Turkish validation of the chronic orchialgia symptom index and its association with the visual analog scale.

OBJECTIVE: To conduct a translation and validation study of the Chronic Orchialgia Symptom Index (COSI), which has 12 questions in three domains pain (P), sexual symptoms (SS), and quality of life (QoL), in the Turkish language. MATERIAL AND METHODS: The study included a total of 175 patients diagnosed with chronic scrotal content pain (CSCP) between January 2023 and January 2024. In addition to demographic data, the scores obtained on the COSI questionnaire and Visual Analog Scale (VAS) were recorded. Internal consistency was assessed using Cronbach alpha coefficients. Reliability was evaluated using the test-retest correlation method. RESULTS: The mean age of the patients was 37.2 ± 14.1 years and the median (IQR) duration of pain was 5.5 (9) months. The median total COSI score was determined as 13 (13) and the median subscores were 7 (7) for P, 1 (2) for SS, and 5 (6) for QoL. The test-retest correlation coefficient for each item was determined to be higher than r = 0.80 (p < 0.001). The Cronbach alpha values for the subscores were 0.80 for P, 0.71 for SS, and 0.80 for QoL. There was determined to be a statistically significant positive correlation between the VAS score and the COSI P, SS, QoL, and total scores (r: 0.63, p < 0.001; r = 0.32, p < 0.001; r = 0.56, p < 0.001; r = 0.59, p < 0.001, respectively). The optimal cutoff point of the COSI total score was determined to be 16.5 points (AUC:0.77, p < 0.001) for the determination of patients experiencing severe pain (⩾ 7.5) according to the VAS score. CONCLUSION: The Turkish version of the COSI questionnaire is a valid, reliable, and repeatable questionnaire that can be used to evaluate the effects of symptom severity in patients with CSCP.

The 5-Factor Modified Frailty Index is effective in treatment decision and the determination of perioperative complications in patients with localized prostate cancer.

PURPOSE: To determine the active treatment option and perioperative complications using the 5-Factor Modified Frailty Index (mFI-5) in localized prostate cancer patients. MATERIAL AND METHODS: Patients diagnosed with localized prostate cancer in our clinic between January 2018 and October 2022 were evaluated. The patients were separated according to the mFI-5 scores as Group 1 (score = 0, n = 74), Group 2 (score = 1, n = 41), and Group 3 (score ≥ 2, n = 69). Factors affecting the determination of treatment selection, oncological results, and surgical complications were identified with regression analysis. RESULTS: The mean age of the patients in Group 1 was lower than in Group 2 and Group 3 (63.09 ± 7.25 years vs. 67.56 ± 7.98 years and 69.2 ± 6.77 years, p < 0.001, respectively). In Group 1, more patients were treated with retropubic radical prostatectomy (RRP), and in Group 3 with radiotherapy (RT) and active surveillance (AS) (62.2%, 53.6%, and 17.4%, p = 0.001, respectively). The rate of Clavien-Dindo grade 3 and 4 complication rates were higher in Group 3 than in Group 1 (50% vs. 8.7%, p < 0.001, respectively). Frailty was found to be an independent risk factor for overall survival (HR: 10.68, p = 0.02), the presence of Clavien-Dindo ≥ 3 complication (HR: 4.9, p = 0.02) and determination of RT/AS as the active treatment option (HR: 2.45, p = 0.04). CONCLUSION: In patients with frailty according to the mFI-5, the complication rate after RRP in localized prostate cancer increased. When selecting the treatment to be applied in these patients, it will be useful to also evaluate the frailty status.

Youtube is an unreliable source of information about delayed ejaculation treatment.

