The Predictive Factors of Renal Loss After Iatrogenic Ureteral Avulsion in the Medicolegal Perspective.

Objectives: As an effective and minimally invasive technique, ureteroscopy has some potential intraoperative complications. Ureteral avulsion is among these complications, although rare. This study aimed to determine factors predicting nephrectomy by considering ureteral avulsion from a medicolegal perspective for the 1st time in the literature. Methods: A total of 33 patients with ureteral avulsion during ureteroscopic surgery, who presented to various hospitals in Turkey between September 2004 and April 2019 and whose cases were being reviewed at the Institution of Forensic Medicine with regard to malpractice, were evaluated retrospectively. The patients who underwent nephrectomy after ureteral avulsion were evaluated as Group 1, and those who underwent reconstructive surgery as Group 2. Results: The mean age of the patients was 39.5±12.1 years. Seventeen (51.5%) patients had partial and 16 (48.4%) had complete ureteral avulsion. Nephrectomy was performed in 14 (42.4%) patients, and ureteral reconstruction in 19 (57.5%) patients. It was determined that the patients in Group 1 had more proximal stones and a higher degree of hydronephrosis compared to Group 2. Complete avulsion developed in 71.4% of the patients in Group 1 and in 31.6% of those in Group 2. After avulsion, 78.6% of the patients in Group 1 were treated in a state hospital, and 63.2% of those in Group 2 were treated in a tertiary referral hospital. The increase in the degree of hydronephrosis, presence of complete avulsion, and intervention at a state hospital were determined as independent predictive factors for nephrectomy. Conclusion: This is the first study with the largest cohort in the literature to medicolegally evaluate ureteral avulsion and determine predictive factors for nephrectomy. Although each patient should be treated with different methods in the presence of ureteral avulsion, our study aimed to provide a common approach to this catastrophic complication.

Analysis of the Causes of Newborn Priapism: A Retrospective Clinical Study.

Priapism is a rare condition in the newborn. The aim of this study was to investigate the demographic, etiologic and clinical features of neonatal priapism. We retrospectively analysed the data of 11 patients diagnosed with neonatal priapism in the neonatal intensive care unit between 2000 and 2019. Priapism was defined as an erection in the neonatal period, lasting more than 4 hours. Etiological examinations revealed polycythemia in one (9.09%) patient, D-dimer elevation in three patients, and heterozygous methyltetrahydrofolate 667 gene mutations in one patient. Other patients were considered idiopathic. Detumescence was achieved in all 11 (100%) patients during the follow-up period. The median hospitalization duration was 6 (IQR [4, 8]; range, 2-9) days. The median follow-up duration was 38 (IQR [30, 42]; range, 13-94) months for patients followed-up in our hospital after discharge. Neonatal priapism is a rare condition. Successful treatment results can be achieved with conservative methods. Data acquired from our study showed that diseases with a tendency to hypercoagulation belong to the etiology by damaging penile microcirculation and make the response to conservative treatment more challenging.

Can shock wave lithotripsy lead to impaction of ureteral stones?

BACKGROUND: One of the underlying reasons for shock wave lithotripsy (SWL) resistance is the ureteral stone impaction. This study aimed to investigate the accuracy of the hypothesis, suggesting that SWL per se can be the reason for ureteral stone impaction. METHODS: One hundred and seventy-six patients were enrolled in the study. Data of the patients (N.=50) treated with SWL and subsequent semirigid ureteroscopic laser lithotripsy (SULL) in our center between January 2014 and January 2020 were retrospectively reviewed compared with the data of the patients (N.=126) who underwent SULL without prior SWL treatment during the same period. Patients reported to have ureteral stone impaction during SULL were compared with those without stone impaction in terms of demographic parameters, stone characteristics and clinical data, including symptom duration and presence or absence of SWL history. RESULTS: The success rate of SULL was determined as 80.1% (141/176). Univariable analysis revealed statistically significant differences between the patients with and without stone impaction concerning stone diameter, stone volume, pre-SULL SWL history, symptom duration and ureteral wall thickness (UWT). Multivariable logistic regression analysis revealed that symptom duration and UWT were independent predictive factors for ureteral stone impaction. CONCLUSIONS: Symptom duration and UWT are independent predictors of ureteral stone impaction. Symptom duration and UWT should be considered during treatment planning and informed consent process before proceeding with SULL.

Hybrid Ga-68 prostate-specific membrane antigen PET/MRI in the detection of skeletal metastasis in patients with newly diagnosed prostate cancer: Contribution of each part to the diagnostic performance.

