An overlooked complication of the clean intermittent catheters: prostate calculi.

OBJECTIVE: Although the clinical importance of prostate calculi has been understood over time, it is a urinary system disease that can cause different symptoms and can be ignored by urologists sometime. Clean intermittent catheter (CIC) is the gold standard method for bladder rehabilitation and urinary drainage in patients with neurogenic bladder. The aim of this study was to compare the incidence of prostate calculi and related pathologies between patients using CIC and not using CIC. MATERIAL-METHOD: A total of 314 neurogenic bladder patients who were followed up and treated in our urology clinic were included in this study. The patients were divided into two groups as patients non-using CIC (Group-1, n:154) and patients using CIC (Group-2, n:160).Presence of prostate calculi, the number of CIC used per/day, plasma uric acid levels, urine parameters, mean-stone-density (MSD) and calculi sizes were retrospectively scanned from patient records. RESULTS: In this study, no significant difference was observed between the parameters such as age, uric acid level, MSD, urine parameters, and other electrolyte levels (Table 1) While the incidence of prostate calculi in Group 1 was 23.4%; The incidence of prostate calculi in group 2 was 37.5(p = 0.007) (Fig. 2). CONCLUSiON: In this study, it was tried to show the relationship between the use of CIC and prostate calculi that cause LUTS and dysuria, which are generally ignored in clinical evaluation but do not pass in patients. As a result of this study, it was determined that the incidence of prostate calculi increased in patients using CIC.

Comparison of early period sexual function parameters between surgical repair and conservative treatment after penile fracture.

INTRODUCTION AND OBJECTIVES: Comparison of early period sexual function parameters in patients who had surgical repair and conservative follow-up after penile fracture and the evaluation of surgical intervention time on these parameters were planned in this study. MATERIALS AND METHODS: Total of 26 patients who were treated for penile fracture were evaluated. 19 patients had surgical repair and 7 patients had conservative treatment. Sexual function and erectile dysfunction (ED) degree of the patients before penile fracture and in the 12th week after fracture were evaluated with 5-question International Index of Erectile Function (IIEF-5) questionnaire, Erection Hardness Score (EHS), Sexual Encounter Profile(SEP) 2 and SEP 3. Parameters showing sexual function before and after the fracture were compared. RESULTS: In both groups, a significant change was detected in IIEF-5 score, EHS, SEP-2 and SEP-3 parameters of the patients measured after penile fracture compared to the values before the fracture (all parameters, p<0.05). No difference was detected in the parameters measured before and after the fracture among surgical repair and conservative treatment groups (all parameters p>0.05). Mean time passing until the surgery after fracture was measured as 9.6±6.85h in 19 patients who had surgery. CONCLUSION: A difference wasn't detected in sexual parameters in conservative treatment and surgical repair groups in this study. As a significant decrease was observed in sexual function parameters even in conservative treatment cases without sudden detumescence and tunica albuginea rupturing, we think that quick surgical exploration would be useful in cases considered to have penile fracture.

Visceral adiposity index in kidney stone patients who have undergone surgery.

Introduction: The visceral adiposity index (VAI) is a gender-specific metabolic index that indirectly measures visceral adipose function and distribution using waist circumference, body mass index (BMI), and triglyceride and high-density lipoprotein (HDL) cholesterol values. To assess visceral fat in the diagnostic pathway of urinary stone patients, we investigated the relationship between the VAI and nephrolithiasis as well as the relationship between the VAI and stone and surgery-related parameters. Material and methods: Patients who underwent percutaneous nephrolithotomy and retrograde intrarenal surgery for kidney stones were included in the study. The control group comprised of healthy individuals who volunteered to take part in study and did not have urolithiasis as confirmed by abdominal computed tomography imaging. A total of 148 patients were divided into the nephrolithiasis (n = 103) and the control (n = 45) groups. Weight, height, BMI, waist circumference measurements, and VAI were among the metabolic parameters measured. Stone and surgical parameters were evaluated. Results: VAI (4.57 vs 2.76), waist circumference (92.1 vs 87.1), and BMI (28.31 vs 26.51) values were higher in the nephrolithiasis group(p = 0.02,p = 0.04, p <0.001,respectively). The VAI was statistically significant in the multivariate analysis for the presence of nephrolithiasis (p <0.001). The VAI negatively correlated with the stone Hounsfield unit (HU) and positively correlated with very-low-density lipoprotein (VLDL), blood creatinine, and calcium levels. The relationship between VAI and surgical parameters was not significant. Conclusions: A significant relationship was detected between nephrolithiasis and VAI, a new gender-specific metabolic index that distinguishes between subcutaneous and visceral adipose mass and demonstrates metabolic syndrome. No significant effect of this relationship on surgical parameters was demonstrated in the present study.

