Risk-Adapted Strategy Combining Magnetic Resonance Imaging and Prostate-Specific Antigen Density to Individualize Biopsy Decision in Patients With PI-RADS 3 ``Gray Zone'' Lesions.

INTRODUCTION: Recent guidelines suggest that biopsy may be omitted in some groups of patients with PI-RADS 3 lesions on mpMRI. In this study, we aimed to evaluate biopsy strategies involving prostate-specific antigen density (PSAd) to avoid unnecessary biopsy versus the risk of missing clinically significant prostate cancer (csPCa) in patients with PI-RADS 3 lesions. MATERIAL AND METHODS: Data of 616 consecutive patients who underwent PSAd and mpMRI before prostate biopsy between January 2017 and January 2022 at a single center were retrospectively assessed. All of these patients underwent combined cognitive or fusion targeted biopsy of suspicious lesions and transrectal ultrasonography guided systematic biopsy. PI-RADS 3 based strategies with PSAd and mpMRI combination were created. For each strategy, avoided unnecessary biopsy, reduced ISUP Grade 1, and missed ISUP Grade ≥ 2 ratios were determined. Decision curve analysis (DCA) was used to statistically compare the net benefit of each strategy. RESULTS: DCA revealed that patients who had PI-RADS 3 lesions with PSAd ≥ 0.2, and/or patients who had PI-RADS 4 and 5 lesions had the most benefit, under the threshold probability level between 10% and 50%, which avoided 48.2% unnecessary prostate biopsies and reduced 51% of ISUP grade 1 cases, while missed 17.5% of ISUP grade ≥ 2 cases. (22.1% for ISUP grade 2 and 8.8% for ISUP grade ≥ 3). Strategy 1 (PI-RADS 4-5 and/or PSAd ≥ 0.2), 3 (PI-RADS 4-5 and/or PI-RADS 3 if PSAd ≥ 0.15), and 7 (PI-RADS 4-5 and/or PI-RADS 3 if PSAd ≥ 0.15 and/or PI-RADS 2 if PSAd ≥ 0.2) were the next three best strategies. CONCLUSION: mpMRI combined with PSAd strategies reduced biopsy attempts in PI-RADS 3 lesions. Using these strategies, the advantage of avoiding biopsy and the risk of missing the diagnosis of csPCa can be discussed with the patient, and the biopsy decision can be made afterwards.

Effects of onabotulinum toxin-A injection on sexual function in women with refractory interstitial cystitis/bladder pain syndrome: A prospective study.

OBJECTIVES: To determine the effect of intravesical onabotulinum toxin-A (BoNT-A) treatment on sexual functions in female patients with refractory interstitial cystitis/bladder pain syndrome (IC/BPS). METHODS: Female patients with IC/BPS refractory to previous treatments were included in the study between January 2020 and April 2022. Patients were treated with the trigone-sparing injection (Group 1) or trigone-included injection (Group 2) techniques. 100 Units of BoNT-A was applied submucosally on 20 different points. The patients were evaluated with visual analog scale (VAS), O'Leary-Sant Interstitial Cystitis Symptom Index (ICSI), Interstitial Cystitis Problem Index (ICPI), Female Sexual Function Index (FSFI) questionnaires, 3-day voiding diary, uroflowmetry, and post-voiding residual volume analysis in the preoperative period, as well as on the 30th and 90th days postoperatively. For the repeated measurements, analysis of variance was used to assess the time-dependent variation across groups. RESULTS: The baseline FSFI score of the patients was 15.96 ± 3.82. Following the treatment, the FSFI scores were 22.43 ± 4.93 and 24.41 ± 5.94 on the 30th and 90th days, respectively (p < .001). We observed statistically significant improvement in all FSFI subdomains (p < .05). Statistically significant improvements with treatment on ICSI, ICPI, and VAS scores were achieved (p < .05). Preoperative FSFI scores were similar in Group 1 and Group 2 (p = .147). While the preoperative FSFI scores were 17.00 ± 3.73 and 14.84 ± 3.72 for Group 1 and Group 2, respectively, the scores after the treatment were 22.85 ± 5.01 and 21.98 ± 5.01 on the 30th day, and 24.62 ± 6.06 and 24.19 ± 6.05 on the 90th day postoperatively. Significant improvement was observed in FSFI scores with treatment, and no difference was observed between the two groups in terms of treatment response (p = .706). CONCLUSIONS: Intravesical BoNT-A injection in the treatment of women with refractory IC/BPS improves sexual functions. It also significantly improves pain and symptom scores. Both trigone-sparing and trigone-including injections are similarly safe and effective.