PURPOSE: Bone metastasis is essential in patients with prostate cancer (PCa) as it determines prognosis and survival. Hybrid PET/MRI allows simultaneous acquisition of PET and MRI data, thus combining the strength of both technologies allows the detection of bone marrow metastases that are missed by PET/CT. In this retrospective study, we aimed to evaluate the diagnostic efficiency of hybrid PET/MRI with Ga-68 prostate-specific membrane antigen (PSMA) in detecting skeletal metastases in newly diagnosed PCa patients and compared the effectiveness of stand-alone PSMA PET reviewing versus stand-alone whole-body (WB) MRI evaluation. We also investigated the effect of the interpretation of all PET/MR data together on clinical management. METHODS: We studied 74 newly diagnosed PCa patients who underwent PSMA PET/MRI for staging purposes. At first, PET and MRI were evaluated separately for bone lesions on a patient-and-lesion basis and then a further joint PSMA PET/MRI interpretation was made. RESULTS: Patient-based sensitivity, specificity, positive predictive value, negative predictive value and accuracy analysis for bone metastasis was, respectively, 1.0, 0.83, 0.54, 1.0, 0.86 for PET; 0.75, 0.96, 0.81, 0.95, 0.93 for WB MRI and 0.91, 0.95, 0.78, 0,98, 0.94 for PET/MRI. The combined PET/MRI evaluation changed the clinical impact in 13.5% of patients (eight correct and two wrong decisions) compared to PET stand-alone interpretation. CONCLUSION: PSMA PET imaging showed superior sensitivity to WB MRI in detecting bone metastases in newly diagnosed PCa patients, whereas WB MRI has superior specificity and PPV. Furthermore, the specificity and PPV of joint PET/MRI evaluation are better than PSMA PET alone. Despite the longer acquisition period, adding WB MRI sequences to PSMA PET imaging appears beneficial for PCa patient management.

The presence of chronic inflammation in positive prostate biopsy is associated with upgrading in radical prostatectomy.

OBJECTIVE: This study aimed to determine the predictive effect of the presence of chronic prostatitis associated with prostate cancer (PCa) in prostate biopsy on Gleason score upgrade (GSU) in radical prostatectomy (RP) specimens. MATERIALS AND METHODS: The data of 295 patients who underwent open or robotic RP with a diagnosis of localized PCa following biopsy were retrospectively analyzed. Patients were divided into two groups with and without GSU following RP. Predictive factors affecting GSU on biopsy were determined. The impact of chronic prostatitis associated with prostate cancer on GSU was examined via logistic regression analysis. RESULTS: Out of 224 patients with Gleason 3+3 scores on biopsy, 145 (64.7%) had Gleason upgrade, and 79 (35.2%) had no upgrade. Whilst comparing the two groups with and without Gleason upgrade in terms of patient age, prostate-specific antigen (PSA) value, PSA density (PSAD), prostate volume (PV), neutrophil/lymphocyte (N/L) ratio, number of positive cores, percentage of positive cores, and Prostate Imaging Reporting and Data System version 2 score, no statistically significant difference was detected. The presence of chronic prostatitis associated with PCa was higher in the patient cohort with GSU in contrast to the other group (p < 0.001). According to the univariate logistic regression analysis, the presence of chronic prostatitis was identified to be an independent marker for GSU. CONCLUSIONS: Pathologists and urologists should be careful regarding the possibility of a more aggressive tumor in the presence of chronic inflammation associated with PCa because inflammation within PCa was revealed to be linked with GSU after RP.

Factors predicting duration and success of semirigid ureteroscopy for ureteral stones in different localizations. / Factores predictores de la duración y éxito de la ureteroscopia semirígida para litiasis ureterales en diferentes localizaciones.

OBJECTIVE: In this study, we aimed to determine the factors predicting the duration and successof semirigid ureteroscopy performed for the treatment of ureteral stones in different localizations. MATERIALS AND METHODS: Medical records of the patients whom under went semirigid ureteroscopy for urolithiasis in our centre between January 2015 and December 2019 were retrospectively reviewed. The study group composed of 170 patients and divided into three subgroups; of which 54 in proximal ureter (31.8%), 51 in the mid (30 %) and 65 (38.2%) in the distal ureter. Predictive factors of semirigid ureteroscopy duration and success were determined by performance of correlation analysis and multivariate analysis. RESULTS: Overall stone-free rate was calculated as 78.8%. Success rates for proximal, mid and distal ureteral stones were 72.2% (39/54 patients), 74.5% (38/51 patients) and 87.7% (57/65 patients), respectively. Complications were present in 19 patients (11.2%). Multivariate analysis indicated that stone diameter and stone burden independently affected the stone-free rate. Statistically significant negative correlation was determined between success of the procedure and stone diameter, stone burden, impaction and more proximal stone localization. While there was a statistically significant positive correlation between duration of procedure and stone burden, diameter, impaction, historyof ipsilateral ureteroscopy and more proximal stone localization, there was negative correlation between duration of procedure and stone-free status. CONCLUSION: We conclude that stone diameter, stone burden, impaction and more proximal stone localization are common factors affecting both duration and success of semirigid ureteroscopy. In addition, stone size and stone burden were determined as independent markers of stone-free status.