BACKGROUND: Social platforms such as YouTube have become sources of information about diseases as they can be easily and rapidly accessed. However, this also has the risk of ill-intentioned content and misleading information. OBJECTIVE: To evaluate the reliability of YouTube video content about delayed ejaculation treatment. MATERIAL AND METHODS: YouTube videos were searched using the terms "delayed ejaculation," "retarded ejaculation," "inhibited ejaculation," and "anejaculation." Videos were excluded if they were not in English, were not related to the subject, or did not have audio and visual content. In accordance with the scientifically proven accurate information, the videos were separated as reliable (Group 2, n: 112) and unreliable videos (Group 1, n: 94). The groups were compared in respect of the video characteristics, and the scores obtained in the DISCERN-5, Global Quality Scale, the Patient Education Materials Assessment Tool Audiovisual, and the Journal of the American Medical Association scales. Intraclass correlation test was used to evaluate the level of agreement between the two investigators. RESULTS: Of the 1200 videos, 994 were excluded. No significant difference was determined between the Group 1 and Group 2 in respect of the median number of views [1672 (4555) vs 1547 (28,559), p = 0.63] and likes [10 (42) vs 17 (255), p = 0.07]. There was a greater number of videos in the Group 2 (54.4%) and the points obtained on the scoring scales were significantly higher than the Group 1 (p < 0.001). The videos originating from universities/professional organizations/non-profit physician/physician group were comprised the majority of the reliable videos (55.3%) and the unreliable videos had more content related to treatment (71.4%) (p < 0.001). CONCLUSION: Although there was a greater number of reliable videos related to the problem of delayed ejaculation, the content could be misleading and should be avoided by patients seeking treatment without consulting a physician.

An increase in tumor size increases the risk of the development of postoperative cardiopulmonary events in patients undergoing partial nephrectomy.

PURPOSE: The aim of this study was to examine the effect of kidney tumor size on the risk of CPE developing in the first postoperative month. MATERIAL AND METHODS: Evaluation was made of 127 patients who underwent PN between January 2010 and November 2022. The patients were separated into two groups as Group 1 (n: 13) including patients who developed CPE within the first postoperative month and Group 2 (n: 114) of patients who did not develop CPE. The factors that could affect CPE and overall survival were analyzed with multivariate logistic and Cox regression analysis, respectively. RESULTS: The groups were determined to be similar in respect of age, gender and Charlson Comorbidity Index (p = 0.35, p = 0.68, p = 0.42, respectively). The values of mean tumor size (48.6 ± 12.9 vs. 29.2 ± 8.7 mm, p < 0.001), clinical T1b stage (61.5% vs. 9.6%, p < 0.001), median R.E.N.A.L. Nephrometry Score (9[3] vs.6 [1], p = 0.001) and mean warm ischaemia time (21.2 ± 3.5 vs. 15.9 ± 2.63 min, p < 0.001) were determined to be statistically significantly higher in Group 1 than in Group 2. In the ROC curve analysis performed to predict the development of CPE within the first postoperative month, 35.5 mm was determined to be the best cut-off point for tumor diameter (AUC = 0.88, p < 0.001). In the multivariate analysis, the presence of CPE for overall survival, and increased tumor size for the development of CPE were each determined to be independent risk factors (OR: 3.25, p = 0.03; OR: 1.4, p = 0.001, respectively). CONCLUSION: Tumor size serves as a significant marker for the development of CPE within the initial month following PN.

The prognostic effect of immunohistochemical staining rates in patients with non-muscle-invasive bladder cancer.

Context: Despite the follow-up protocols developed in non-muscle-invasive bladder cancer patients, progression and recurrence could not be prevented. Aims: We aimed to investigate whether proteins such as OCT-4, CD47, p53, Ki-67, and Survivin, which increase in bladder cancer cells, can be used as prognostic markers for patients with non-muscle-invasive bladder cancer. Settings and Design: The study included a total of 89 patients with newly diagnosed non-muscle-invasive bladder cancer between January 2015 and December 2020. Materials and Methods: Levels of OCT-4, CD47, p53, KI-67, and Survivin proteins in cancer cells were determined with a semi-quantitative immunohistochemical experiment. Pathological data and survival rates were compared according to the staining rates. Statistical Analysis Used: Data obtained in the study were analyzed statistically with SPSS 22.0 (SPSS, Chicago, IL, USA). Results: The mean age of the patients was 64.25 ± 9.91 years, and the median follow-up period was 55 months. Recurrence rate was determined to be 36% (n = 32), and the rate of progression at 40.4% (n = 36). The staining rates were stronger for each marker in the progression group and advanced-stage tumors (p < 0.001). The findings of the multivariate analysis carried out as part of the study showed that older age and higher tumor stage were independent risk factors for recurrence-free survival (HR = 1.048 and 7.074, respectively; P = 0.02). Also, higher tumor stages, diameters, and grades were associated with reduced progression-free survival (HR = 0.105, 0.395, 0.225, respectively; P < 0.05). Conclusions: Although immunohistochemical staining rates are promising, it is more appropriate to use tumor characteristics when assessing survival rate in patients with non-muscle-invasive bladder cancer.