Simultaneous uroflowmetry and urinalysis with single specimen - A prospective evaluation of automatic urine strip analyzer of ORUBA INALYS: Uroflowmetry-urinalysis combined device.

Objective: To evaluate the consistency of the urinalysis results performed with the ORUBA INALYS device, (Oruba, Ankara, Turkey) which can perform urinalysis and uroflowmetry simultaneously, with the analysis results performed with the SYSMEX UC3500 automated urine chemistry analyzer (Sysmex, Kobe, Japan). Material and methods: In this prospective study, urinalysis of 50 male patients with lower urinary tract symptoms were evaluated. The parameters of glucose, pH, urobilinogen, bilirubin and ketone, leukocyte, protein, and blood were measured with ORUBA INALYS, and the same urine specimens collected from ORUBA INALYS by a special setup were sent to the laboratory for urinalysis with Sysmex UC-3500 to assess the concordance of the results between two devices. Results: Urinalysis results in ORUBA INALYS device in terms of glucose, pH, urobilinogen, bilirubin, and ketone parameters were shown to achieve 100% agreement within ±1 category with SYSMEX UC3500 whereas these values were slightly decreased to 88%, 96%, and 98% for leukocyte, protein, and blood, respectively. Among the calculable weighted kappa values for the test parameters, the highest value was found for glucose and followed by blood, pH, leukocyte, and specific gravity respectively. Conclusion: Significant consistency of the urinalysis results obtained from ORUBA INALYS with those obtained from device SYSMEX UC3500 shows the reliability of the urinalysis performed with ORUBA INALYS. ORUBA INALYS could minimize costs and workload, provide time save and reduce plastic waste.

Anatomic outcomes of sacrohysteropexy without posterior mesh placement in patients with asymptomatic grade 1 and 2 rectoceles: Is a rectouterine mesh really necessary?

OBJECTIVES: To present the anatomic outcomes of sacrohysteropexy surgery without posterior mesh placement in patients with asymptomatic grade 1 and 2 rectoceles. METHODS: The patients who underwent abdominal sacrohysteropexy without posterior mesh placement for the treatment of symptomatic grade 3 and 4 anterior/apical prolapse + asymptomatic grade 1 and 2 rectocele between May 2015 and January 2021 were evaluated retrospectively. The success rate, the anatomic outcomes (for anterior, apical, and posterior pelvic organ prolapse [POP]), and perioperative data of the surgical procedure were assessed. The objective failure criteria after surgery included the presence of grade 1 or higher in any compartment (anatomical criteria), recurrent POP requiring an operation, and/or usage of pessaries. Perioperative adverse events were categorized according to the Clavien-Dindo classification. RESULTS: Fifty-one patients underwent sacrohysteropexy without posterior mesh. The mean age of the patients was 56.8 ± 10 years. The success rates (anatomical outcomes) for the anterior/apical and posterior POP in the study group were 60.7%, 54.9%, and 58.8%, respectively, at a median follow-up time of 40.24 (24-71) months. The median hospital stay was 3.1 (2-6) days. The mean estimated blood loss was 127.6 (80-150) mL. The mean operation time was 114 (90-156) min. The mean urethral and catheter removal times were 1.3 (1, 2) and 2.1 (2-4) days, respectively. The mean recovery time of gastrointestinal motility was 14.4 h (11-35). CONCLUSIONS: Sacrohysteropexy without posterior mesh placement might be associated with less pain, shorter operative time, and shorter recovery time of gastrointestinal motility, without compromising the anatomic success.

Sexual dysfunction in women with interstitial cystitis/bladder pain syndrome: Do onabotulinum toxin-A injections improve sexual function?