OBJETIVO: En este estudio determinamos los factores predictores de la duración y el éxito de la ureteroscopia semirígida realizada como tratamiento de las litiasis ureterales en diferentes localizaciones. MATERIALES Y MÉTODOS: Revisamos retrospectivamente las historias clínicas de los pacientes que han sido sometidos a una ureteroscopia semirígida por litiasis en nuestro centro entre enero 2015 y diciembre 2019. El grupo de estudio está formado por 170 pacientes y dividido en 3 subgrupos: 54 con litiasis en uréter proximal (31,8%) 51 en medio (30%) y 65 (38,2%) en el uréter distal. Los factores predictores de duración y éxito de la ureteroscopia semirígida fueron determinados con análisis de correlación y multivariante. RESULTADOS: La tasa global libre de litiasis fue de 78,8%. La tasa de éxito en uréter proximal, medio y distal fue de 72,2% (39/54 pacientes), 74,5% (38/51pacientes) y 87,7% (57/65 pacientes), respectivamente. Las complicaciones estuvieron presentes en 19 pacientes (11,2%). El análisis multivariante indicó que el diámetro de la litiasis y el volumen afectaron de forma independiente la tasa libre de litiasis. Una significación estadística negativa fue determinada entre el éxito del procedimiento y el diámetro de la litiasis, volumen, impactación y localización proximal. Una significación estadística positiva entre la duración del procedimiento y el volumen de la litiasis, diámetro, impactación, previas ureteroscopias y localización proximal. Se observó una correlación negativa entre la duración del procedimiento y el estado libre de litiasis. CONCLUSIÓN: Concluimos que el diámetro de la litiasis,volumen, impactación y localización proximal son los factores que afectan a la duración y el éxito de la ureteroscopia semirígida. Además, el tamaño de la litiasis y el volumen fueron predictores independientes de la tasa libre de litiasis.

Factors predicting duration and success of semirigid ureteroscopy for ureteral stones in different localizations / El papel diagnóstico de la proteína fijadora de ácidos grasos testiculares en la isquemia testicular: un estudio experimental controlado aleatorizado

Objetive: In this study, we aimed to determine the factors predicting the duration and successof semirigid ureteroscopy performed for the treatment ofureteral stones in different localizations.Materials and methods: Medical records of thepatients whom underwent semirigid ureteroscopy forurolithiasis in our centre between January 2015 and December 2019 were retrospectively reviewed. The studygroup composed of 170 patients and divided into threesubgroups; of which 54 in proximal ureter (31.8%), 51in the mid (30 %) and 65 (38.2%) in the distal ureter.Predictive factors of semirigid ureteroscopy duration andsuccess were determined by performance of correlationanalysis and multivariate analysis. Rresults: Overall stone-free rate was calculated as78.8%. Success rates for proximal, mid and distalureteral stones were 72.2% (39/54 patients), 74.5%(38/51 patients) and 87.7% (57/65 patients), respectively. Complications were present in 19 patients(11.2%). Multivariate analysis indicated that stone diameter and stone burden independently affected thestone-free rate. Statistically significant negative correlation was determined between success of the procedureand stone diameter, stone burden, impaction and moreproximal stone localization. While there was a statistically significant positive correlation between duration ofprocedure and stone burden, diameter, impaction, history of ipsilateral ureteroscopy and more proximal stonelocalization, there was negative correlation betweenduration of procedure and stone-free status.Conclusion: We conclude that stone diameter,stone burden, impaction and more proximal stone localization are common factors affecting both durationand success of semirigid ureteroscopy. In addition, stonesize and stone burden were determined as independentmarkers of stone-free status.(AU)