Comparison of retrograde intrarenal stone surgery with and without a ureteral access sheath using kidney injury molecule-1 (KIM-1) levels: a prospective randomized study.

The objective is to compare patients who underwent retrograde intrarenal surgery with and without a ureteral access sheath (UAS) using kidney injury molecule-1 (KIM-1) levels. We also examined the difference in kidney damage between standard and dual lumen UAS. Sixty patients diagnosed with kidney stones and scheduled for RIRS were randomized into three groups: RIRS without UAS (Group 1), 11Fr/13Fr Boston scientific Navigator™ UAS (Group 2), and 11Fr/13Fr dual lumen ClearPetra™ UAS (Group 3). Data were prospectively collected in consecutive patients. Urine KIM-1/Cr levels were measured preoperatively, at postoperative 4 h, and on a postoperative day 14. Stone size, location, number, pre- and postoperative stent use, operation time, stone-free rate (SFR), post-ureteroscopic lesion scale (PULS) grade, hospitalization duration, and complications were recorded. There was no significant difference in demographical parameters and preoperative KIM-1/Cr levels among the groups. Postoperative 4th-hour urine KIM-1/Cr levels were higher in patients without UAS than patients with UAS (1.86, 0.67, 0.63 Groups 1, 2, 3, respectively). In comparing group 1 with groups 2 and 3 separately, Group 1 had a statistically significantly higher value than both groups (p = 0.002, p = 0.001, respectively). According to UAS type, there was no significant difference between groups 2 and 3. The use of UAS during RIRS has been shown to reduce kidney injury in the evaluation with KIM-1. Different UAS types on kidney injury and which one can protect the kidneys more during the procedure; will be elucidated by prospective randomized studies involving larger patient groups and UAS types.

The role of prostate inflammation in the pathogenesis of urethral strictures occurring after transurethral resections.

OBJECTIVE: To make an extensive evaluation about the effects of histopathological findings acquired from the resection materials of patients who underwent transurethral resection of prostate (TUR-P) due to benign prostate hyperplasia (BPH) on postoperative urethral stricture formation. MATERIALS AND METHODS: Among patients who had TUR-P due to BPH and were followed up for minimum 6 months, 51 patients detected to have urethral stricture based on endoscopic imaging were included in the urethral stricture group (Group 1) and 52 patients without urethral stricture were included in the control group (Group 2). The relation between histopathological findings of TURP materials and postoperative stricture occurrence was investigated. RESULTS: No difference in age, prostate volume, operation time and postoperative catheterization time was detected among the groups (p=0.86, p=0.13, p=0.06, p=0.32, respectively). Average time until the urethral stricture diagnosis in the group with urethral stricture was measured as 57.9±27.2 days. In our study, inflammation intensity in peri-urethral, stromal and periglandular areas and intraglandular destruction ratios were higher in urethral stricture group (Group 1) (p=0.048, p=0.3, p=0.03, p=0.01, respectively). Again, it was detected that neutrophil, plasmocyte and eosinophil cell ratios were higher in peri-urethral, stromal and periglandular areas and lymphocyte values were lower compared to the control group. CONCLUSION: Acquired data has shown that acute inflammatory attacks may be related to urethral stricture with a mostly chronic inflammation background in the prostate. During histopathological examination of prostate tissue acquired through TURP, especially high peri-urethral neutrophil, plasmocyte and eosinophil cell ratios and intra-glandular destruction ratios are important for predicting postoperative urethral stricture occurrences.

The Benign Renal Masses that Were Exposed after Nephron-Sparing Surgery: "Postsurgical Fatty Tumor." Is It Related to the Surgical Technique?