The effect of intraurethral heparin on inflammation and spongiofibrosis in a rat model of experimentally induced urethral trauma.

AIM: To determine the effect of heparin administered during the early post urethral trauma period on inflammation and spongiofibrosis in rats. MATERIALS AND METHODS: The study included 24 male rats that were randomized into 3 groups of 8 each. The urethra was traumatized using a 24-G needle sheath in all rats. Group 1 (control group) received intraurethral saline 0.9% injected b.i.d. for 27 days, group 2 received intraurethral Na-heparin (liquemine-Roche) 1500 IU kg-1 injected b.i.d. for 27 days, and group 3 received intraurethral Na-heparin 1500 IU kg-1 injected b.i.d and saline 0.9% s.i.d. for 27 days. On day 28 the rats' penises were degloved and penectomy was performed. Inflammation, spongiofibrosis, and congestion in the urethra were investigated in each group. RESULTS: A statistically significant difference was found between the three groups (control, heparin, and heparin + saline) in the histopathological status of spongiofibrosis, inflammation, and congestion, respectively (P = 0.0001, P = 0.002, P = 0.0001). Severe spongiofibrosis was observed in six (75%) of the rats in group 1 (control group), whereas severe spongiofibrosis was not observed in group 2 (heparin) or group 3 (heparin + saline). CONCLUSION: We observed that intraurethral Na-heparin 1500 IU kg-1 injectioned during the early posturethral trauma period in rats significantly decreased inflammation, spongiofibrosis, and congestion.

Which type of female urinary incontinence has more impact on pelvic floor and sexual function in addition to anxiety and depression symptoms: A questionnaire-based study.

PURPOSE: To evaluate pelvic floor and sexual dysfunction, and anxiety and depression symptoms in females with different urinary incontinence (UI) types. MATERIALS AND METHODS: A cross sectional evaluation was made of 73 patients diagnosed with UI in the Urology Clinic between December 2021 and November 2022. In addition to demographic data, the points were recorded from the International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms (ICIQ-FLUTS), Hospital Anxiety and Depression Scale (HADS), Female Sexual Function Index (FSFI), and the Pelvic Floor Distress Inventory-20 (PFDI-20). RESULTS: The mean age of the patients was 38.3 ± 3.7 years. Incontinence types of the patients were determined as 42% urgency urinary incontinence (UUI), 30.1% stress urgency incontinence (SUI), and 27.4% mixed type urinary incontinence (MUI). Anxiety symptoms were determined in 20.5% and depression symptoms in 41.1% of all the patients. The median ICIQ-FLUTS score was determined to be significantly higher in the MUI patients than in the other types [25.5 (MUI) vs. 17 (SUI), p = 0.007; 16 (UUI), p = 0.001]. The median FSFI and HADS scores were seen to be similar in all the UI types (p = 0.1). The median PFDI-20 score was found to be higher in the MUI group than in the UUI group (126.5 vs. 88.5, p = 0.02). CONCLUSION: The sexual dysfunction and psychological symptoms were found to be similar in the patients according to UI type. The MUI patients were seen to have more incontinence symptoms compared to the other types and experienced more pelvic floor dysfunction than patients with UUI.