Objetivo: En este estudio determinamoslos factores predictores de la duración y el éxito de laureteroscopia semirígida realizada como tratamiento delas litiasis ureterales en diferentes localizaciones.Materiales y métodos: Revisamos retrospectivamente las historias clínicas de los pacientes que han sido sometidos a una ureteroscopia semirígida por litiasis ennuestro centro entre enero 2015 y diciembre 2019. Elgrupo de estudio está formado por 170 pacientes y dividido en 3 subgrupos: 54 con litiasis en uréter proximal(31,8%) 51 en medio (30%) y 65 (38,2%) en el uréterdistal. Los factores predictores de duración y éxito de laureteroscopia semirígida fueron determinados con análisis de correlación y multivariante.RESULTADOS: La tasa global libre de litiasis fue de78,8%. La tasa de éxito en uréter proximal, medio y distal fue de 72,2% (39/54 pacientes), 74,5% (38/51pacientes) y 87,7% (57/65 pacientes), respectivamente. Las complicaciones estuvieron presentes en 19 pacientes (11,2%). El análisis multivariante indicó que eldiámetro de la litiasis y el volumen afectaron de formaindependiente la tasa libre de litiasis. Una significaciónestadística negativa fue determinada entre el éxito delprocedimiento y el diámetro de la litiasis, volumen, impactación y localización proximal. Una significación estadística positiva entre la duración del procedimiento yel volumen de la litiasis, diámetro, impactación, previasureteroscopias y localización proximal. Se observó unacorrelación negativa entre la duración del procedimiento y el estado libre de litiasis.CONCLUSIÓN: Concluimos que el diámetro de la litiasis, volumen, impactación y localización proximal sonlos factores que afectan a la duración y el éxito de laureteroscopia semirígida. Además, el tamaño de la litiasis y el volumen fueron predictores independientes de latasa libre de litiasis.(AU)

Specific urogenital disease information-revealing male genital votive offerings dedicated to gods in ancient age sanctuary medicine. / Información en los votivos de órganos genitales masculinos sobre enfermedades urogenitales, en las ofrendas a dioses en la antigua medicina para la sanación.

OBJECTIVES:  The people of ancient age appealed to sanctuaries of different gods and goddesses they believed to have healing powers and consecrated anatomical votive offerings representing their sick or healed organs. Male genital organ votives were also present among these votives. In this article, male genital organ votive offerings presented to gods and goddesses were examined and the votives giving information about the diseases they indicated were revealed in contemporary medicine. METHODS: Information available in written resources on ancient medicine and diseases was reviewed. Main sanctuary healing centers in Anatolia (Asia Minor), Greece and Italy which concurrently hosted similar civilizations were investigated. Male genital organ shap anatomical votive samples in national and foreign medical history and archaeology museums, galleries and special collections were investigated and examined. RESULTS:  It was observed that most male genital organ votives had a healthy and normal structure and didn't provide any specific information on a urogenital disease. But it was also observed that some votives among genital organ votives consecrated by sick individuals to gods demonstrated some urogenital diseases and conditions. Among this very limited number of genital votives providing disease information, votives indicating phimosis, hypospadias, varicocele, penile hemangioma or condylama, Peyronie's disease or penile curvature, genital hidradenitis suppurativa, condition of pubic hair and erectile condition of penis were detected. CONCLUSIONS: As proofs of seeking a remedy for diseases or recovering from diseases, anatomical organ votives are very important to understand ancient sanctuary medicine. Among male genital organ votives, very limited number of samples providing specific information on diseases provided us important information so that we can understand some ancient age diseases.

OBJETIVOS:  Los habitantes de la era antigua acudían a santuarios de distintos dioses con la creencia de que éstos tenían poderes curativos y les entregaban ofrendas votivas de partes anatómicas enfermas, bien para que fueran sanados o como ofrenda una vez sanados. Entre estas ofrendas votivas encontramos órganos reproductores masculinos. En este artículo se han revisado y examinado estas ofrendas votivas de órganos reproductores masculinos y de ello se ha podido obtener información sobre enfermedades que existen en la medicina contemporánea. MÉTODOS: La información presente en escritos de medicina ancestral y enfermedades se revisó. Los principales santuarios de sanación en Anatolia (Asia Menor), Grecia e Italia que de forma concurrente tuvieron diferentes civilizaciones, fueron investigadas. La forma del órgano genital masculino en muestras votivas de historia de la medicina nacional y extranjera, museos arqueológicos, galerías y colecciones especiales, fueron investigadas y examinadas. RESULTADOS: Se observa que la mayoría de votivos de órganos genitales masculinos tenían una forma natural y sana y no proporcionaban ninguna información especial respecto a enfermedades urogenitales. Aunque también se observó que algunos votivos de individuos enfermos a dioses si presentaban algunas enfermedades urogenitales y condiciones especiales. Entre los votivos enfermos, encontramos votivos con fimosis, hipospadias, varicocele, hemangioma peneanos y condilomas, enfermedad de Peyronie o curvatura peneana, hidradenitis genital supurativa, desarrollo de pelo púbico y condiciones eréctiles del pene. CONCLUSIONES: Como prueba del interés por encontrar un remedio a las enfermedades o recuperarse de enfermedades, los votivos de órganos anatómicos fueron muy importantes para entender la medicina antigua. Entre todas estas ofrendas votivas de órganos genitales, a pesar de que un número muy limitado de ellas nos ha proporcionado información concreta sobre enfermedades, la información obtenida en ellas ha sido crucial para entender algunas de las enfermedades de la edad antigua.