After nephron-sparing surgery (NSS), postsurgical fatty tumor could be mistakenly reported as angiomyolipoma during radiologic imaging of some patients. In the present paper, we studied the postsurgical fatty tumor detected after NSS but not covered before in the literature. In addition, we also evaluated whether the postsurgical fatty tumor was related to the surgical technique employed. Patients admitted to the urology department of our university hospital from 2014 to 2019 and operated with open NSS were evaluated retrospectively. We detected those 156 patients were operated with NSS. Nine patients with angiomyolipoma as primary pathology and four patients with surgical border positivity were excluded from the study. The patients were divided into two groups based on the repair of tumor extraction region. In Group 1, fatty tissue was used for repair, and Group 2 is the primary repair group. In all, 143 patients (Group 1 = 79, and Group 2 = 64) were included in the study. No demographic and radiologic differences, such as number of patients, age, gender, positioning of tumor, mass localization, tumor diameter, and RENAL nephrometry scoring system, were detected between the two groups. Postsurgical fatty tumors were detected in 28 patients in Group 1 and in two patients in Group 2 (P < 0.001). In patients with negative surgical margins after partial nephrectomy, lesions that were radiologically detected mimicking as angiomyolipoma were defined as "postsurgical fatty tumor." This mass containing adipose tissue only neither depicted vascularization and enhancement nor increase in size for at least 1 year. We assumed that these lesions must be followed as benign lesions not requiring additional treatment.

The effects of pelvic floor muscle training combined with Kinesio taping on bladder symptoms, pelvic floor muscle strength, and quality of life in women with overactive bladder syndrome: A randomized sham-controlled trial.

Background: There is insufficient study using Kinesio taping (KT) in bladder problems. Objectives: To investigate the effects of pelvic floor muscle training (PFMT) combined with KT on bladder symptoms, pelvic floor muscle strength, and quality of life in women with overactive bladder (OAB) syndrome and compare this combination with PFMT plus sham tape (ST). Methods: Women with OAB were randomly allocated into PFMT+KT and PFMT+ST groups. All patients were given PFMT for 6 weeks and applied taping according to groups. Before and after treatment, the OAB symptoms with the Overactive Bladder Assessment Form (OAB-V8) and Patients' Perception of Intensity of Urgency Scale (PPIUS), bladder function with a 3-day voiding diary, pelvic floor muscle strength with the Modified Oxford Scale, and quality of life with the King's Health Questionnaire (KHQ) were assessed. Results: OAB-V8, PPIUS, and KHQ scores decreased and the MOS improved in both groups (P < .05) after treatment. The intergroup comparisons revealed a further decrease in voids/day, voids/night, incontinence episodes/day, and personal limitation scores of the KHQ in the PFMT+KT group compared to the PFMT+ST group (P < .05). Conclusion: PFMT+KT was more effective in reducing the OAB symptoms compared to PFMT+ST. KT could be a complementary application for reducing symptoms in OAB.

Prostate incidentaloma on 18F-fluorodeoxyglucose positron emission tomography: Diagnostic value of volumetric positron emission tomography parameters.

OBJECTIVE: To evaluate whether volumetric PET parameters such as metabolic tumor volume (MTV) and total lesion glycolysis (TLG) contributed to maximum standardized uptake value (SUVmax) in predicting prostate carcinoma in the prostate incidentalomas (PI) in 18F-FDG PET/CT. MATERIALS AND METHODS: This retrospective study comprised 107 patients with PI of 4723 male patients who had undergone 18F-FDG PET/CT. SUVmax and volumetric PET parameters of PIs were assessed. MTV and TLG were acquired with each SUV threshold as 2.5, 3.0, 3.5, 4.0, 4.5, and 5.0. RESULTS: The PI incidence was 2.3%, and the malignancy ratio of PI was 15.9%. According to further analysis results, 17 patients were in the malignant group, and 46 patients were in the benign group. Malignant PIs had higher SUVmax (10.6 vs. 6.4 and p<0.01), MTV (all p < 0.01) and TLG (all p < 0.01) than benign incidentalomas. All volumetric PET parameters had higher area under the curve (AUC) than SUVmax. SUVmax AUC was 0.835 [95% confidence interval (CI): 0.728-0.942]. MTV 2.5 and TLG 2.5 had the highest performance for predicting malignant PI.MTV2.5 AUC was 0.871 (95% CI: 0.775-0.968), and TLG2.5 AUC was 0.882 (95% CI: 0.797-0.967). Using TLG 2.5 greater than 29.8 as the cut-off point, the sensitivity and specificity for malignancy prediction were 94.1% and 82.6%, respectively. CONCLUSION: In this study, in which the effectiveness of volumetric parameters in the diagnosis of PI was evaluated for the first time, it was shown that they could potentially have clinical value along with SUVmax.

