estado anímico y la QoL de los pacientes que se sometieron a prostatectomía radical debido a un cáncer de próstata localizado y no recidivante al menos 12 meses después de la intervención. Material y método. Se evaluaron 35 pacientes que se sometieron a prostatectomía radical entre los años 2000 y 2011 y no mostraron ninguna reducción durante los 12 meses de control. Se entregaron y analizaron los resultados en los test IIEF, Inventario de Depresión de Beck y EORTC 3.0 de calidad de vida. En este estudio se examinan los efectos de la disfunción eréctil conforme al Inventario de Depresión de Beck y la puntuación de QoL, así como la correlación entre el estado anímico y la calidad de vida. Resultados. En nuestro estudio, los grupos clasificados con disfunción eréctil leve, moderada o grave no guardaron correlación con las puntuaciones de depresión de Beck (p = 0,874). Únicamente los pacientes con una disfunción eréctil grave o moderada arrojaron resultados de depresión moderada o grave. Se estableció una correlación negativa (p = 0,013) de los datos de Depresión de Beck con los del IIEF sin clasificar los grupos con disfunción eréctil. Asimismo, se ratifica una correlación negativa (p = 0,048) entre el IIEF y la QoL, si bien sí existe una correlación (r = 0,756 y p < 0,001) entre los datos de la QoL y el Inventario de Depresión de Beck. Conclusiones. Observamos que un aumento en la disfunción eréctil eleva los síntomas de depresión y acarrea una peor calidad de vida. Es importante utilizar métodos que no afecten la calidad de vida para el control de los tumores (AU)