Specific urogenital disease information-revealing male genital votive offerings dedicated to gods in ancient age sanctuary medicine / Información en los votivos de órganos genitales masculinos sobre enfermedades urogenitales, en las ofrendas a dioses en la antigua medicina para la sanación

OBJECTIVES: The people of ancient age appealed to sanctuaries of different gods and goddesses they believed to have healing powers and consecrated anatomical votive offerings representing their sick or healed organs. Male genital organ votives were also present among these votives. In this article, male genital organ votive offerings presented to gods and goddesses were examined and the votives giving information about the diseases they indicated were revealed in contemporary medicine. METHODS: Information available in written resources on ancient medicine and diseases was reviewed. Main sanctuary healing centers in Anatolia (Asia Minor), Greece and Italy which concurrently hosted similar civilizations were investigated. Male genital organ shaped anatomical votive samples in national and foreign medical history and archaeology museums, galleries and special collections were investigated and examined. RESULTS: It was observed that most male genital organ votives had a healthy and normal structure and didn’t provide any specific information on a urogenital disease. But it was also observed that some votives among genital organ votives consecrated by sick individuals to gods demonstrated some urogenital diseases and conditions. Among this very limited number of genital votives providing disease information, votives indicating phimosis, hypospadias, varicocele, penile hemangioma or condylama, Peyronie’s disease or penile curvature, genital hidradenitis suppurativa, condition of pubic hair and erectile condition of penis were detected. CONCLUSIONS: As proofs of seeking a remedy for diseases or recovering from diseases, anatomical organ votives are very important to understand ancient sanctuary medicine. Among male genital organ votives, very limited number of samples providing specific information on diseases provided us important information so that we can understand some ancient age diseases

OBJETIVOS: Los habitantes de la era antigua acudían a santuarios de distintos dioses con la creencia de que éstos tenían poderes curativos y les entregaban ofrendas votivas de partes anatómicas enfermas, bien para que fueran sanados o como ofrenda una vez sanados. Entre estas ofrendas votivas encontramos órganos reproductores masculinos. En este artículo se han revisado y examinado estas ofrendas votivas de órganos reproductores masculinos y de ello se ha podido obtener información sobre enfermedades que existen en la medicina contemporánea. MÉTODOS: La información presente en escritos de medicina ancestral y enfermedades se revisó. Los principales santuarios de sanación en Anatolia (Asia Menor), Grecia e Italia que de forma concurrente tuvieron diferentes civilizaciones, fueron investigadas. La forma del órgano genital masculino en muestras votivas de historia de la medicina nacional y extranjera, museos arqueológicos, galerías y colecciones especiales, fueron investigadas y examinadas. RESULTADOS: Se observa que la mayoría de votivos de órganos genitales masculinos tenían una forma natural y sana y no proporcionaban ninguna información especial respecto a enfermedades urogenitales. Aunque también se observó que algunos votivos de individuos enfermos a dioses si presentaban algunas enfermedades urogenitales y condiciones especiales. Entre los votivos enfermos, encontramos votivos con fimosis, hipospadias, varicocele, hemangioma peneanos y condilomas, enfermedad de Peyronie o curvatura peneana, hidradenitis genital supurativa, desarrollo de pelo púbico y condiciones eréctiles del pene. CONCLUSIONES: Como prueba del interés por encontrar un remedio a las enfermedades o recuperarse de enfermedades, los votivos de órganos anatómicos fueron muy importantes para entender la medicina antigua. Entre todas estas ofrendas votivas de órganos genitales, a pesar de que un número muy limitado de ellas nos ha proporcionado información concreta sobre enfermedades, la información obtenida en ellas ha sido crucial para entender algunas de las enfermedades de la edad antigua

Comparison of Two Different Scoring Systems in Encrusted Ureteral Stent Management: A Single-Center Experience.