The effect of intratesticular dexpanthenol on experimentally-induced testicular ischaemia/reperfusion injury.

INTRODUCTION: Testis torsion is a urological emergency and a serious situation that may cause testis atrophy, testicular dysfunction and infertility due to ischaemia/reperfusion(I/R) injury even with early intervention. OBJECTIVE: To assess the protective effect of dexpanthenol administered intratesticular after detorsion against testis I/R injury. STUDY DESIGN: Twenty-seven rats were randomly divided into 3 groups containing 9 rats each. The 1st group comprised the sham group with no procedure performed. The 2nd group had only torsion applied, while the 3rd group had torsion + dexpanthenol applied. Rats had 720° clockwise rotation applied to the left testis. After 2 h of ischaemia, testes were de-torsioned and the dexpanthenol group had 500 mg/kg dexpanthenol administered intratesticular after detorsion. After 4 h of reperfusion, rats had blood samples taken and orchiectomy was performed for histologic assessment. RESULTS: A significant difference was detected in all parameters [necrosis(p:<0.001), Cosentino grade (p < 0.001), congestion (p:0.005), fibrosis (p:<0.001), interstitial oedema (p:0.017), JTBS score (p:<0.001), apoptosis (p < 0.001) and testosterone levels (p:0.006)] when the sham, torsion, and torsion + dexpanthenol groups were compared. Significant differences were observed for fibrosis (p:0.010), Cosentino score (p < 0.001), JTBS score (p:<0.001), apoptosis (p:0.001) and total testosterone levels (p:0.013) when torsion and torsion + dexpanthenol groups were compared. The torsion + dexpanthenol group was identified to have more preservation of testis function observed histologically and hormonally compared to the torsion group. DISCUSSION: Dexpanthenol is used in many areas due to both epithelizing and antioxidant effects and lack of clear side effects. In spite of use of many chemical and biological agents to protect against testis I/R injury, none have entered routine use. This study showed that dexpanthenol, which can be easily injected intratesticular during detorsion surgery, has protective effect against histological and functional injury that may develop linked to testis I/R injury. The main limitations of the study are short duration of follow-up due to being a rat experiment and lack of comparison of lipid peroxidation products. CONCLUSION: This study identified that dexpanthenol with clinically easy use by intratesticular injection after detorsion during surgery had a protective effect against histological and functional injury that will develop linked to I/R injury in the testis.

Efficiency of retrograde intrarenal surgery in lower pole stones: disposable flexible ureterorenoscope or reusable flexible ureterorenoscope?

PURPOSE: The primary aim of this study to comparison of reusable and disposable flexible ureterorenoscope (fURS) efficiency in lower pole renal stone disease management. In addition, the secondary goal of this study was to evaluate the factors affecting stone-free rates (SFR) in lower pole stones. MATERIALS AND METHODS: A prospective case-control study utilizing data from 122 consecutive ureteroscopic cases. The patients were divided into two groups according to the ureterorenoscope employed in the surgical intervention as disposable fURS (Group1, n:52) and reusable fURS (Group 2, n:70). Demographic characteristics, stone size, infundibulopelvic angle (IPA), SFR, hospitalization time, intraoperative complication rate (CR), operative time, preoperative or postoperative JJ stenting, and postoperative CR were analyzed. RESULTS: There was no statistical difference between the demographic and renal stone-related data between the groups. Likewise, no difference is observed in term of intraoperative and postoperative outcomes such as fluoroscopy time, CR, and hospitalization time between the groups. Although SFR was higher in the disposable fURS group, there was no difference statistically. However, the operative time was longer in reusable fURS Group (47.02 ± 9.91 min in Group 1, and it was 57.97 ± 14.28 in Group 2) (p: 0.001). The multivariate regression analysis result to evaluate the factors of effect to operative time; the use of disposable fURS was associated with a 10.95-min decrease in procedure duration (p < 0.001). CONCLUSIONS: Disposable fURS and reusable fURS have similar clinical efficiency and complication rates in the treatment of lower calyceal stones with RIRS. Nevertheless, disposable fURS is a useful treatment option for increased stone volume due to the advantages such as shorter operative time.