Effects of epidemiological risk factors on prognosis in testicular cancer.

PURPOSE: Testicular cancer is frequently seen, especially in young males, and constitutes 1% of all male cancers. Family history, testicular dysgenesis syndrome, and the presence of tumour in the contralateral testis are each well-defined epidemiological risk factors. The aim of the current study was to determine the distribution of these risk factors according to tumour stage and to evaluate the effects on progression. MATERIALS AND METHODS: A total of 71 patients diagnosed with testicular cancer in our clinic between January 2018 and December 2021 were classified according to tumour stage (Group 1: Early, n = 29; Group 2: Advanced, n = 42). The presence of risk factors, and demographic and pathological data were recorded. RESULTS: No significant difference was determined between the groups in respect of age, comorbidities, and tumour type (p > 0.05). There was no difference between Group 1 and Group 2 in terms of median follow-up time [15.5 (17.5), 16.5(26.5) months, respectively, p = 0.4]. Epidemiological risk factors were seen more in Group 2 than in Group 1 (p = 0.03). Progression-free survival was determined to be shorter in patients with risk factors compared to those without (7.95 ± 1.3 vs. 29.4 ± 2.06 months, p < 0.001, respectively). Family history and testicular dysgenesis syndrome were determined to be independent risk factors for progression [HR:0.046 (0.004-0.485); HR:0.101 (0.03-0.347), p < 0.05, respectively]. CONCLUSIONS: More advanced-stage tumours are seen in patients with testicular cancer when epidemiological risk factors are also present. Of these risk factors, family history and testicular dysgenesis syndrome have a negative effect on progression.

COVID-19 effect on perioperative findings of flexible/semi-rigid ureterorenoscopic lithotripsy: A match-pair analysis.

PURPOSE: If not treated on time with proper management options, urolithiasis cause serious morphologic and functional alterations in the involved renal units. Like many other pathologies, the diagnosis, treatment, and follow-up principles of patients with urinary stones have been negatively affected by the unestimated changes in the healthcare systems dealing intensively with COVID-19 patients. In this present study, we aimed to evaluate and present the possible effects of COVID-19 infection on the ureterorenoscopic stone treatment. MATERIALS AND METHODS: Clinical and procedural characteristics of 96 patients undergoing flexible and/or rigid ureterorenoscopy because of urolithiasis between March 2020 and January 2021 were evaluated in a retrospective manner. Obtained data were evaluated after match-pair analysis in a comparative manner between cases with a positive medical history of COVID-19 infection (Group 1, n: 48) and those without any COVID-19 infection (Group 2, n: 48). RESULTS: There was no statistically significant difference between the two groups of cases with respect to age, gender, associated comorbidities, and stone characteristics (p > 0.05). The mean serum creatinine level was determined to be higher in Group 1 than in Group 2 (1.15 ± 0.59 mg/dl, 0.83 ± 0.21 mg/dl, p = 0.007, respectively). Evaluation of the operative parameters revealed longer mean time from diagnosis to surgery (33.5 ± 14.27 vs 12.12 ± 6.33 days, p = 0.001), operating time, median length of stay in hospital along with higher additional intervention rates, and Clavien-Dindo complication scores again in Group 1 (p < 0.05). CONCLUSION: Our results indicate that the presence of COVID-19 infection anamnesis may affect the clinical and operative parameters of ureteroscopic stone management in cases with urolithiasis due to the possible effects of renal units damage and longer waiting time. Urologists may be aware of these unestimated problems during and after the intervention to take necessary measures for a safe and successful ureteroscopic stone removal.

Erectile dysfunction, anxiety, perceived stress, and insomnia are more common among acquired premature ejaculation patients compared to other premature ejaculation syndromes.