PURPOSE: To report our single-center experience in encrusted ureteral stent management and to compare the utility of two different scoring systems, KUB (Kidney, Ureter, Bladder) versus FECal (forgotten, encrusted, calcified), in patient management. MATERIALS AND METHODS: We retrospectively analyzed the medical records of all patients who were found to have encrusted/retained ureteral stent and underwent various procedures to remove encrusted ureteral stent in our clinic between May 2014 and December 2018. Encrusted stent grading was performed using KUB and FECal grading systems. KUB system score is the sum of the stone burden scores of 3 different parts of an encrusted stent within the kidney, ureter and bladder determined using a scale from 1 to 5 according to the maximal diameter of encrustation. FECal grading system is based on the stone size, location and degree of stent encrustation and scored from Grade 1 to Grade 5. RESULTS: A total of 39 patients (29 males and 10 females) were included the study. The mean age of the patients was 46.4 ± 14.5 years, ranging from 13 to 71 years. The mean time from ureteral stent insertion to encrustation was 13.7 ± 26.4 months, varying between 2 and 120 months. The mean KUB score was 6.4 ± 2.4. According to FECal system, 53.8% of the patients were classified as Grade 1 and 15.4% as Grade 2. The encrusted ureteral stents of eight patients (20.5%) could be removed with the aid of a foreign body forceps inserted through a cystoscope. Fourteen patients (35.9%) underwent cystolithotripsy, seven (17.9%) underwent flexible ureterorenoscopy (URS), six (15.4%) underwent rigid URS, and three (7.7%) underwent combined percutaneous nephrolithotomy and URS beside stent removal. In multivariate regression analysis, largest encrustation diameter, FECal system grade and KUB score were found to be significant predictors of stone- and stent-free status (p<0.001 for all). Also, KUB score was found to be associated with the number of required procedures (r= .506, p= .001). CONCLUSION: KUB encrusted stent scoring system might be useful in predicting the number of required procedures to achieve stone- and stent-free status. Pure intracorporeal endourologic procedures, percutaneous interventions or open surgery might be preferred according to the patient's situation and the surgeon's experience and preference.

Die präoperative Anwendung von Dutasterid hat keine Auswirkung auf intraoperative Blutungen bei transvesikaler offener einfacher Prostatektomie zur Behandlung der benignen Prostatahyperplasie.

OBJECTIVE: There are a few studies in the literature investigating the effect of preoperative dutasteride use on bleeding in open simple prostatectomy. We aimed to evaluate the effect of preoperative dutasteride use on perioperative bleeding during open simple prostatectomy. METHODS: We retrospectively analyzed the medical records of all patients who underwent transvesical open prostatectomy due to benign prostatic hyperplasia in our institution between 2008 and 2018. Patients were divided into 2 groups regarding the use of dutasteride prior to surgery as group 1 = received dutasteride during at least six weeks prior to surgery; group 2 = dutasteride naive. RESULTS: A total of 167 patients who met the inclusion criteria were included in the study. The mean operative time was 86.5±18.7 min while the estimated blood loss was 640.7±55.7 ml. There was no statistically significant difference in operative time, estimated blood loss, hemoglobin, and hematocrit decrease among the two groups. CONCLUSION: We were not able to find an advantage of pre-operative dutasteride use in terms of perioperative bleeding in open simple prostatectomy performed for benign prostatic hyperplasia.

[Urogenital votive offerings and diseases in ancient healing temples of Greco-Roman culture]. / Urogenitale Votivgaben und Krankheiten in antiken Heiltempeln des griechisch-römischen Kulturkreises.

In polytheistic antiquity, people went to the temples, which were dedicated to different gods and goddesses, to seek healing for their diseases. There were also anatomical votive offerings that symbolized their affected organs. In this article, votive offerings in the field of urology and the diseases they point to are presented.

The utility of De Ritis Ratio in predicting prognosis in testicular cancer.