Early kidney injury in immunoglobulin A vasculitis: Role of renal biomarkers.

BACKGROUND: We aimed to determine whether urine kidney injury molecule 1 (KIM-1) and neutrophil gelatinase-associated lipocalin (NGAL) can be used as early noninvasive biomarkers of kidney injury in immunoglobulin A vasculitis. METHODS: Patients who were diagnosed with immunoglobulin A vasculitis were included in the study. Urine samples were collected for determination of urine KIM-1 and NGAL levels. The control group consisted of age-matched healthy children. RESULTS: Sixty-one patients who were diagnosed with immunoglobulin A vasculitis were included in the study; 37.7% of these patients were determined to have renal involvement. Median KIM-1 was found to be significantly higher in the patient group (69.59 pg/mL) than the control group (40.84 pg/mL) (P = 0.001). Median NGAL was determined to be statistically significantly higher in the patient group (59.87 ng/mL) compared with the control group (44.87 ng/mL) (P = 0.013). In 23.6% of the patients without renal involvement at admission renal involvement developed within the following 6 months. When median KIM-1 and NGAL at admission of these patients were compared with the control group, they were determined to be statistically significantly higher (P = 0.001, P = 0.003). CONCLUSIONS: The fact that our patients with late-term nephropathy had no hematuria and / or proteinuria and that KIM-1 and NGAL levels were determined to be high indicates that these biomarkers might be potentially reliable, noninvasive and early determinants of kidney injury.

Long-term outcomes of minimally invasive surgeries in partial nephrectomy. Robot or laparoscopy?

BACKGROUND: To compare long-term oncological and renal functional outcomes of laparoscopic and robotic partial nephrectomy for small renal masses. METHODS: A total of 103 patients who underwent laparoscopic (n = 31) and robotic (n = 72) partial nephrectomy between April 2015 and November 2018 were included in the study. Perioperative parameters, long-term oncological and functional outcomes were compared between the laparoscopic and robotic groups. RESULTS: No significant differences were found in terms of age, tumour size, RENAL and PADUA scores, pre-operative estimated glomerular filtration rate (eGFR), and presence of chronic hypertension and diabetes (P = .479, P = .199, P = .120 and P = .073, P = .561, and P = .082 and P = .518, respectively). Only estimated blood loss was significantly higher in the laparoscopic group in operative parameters (158.23 ± 72.24 mL vs. 121.11 ± 72.17 mL; P = .019), but transfusion rates were similar between the groups (P = .33). In the laparoscopic group, two patients (6.5%) required conversion to open, while no conversion was needed in the robotic group (P = .89). There were no differences in terms of positive surgical margin and complication rates (P = .636 and P = .829, respectively). No significant differences were observed in eGFR changes and post-operative new-onset chronic kidney disease at 1 year after the surgery (P = .768, P = .614, respectively). The overall mean follow-up period was 36.07 ± 13.56 months (P = .007). During the follow-up period, no cancer-related death observed in both group and non-cancer-specific survival was 93.5% and 94.4% in laparoscopic and robotic groups, respectively (P = .859). CONCLUSIONS: In this study, perioperative and long-term oncological and functional outcomes seems to be comparable between laparoscopic and robotic partial nephrectomies.

The examination of the nephroprotective effect of montelukast sodium and N-acetylcysteine in renal ischemia with dimercaptosuccinic acid imaging in a placebo-controlled rat model.