BACKGROUND: Premature ejaculation (PE) is the most common ejaculatory function disorder. To date, four types of PE have been identified depending on the severity, onset, and course of the problem. OBJECTIVES: The aim of this study was to investigate whether or not there is a difference between these types in respect of anxiety, perceived stress, insomnia severity, and sleep chronotype. MATERIALS AND METHODS: The study included 112 patients diagnosed with PE in our clinic between October 2021 and May 2022. The patients were separated into groups according to PE types of lifelong (LPE, n = 39), acquired (APE, n = 45), variable (VPE, n = 10), and subjective (SPE, n = 18). In addition to the demographic and clinical data, the scores were recorded of all participants in the International Index of Erectile Function-5, Hospital Anxiety and Depression Scale, Premature Ejaculation Diagnostic Tool (PEDT), Insomnia Severity Index (ISI), Perceived Stress Scale (PSS), and Morningness Eveningness Questionnaire (MEQ). RESULTS: SPE was determined more in university graduate patients (42.1% vs. LPE, 21.1%; APE, 36.8%; VPE, 0%; p = 0.01). In patients with APE, erectile dysfunction was more severe (80.0% vs. LPE, 8.0%; SPE, 12.0%; VPE, 0%; p < 0.001). The median (IQR) PEDT score was determined to be higher in APE than in LPE and SPE (16(5), 13(7), 11(5), p = 0.001, respectively). Patients with APE were determined to have higher median (IQR) ISI (21(9) vs. LPE, 8(7); SPE, 5(8); VPE 8(4), p < 0.001) and PSS scores (35(12) vs. LPE, 22 (7); SPE,22(5); VPE 21(6), p < 0.001), the sleep chronotype was more eveningness according to the MEQ (80.8% vs. LPE, 19.2%; VPE, 0%; SPE, 0%; p < 0.001), and there were seen be more anxiety symptoms (75.5% vs. LPE,12.2%; VPE, 0%; SPE, 12.2%; p < 0.001). CONCLUSION: Psychological status and sleep health were concluded to be important factors for PE patients, and the patients with acquired PE were the group most affected by these factors.

A Google Trends™ Analysis of Bladder Cancer: Determining Awareness Campaign Success, and Patients' Needs in Clinical Management.

OBJECTIVE: We aimed to determine the interest and changing trends over time in the diagnosis and treatment of bladder cancer and its awareness campaign by examining the Google Trends application as an indicator of people's interest globally. METHODS: Using the Google Trends application, we determined the yearly and country-based relative search volumes of the term "bladder tumor" and of the methods used in the diagnosis and treatment of bladder cancer in the period from January 2004 to December 2019. We compared the median relative search volumes found in the period 2004-2011 (Period 1) with those found in the period 2012-2019 (Period 2). RESULTS: We found that the median relative search volume for bladder cancer decreased in period 2 and this was parallel to the decrease in the incidence rates in North America and Australia (p<0.001). We found that the bladder cancer awareness month did not cause an increase in the online interest (p>0.05). We found that the median relative search volumes of diagnostic cystoscopy and cytology were higher than those of molecular markers and imaging methods in line with guidelines (p<0.001). Also, TURBT was the most sought-term among treatment methods with increasing popularity in the second period (p<0.001). CONCLUSION: People use the internet intensively to search for information about bladder cancer. We think that several types of web-based applications such as "Google Trends" can help determine the behavioural patterns and tendencies of bladder cancer patients and affect the clinical decision-making processes, as well as readily determining the impact of cancer awareness campaigns to bring about an increased awareness in the society for the recognition of the importance of an early diagnosis.

Whether Adding Vitamin D to Tadalafil 5 mg Treatment Is Useful in Patients with Erectile Dysfunction and Vitamin D Deficiency?