OBJECTIVE: We aimed to investigate the possible association between testicular cancer prognosis and De Ritis ratio (AST/ALT). METHODS: The medical records of all patients who underwent radical inguinal orchiectomy at a single tertiary in Istanbul, Turkey between 2006 and 2017 were retrospectively analyzed. Investigated parameters included patients' demographics, complete blood count and blood biochemistry results, pathology results, treatment schemes, imaging results, and survival. De Ritis ratio was calculated as follows: AST/ALT. RESULTS: A total of 171 patients with a mean age of 32.6 ±â€Š10.1 years were included in the study. 73 patients had T1, 83 had T2, 13 had T3 and 2 had T4 disease. Rete testis invasion was detected in 74 patients (43.3 %) as well as lymphovascular invasion in 93 (54.4 %) and tunica albuginea invasion in 80 (46.8 %) patients. The cut-off value for AST/ALT was set at 1.35 [Area Under Curve (AUC): 0.791 with a sensitivity of 80 % and specificity of 73 %]. No statistically significance was observed between patients with and without elevated AST/ALT according to rete testis invasion, lymphovascular invasion, tunica albuginea invasion, and tunica vaginalis invasion (p = .25, p = .63, p = 1.0 and p = 1.0, respectively). 28.2 % of patients with seminoma had AST/ALT > 1.35 however 41.9 % of patients with non-seminoma pathology had AST/ALT > 1.35 (p = .078). Mean estimated survival time of patients with AST/ALT > 1.35 was higher than those with AST/ALT < 1.35, 91.8 versus 70.4 months, p < .001). As seen in Kaplan-Meier analysis elevated AST/ALT is associated with early-term mortality. CONCLUSION: De Ritis ratio was shown to be significantly associated with unfavorable prognosis. De Ritis ratio might serve as a prognostic biomarker in testicular tumor besides well-known tumor markers such as beta-human chorionic gonadotropin (hCG), alpha-fetoprotein (AFP) and lactate dehydrogenase (LDH).

Urology in forensic medicine registries in Ottoman court registry books.

OBJECTIVE: Efforts to determine crimes and culprits were carried out in the Ottoman Empire as in every society. Until the second half of the 19th century, when forensic medicine was institutionalized, the records belonging to these applications were held by the institution of "Qadi" in court registry books. In this study, based on these Shariah court records, we aimed to reveal Ottoman period forensic science procedures and urology's place in them. MATERIAL AND METHODS: Literature searches were made with certain keywords in Ottoman medical sources. Ottoman archive documents and relevant literature were examined in terms of forensic practices and urology, especially in Shariah court records belonging to several cities. RESULTS: Signing Ottoman consent documents before medical interventions, the judgment of physicians due to fraud and mistakes, the consultation of physicians in injuries, infectious diseases, and on-site exploration of deaths were identified as the main forensic medicine applications. Extensive information about urologic diseases and forensic urology of the period in the consent documents was uncovered. CONCLUSION: Shariah court records provided information, through consent documents, about forensic medicine procedures, urogenital diseases, and urologic forensic cases of the period. Informed consent documents, which were introduced in Europe in the 19th century, were used in the Ottoman Empire since the 15th century, showing the Ottomans' medical ethics in terms of physician and patient rights.

The association between CHA2DS2-VASc score and erectile dysfunction: a cross-sectional study.

PURPOSE: This study aims to assess the association between CHA2DS2-VASc score and erectile dysfunction in patients who were admitted to cardiology outpatient clinics. MATERIALS AND METHODS: One hundred and two male patients who were admitted to the cardiology outpatient clinic were included to the study. Erectile dysfunction was evaluated in the urology outpatient clinic in the same hospital and scored using Turkish Version of The International Index of Erectile Function. CHA2DS2-VASc score was calculated for every patient using the current associated guidelines. RESULTS: There was a negative correlation between The International Index of Erectile Function score and CHA2DS2-VASc score, age, hypertension, heart failure, diabetes mellitus, stroke respectively. Smoking and dislipidemia were not correlated with The International Index of Erectile Function score (p>0.05). CONCLUSION: CHA2DS2-VASc score can be used to detect Erectile dysfunction in patients who are admitted to the cardiology outpatient clinics.

The association between CHA2DS2-VASc score and erectile dysfunction: a cross-sectional study

ABSTRACT Purpose: This study aims to assess the association between CHA2DS2-VASc score and erectile dysfunction in patients who were admitted to cardiology outpatient clinics. Materials and methods: One hundred and two male patients who were admitted to the cardiology outpatient clinic were included to the study. Erectile dysfunction was evaluated in the urology outpatient clinic in the same hospital and scored using Turkish Version of The International Index of Erectile Function. CHA2DS2-VASc score was calculated for every patient using the current associated guidelines. Results: There was a negative correlation between The International Index of Erectile Function score and CHA2DS2-VASc score, age, hypertension, heart failure, diabetes mellitus, stroke respectively. Smoking and dislipidemia were not correlated with The International Index of Erectile Function score (p>0.05). Conclusion: CHA2DS2-VASc score can be used to detect Erectile dysfunction in patients who are admitted to the cardiology outpatient clinics.