PURPOSE: To determine the nephroprotective effect of NAC and Montelukast Sodium administration against the development of renal damage associated with long warm renal ischemia. METHODS: Twenty-seven rats were randomly divided into 3 study groups, which received NAC, montelukast and placebo, and 3 rats were included in the sham-treated control group. Medications were given 3 days before the procedure. DMSA renal scintigraphy was performed before and after surgery. The right renal pedicle was occluded for 45 min to induce ischemia and then subjected to reperfusion for 6 h (I/R groups). RESULTS: On pathological examination, the mean pathological scores of the montelukast and NAC groups were significantly lower than those of the placebo group. (p <0.05). In biochemical examination, significant differences were found in all parameter levels between the placebo group and the montelukast and NAC groups. (p <0.05) When postoperative DMSA renal scintigraphy measurements and renal function levels were compared, significant differences were found between the montelukast and NAC groups and the placebo and sham groups. CONCLUSION: The administration of NAC and montelukast sodium was seen to have a nephroprotective effect against the development of renal damage associated with warm renal ischemia.

Is there a Difference in Platelet-Rich Plasma Application Method and Frequency to Protect Against Urethral Stricture?

PURPOSE: To determine the efficacy of instillation frequency and submucosal injection of platelet-rich plasma (PRP) after urethral trauma to prevent urethral inflammation and spongiofibrosis. MATERIALS AND METHODS: Sixty-five rats were used in the study; 50 rats were randomized into 5 groups with 10 rats in each group and 15 rats were allocated for PRP preparation. The urethras of all rats were traumatized with a pediatric urethrotome knife at 6 and 12 o'clock positions, except in the sham group. Group 1 was the sham group and had only urethral catheterization daily for 15 days, Group 2 was given 0.9% saline (physiologic saline [(UI+PS]) once a day after urethral injury (UI+ PS), Group 3 was injected with PRP submucosally after urethral injury, Group 4 was given PRP once a day as intraurethral instillation using a 22 Ga catheter sheath with urethral injury, and Group 5 was given PRP twice a day as intraurethral instillation using a 22 Ga catheter sheath with urethral injury. Each administration of PRP was administered as 300 million platelets/150 microliters. On day 15, the penises of the rats were degloved to perform penectomy. Histopathologic evaluation was made for spongiofibrosis, inflammation, and congestion in vascular structures. RESULTS: When the sham group, UI+PS, UI+PRPx1, UI+PRPx2 and UI+PRPs groups are compared in total, there were significant differences identified for parameters other than edema. When the UI+PS, UI+PRPx1, UI+PRPx2 and UI+PRPs groups are compared, the UI+PS group was observed to have significantly more inflammation (mucosal inf. 2.42 ± 0.53) and spongiofibrosis (2.42 ± 0.53). All the PRP groups were identified to have significantly less mucosal inflammation (UI+PRPs 1 ± 0, UI + PRPx1; 1.4 ± 0.51, PRPx2; 1.33 ± 0.5) and spongiofibrosis (UI+PRPs; 1.57 ± 0.53, PRPx1; 1.2 ± 0.42, PRPx2; 1.55 ± 0.52). The group with the lowest spongiofibrosis was the PRPx1 group. CONCLUSION: This study showed that PRP significantly reduced mucosal inflammation and spongiofibrosis, independent of the administration route, when applied to the urethra after urethral trauma.

Our Retroperitoneal Cystic Echinococcosis Surgery Experiences at Mehmet Akif Inan Training and Research Hospital in Sanliurfa

Objective: This study aimed to discuss the place of surgical technique in patients who were operated for retroperitoneal hydatid cyst at our clinic, in the light of current literature. Methods: Data from seven patients who were operated for retroperitoneal hydatid cyst between May 2012 and May 2019 were retrospectively collected and evaluated. Results: Two patients were operated for isolated retroperitoneal hydatid cyst, one for liver hydatid cyst accompanying renal hydatid cyst and four patients were operated only for renal hydatid cyst. Recurrence was not observed in the follow-up. Conclusion: In our study, emphasis was laid on the fact that cysts can be treated successfully by using total, subtotal and partial cystectomy methods based on the organ and tissue neighbourhood.

Do variations in labial anatomy have an effect on recurrent urinary tract infection?