INTRODUCTION: Numerous factors such as endothelial disease and hormonal disorder cause the development of erectile dysfunction (ED). However, the relationship between vitamin D deficiency (VDD) and ED is unclear. Moreover, the benefit of vitamin D replacement on ED patients with VDD is uncertain. As far as we know, there is no study yet in the literature regarding the addition of vitamin D to phosphodiesterase type 5 inhibitors in the treatment of ED patients with VDD. In this study, we investigated whether adding vitamin D to daily tadalafil treatment would be beneficial in ED patients with VDD. METHODS: A total of 111 patients with VDD accompanying ED were retrospectively evaluated between January 2016 and December 2019. Patients were divided into 2 groups according to the treatment they received. Group 1 (n = 58) was treated with daily oral tadalafil 5 mg, while group 2 (n = 53) received oral tadalafil 5 mg and 4,000 IU vitamin D3. Total International Index of Erectile Function-15 (IIEF-15) scores and vitamin D levels of the groups were compared at the end of the study. RESULTS: The mean vitamin D level was increased statistically significant in group 2, but no difference was seen in group 1 (p < 0.001 and p > 0.05, respectively). There was a significant increase in median erectile function, orgasmic function, sexual desire, sexual satisfaction, and overall satisfaction scores in both groups (p < 0.001). However, the increase in median erectile function and sexual desire scores was significantly higher in group 2 compared to group 1 at the end of the study (p = 0.01 and p < 0.001, respectively). CONCLUSION: We found that adding vitamin D to 5 mg oral daily tadalafil treatment may have an additional positive effect on erectile function and sexual desire in ED patients with VDD.

Comparison of hormone profile and systemic inflammation in patients presenting with sexual dysfunction: Which is important?

INTRODUCTION: Erectile dysfunction (ED) is the inability to achieve or maintain erection sufficient for satisfactory sexual performance. Although the definition is well known, there are controversial issues about the effects of hormones and inflammation on ED. OBJECTIVES: We aimed to compare the clinical value of the hormonal and inflammation parameters in sexual dysfunction. MATERIALS AND METHODS: A total of 152 patients diagnosed with erectile dysfunction between September 2018 and March 2019 and 101 healthy males were included in this prospective study as case group and control group, respectively. The 152 patients were divided into three groups based on their total International Index of Erectile Function (IIEF) scores: (I) severe ED, (II) mild-moderate ED and (III) mild ED. All groups were compared in terms of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and total testosterone (TT), estradiol, prolactin, testosterone-to-estradiol ratio and 25 (OH) vitamin D. RESULTS: Patient and control groups differed significantly in term of NLR, PLR, prolactin and vitamin D (p<0.001, p=0.004, p=0.002, p<0.001, p<0.001, respectively). NLR was more significant in determining the severity of ED (p<0.001). It was observed that libido score (the total score of IIEF items #11 and #12) was negatively associated with prolactin and NLR (p<0.001, p=0.023, respectively), was positively associated with vitamin D and TT (p<0.001, p=0.02, respectively), and was lower in severe ED patients. CONCLUSIONS: Although more clinical studies are needed, we think that our findings may be useful on these controversial issues of ED.

The effect of using tadalafil 5 mg/day on neutrophil-lymphocyte and platelet-lymphocyte ratios in mild-medium and severe erectile dysfunction patients; and comparison of clinical response.

To examine the relation between NLR (neutrophil-lymphocyte ratio) and PLR (platelet-lymphocyte ratio) rates and the severity of ED (erectile dysfunction) and the effect of tadalafil 5 mg/day on these, a total of 143 patients were retrospectively evaluated. Sixty-three patients with ED who came for follow-up examinations in the 1st month of the treatment were included as the study group, and 80 men who were not diagnosed with ED were as the control group. The age and Charlson Comorbidity Indexes (CCI) of the study and control groups were compared with the IIEF 5, NLR and PLR values before and after the treatment. The mean age and median CCI were higher in the severe ED group (p < 0.05). The mean NLR and PLR values were lower in the control group (p < 0.001). In the study group, the NLR and PLR values decreased with the increase in the IIEF 5 scores (p < 0.001). The ROC curve was significant for the NLR and PLR scores (AUC = 0.779, [95% CI: 0.698-0.860]; AUC = 0.754, [95% CI: 0.670-0.838] p < 0.001). Although more prospective and randomized studies are needed, the systemic inflammation decreases and the clinical symptoms improve in patients who use tadalafil 5 mg/day.