Understanding the genital diseases of Ancient Anatolia in the light of the inscribed male genital offerings presented to gods.

In the ancient Greek and Roman world, many gods and goddesses were considered to possess healing powers, and there were their temples where they could heal those who prayed. For that reason, in the ancient times, people were going to healing temples of various gods and goddesses to recover from their illnesses or grievous injuries. Sick individuals at the temples were offering some written or unwritten votive reliefs indicating their illnesses, to the gods or goddesses to ask for healing or to express gratitude after finding a cure. Among these, votive stones containing written expressions and reliefs expressing the owner's health problem held an important position. In the research on this antiquity, four inscribed votives that had a male genital organ depicted on them and that were dedicated to Anatolian gods Theos Hypsistos and Sozon, and goddesses Phileis and Ollie, were found. In this article, we aimed to study the inscribed offerings that are still on display in museums and private collections discovered during the excavations in Anatolia hosting the ancient Greek and Roman civilizations simultaneously and their possible relations with the urogenital illnesses.

Correlation of SUVmax and Apparent Diffusion Coefficient Values Detected by Ga-68 PSMA PET/MRI in Primary Prostate Lesions and Their Significance in Lymph Node Metastasis: Preliminary Results of an On-going Study

Objectives: Gallium-68 (Ga-68) prostate specific membrane antigen (PSMA) positron emission tomography (PET) has been shown to be more accurate than multiparametric prostate magnetic resonance imaging (MRI) in detection of primary prostate lesions. Using hybrid PET/MRI we aim to detect the correlation between SUVmax and apparent diffusion coefficient (ADC) in primary prostate lesions and to assess their prognostic value in detection of lymph node (LN) metastasis. Methods: Twenty-six patients, who were diagnosed as having prostate cancer with biopsy and underwent Ga-68 PSMA PET/MRI together with biparametric prostate MRI (bpMRI) were included. SUVmax, SUVmean and ADC were recorded for index lesions drawing a region of interest (ROI) of 1 cm2 around the pixel with the highest SUVmax (ROI-1) and another ROI following borders of prostate tumor detected by bpMRI (ROI-2). Presence of LN metastasis was recorded according to PSMA PET/MRI Results: SUVmax was inversely correlated with ADC (ROI-1: p=0.010; ROI-2: p=0.017 for b=800). SUVmax and SUVmeans were both higher in patients with LN metastasis and ADC was lower in patients with LN metastasis for ROI-1. SUVmax cut-off value of 19.8 for ROI-1 and 20.9 for ROI-2 had sensitivity and specificity of 77.8% and 76.5%, respectively for detection of LN metastasis, whereas ADC (b=800) cut-off value of 0.92x10-3 mm2/s had sensitivity and specificity of 87.5% and 76.5%, respectively. SUVmax/ADC (b=800) ratio increased the sensitivity and specificity to 100% and 82.4%, respectively. Conclusion: SUV and ADC values are inversely correlated in primary prostate lesions and the combined use of both values increases the diagnostic accuracy of hybrid PET/MRI in the detection of primary prostate lesions.

Comparison of Ga-68 PSMA positron emission tomography/computerized tomography with Tc-99m MDP bone scan in prostate cancer patients

Background/aim: The aim of our study was to compare Tc-99m MDP bone scan and Ga-68 PSMA PET/CT in terms of detection of bone metastasis in prostate cancer patients. Materials and methods: A total of 28 prostate cancer patients with bone scan and PSMA PET/CT performed within 90 days were retrospectively included in our analysis. All bone lesions were scored as negative (score-0), positive (score-1), or suspicious (score-2) for metastasis by two experienced nuclear medicine physicians. Both patient-based and region-based analyses were made for all osseous lesions. Results: On per-patient analysis; sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were 72.7%, 52.9%, 50%, 75%, and 60.7%, respectively, for bone scan and 90.9%, 100%, 100%, 94.4%, and 96.4%, respectively, for PSMA PET/CT. On per-region analysis; sensitivity, specificity, PPV, NPV, and accuracy were 76.2%, 80.9%, 57.1%, 91.1%, and 79.8%, respectively, for bone scan and 85.7%, 100%, 100%, 95.5%, and 95.4%, respectively, for PSMA PET/CT. Conclusion: Ga-68 PSMA PET/CT has higher sensitivity, specificity, and accuracy compared to bone scan in terms of bone metastasis detection in prostate cancer patients. Therefore, it might be the modality of choice for patients with suspicion for metastatic disease, despite negative bone scan and conventional imaging results