INTRODUCTION AND HYPOTHESIS: Variations in labial anatomy may constitute a risk factor for vaginal pH increase and recurrent UTIs. Our objective in this study was to show the effects of variations in labial anatomy on vaginal pH and recurrent UTI. METHODS: A total of 331 non-menopausal and sexually active patients between the ages of 18 and 50, meeting recurrent urinary infection criteria and not meeting exclusion criteria were included in the study in group 1, the infection group, and 440 patients without recurrent UTI were included in group 2, the control group. Vaginal pH values of the participants were measured. Labia minora were classified as labial anatomy based on the Banwell classification. Predisposing factors and demographic data were also questioned, measured, recorded, and compared. RESULTS: A significant difference was detected in labial anatomy between groups 1 and 2 based on the Banwell classification. Banwell type 3 in group 1 (76%) and Banwell type 2 in group 2 (55%) were observed to be significantly higher. There was a significant difference in right and left vertical and horizontal dimensions of the labia minora between the two groups. It was also observed that the vaginal pH was significantly more alkaline in group 1 compared with group 2 (6.11 vs 4.48). CONCLUSION: Although there are many causes of recurrent urinary tract infections, this study showed that vaginal pH imbalance and labia minora anatomy in the lower third prominence based on the Banwell classification (type 3) were among the most important causes. Thus, we think that the vaginal anatomy should be evaluated in recurrent UTI patients.

Histopathologic Evaluation of the Effects of Intraurethral Platelet Rich Plasma in Urethral Trauma Experimentally Induced in Rat Model.

OBJECTIVE: To determine the efficacy of platelet rich plasma applied early initialization after urethral trauma for preventing inflammation and spongiofibrosis. MATERIALS AND METHODS: Twenty-three rats were randomized and divided into 3 groups, with 10 rats in 2 groups. Only sham group had 3 rats. The urethras of all rats were traumatized with a pediatric urethrotome knife at 6- and 12-o'clock. For 15 days, group I was given platelet rich plasma (PRP) once a day without urethral injury (sham group), group II (n = 10) was not given any medical treatment only urethral injury group (UI-PRP), group III (n = 10) was given PRP once a day intraurethrally as instillation using a 22 ga catheter sheath with urethral injury (UI+PRP). On day 15, the penises of the rats were degloved to perform penectomy. RESULTS: A significant difference was detected in all parameters when the sham, UI-PRP, UI+PRP groups were compared (respectively, P = .001, / <.001, / .008 / .007) and a significant difference was observed among mucosal inflammation, fibrosis, and edema parameters when UI-PRP and UI+PRP groups were compared. (Respectively; P <.001, / <.001 / .006). CONCLUSION: In this study, it was shown that intraurethral PRP applied after urethral trauma significantly decreased mucosal inflammation, spongiofibrosis, and edema. Depending on the results we acquired in this study, we think that PRP may be a promising option in urethral stricture treatment.

Single-center experience of robot-assisted radical cystectomy (RARC) and extended pelvic lymph node dissection.

OBJECTIVE: To report the outcomes of robot-assisted radical cystectomy (RARC) and extended pelvic lymph node dissection (ePLND) series for bladder cancer. MATERIAL AND METHODS: Between October 2016 and June 2019, overall 57 patients (50 men, 7 women) were included in the study. Patient demographics, operative data, and postoperative pathological outcomes were evaluated. Patients who had a history of pelvic or Professional surgery due to other concurrent malignancy, radiation therapy, or lacked data were excluded from the study. RESULTS: The mean age of the patients was 64.72±9.09 years. The mean operation time, intraoperative estimated blood loss, and hospitalization time were 418.58±85.66 minutes, 313.00±79.16mL, and 13.44±5.25 days, respectively. The postoperative pathological stages were reported as pT0 (n=8), pTis (n=4), pT1 (n=4), pT2 (n=22), pT3a (n=11), pT3b (n=2), pT4a (n=4), pT4b (n=1), and other (n=1). The mean lymph node (LN) yield was 23.45±9.43. Positive LNs were found in 16 (28.1%) patients. Surgical margins were positive in 3 (5.26%) patients. The mean follow-up period was 15.42±8.31 months. According to the modified Clavien-Dindo system, minor (Clavien 1-2) and major (Clavien 3-5) complications occurred in 18 (31.58%) and 9 (15.78%) patients during the early (0-30 days) period and in 4 (7.02%) and 5 (8.77%) patients in the late (31-90 days) period. CONCLUSION: RARC and ePLND are complex but safe procedures with acceptable morbidity and excellent surgical and oncologic outcomes in muscle-invasive or high-risk bladder tumors.