INTRODUCTION: Interstitial cystitis/bladder pain syndrome (IC/BPS) has a negative impact on female sexual function. We aimed to evaluate the effect of intravesical botulinum toxin-A (BTX-A) injection on the improvement of sexual dysfunction and urinary symptoms using the multi-domain female sexual function Index (FSFI), interstitial cystitis symptom index (ICSI), and interstitial cystitis problem index (ICPI). MATERIAL AND METHOD: The data of the 23 patients (study group) who received intravesical BTX-A with the diagnosis of IC/BPS were reviewed. Twenty-three age-matched healthy, sexually active women were determined as the control group. Patients received 100 U BTX-A submucosally injections, including the trigone. One hundred units of BTX-A were diluted to 20 cc 0.9% saline, and 1 cc was then applied submucosally on 20 different points of the bladder wall (5 U/1 mL per site). The study group was asked to fill out FSFI, ICSI, and ICPI, as well as the visual analog scale (VAS) and bladder diary before and 3 months after the treatment. Patients in the control group completed the same questionnaires once. The pre- and post-treatment questionnaire scores were compared in the study group. The study group's data were also compared to the control group. RESULTS: Compared to the pretreatment period, the study group showed statistically significant improvement in the total FSFI score and each domain of the FSFI after BTX-A injection. The mean total FSFI score and three domains of FSFI (desire, lubrication, pain) reached to the score of the control group following BTX-A injection. Statistically significant improvements were also shown in scores of ICSI, ICPI, and VAS. (p < 0.05). CONCLUSION: IC/BPS is associated with a very high incidence of sexual dysfunction. Intravesical BTX-A injection may provide significant improvement in sexual dysfunction in women with IC/BPS.

Does Switching Bacillus Calmette-Guerin Strains During Maintenance Therapy Affect the Outcome in Non-Muscle Invasive Bladder Cancer?

OBJECTIVE: To compare the patients who have received 1 type of BCG strain during maintenance therapy with patients treated with multiple BCG strains. MATERIAL AND METHODS: We reviewed 279 patients treated with BCG between January 2012 and May 2019, retrospectively. The primary endpoints of the study were recurrence-free survival (RFS) and progression-free survival (PFS) rates among patients receiving same BCG strain (Group-1) and multiple BCG strains (Group-2). Matching analysis was performed to balance the groups. The Kaplan-Meier method was used for estimating RFS and PFS. The difference between the 2 groups in terms of adverse effects was evaluated using the chi-square test. RESULTS: A total of 225 (80.6 %) patients were treated with single BCG strain, and 54 (19.4 %) were treated with multiple BCG strains. Overall, recurrence and progression was observed in 86 (30.8%) and 38 (13.6%) patients, respectively. There was no significant difference between the 2 groups in terms of recurrence-free survival and progression-free survival on both without matching and with propensity score match analysis (log rank; P=.760 and P=.559, P=.533 and P=0509 for non-match and matched analysis respectively). Most of the patients in both groups experienced BCG therapy related side effects, but there was no statistically significant difference between groups (P=.235/.833). CONCLUSIONS: Switching the BCG strain because of unavailability of the induction strain does not decrease the effectiveness of the treatment. When it is not possible to reach the starting BCG strain, treatment can be safely continued with any available strain.

Perioperative adverse events and functional outcomes following open and robot-assisted prostatectomy in patients over age 70.

AIM: To evaluate the safety (perioperative adverse events) of robot-assisted radical prostatectomy (RARP) and functional outcomes (continence and erectile dysfunction) of open and robotic radical prostatectomy in elderly patients. METHODS: The data of patients (≥70 years old) who underwent open retropubic radical prostatectomy (ORRP) and RARP within the period from November 2014 to February 2019 were evaluated retrospectively. The perioperative adverse events and the functional outcomes of both surgical approaches were evaluated. RESULTS: A total of 149 men (59.3%) underwent ORRP, and 102 men (41.7%) underwent RARP. The mean age in the ORRP group was 73.6 ± 3.2 years, and that in the RARP group was 74.7 ± 4.1 years. The rate of grade 3 or higher (major) complications for the ORRP group was 4.7% (7 out of 149), and that for the RARP group was 4.9% (5 out of 102). The 24 months full continence and potency rates of the ORRP and RARP groups were 78.5% vs 79.4% and 21.8% vs 22.6%, respectively. CONCLUSION: The perioperative adverse events are similar in elderly patients undergoing ORRP and in RARP. The continence rates are favourable and reasonable, although the potency rates are low in elderly men who underwent prostatectomy. The results of the present study may be useful for surgeons in their decision making and counselling of elderly patients.

The outcomes of three buccal mucosal graft urethroplasty techniques in women with urethral stricture disease.

AIM: The purpose of this paper is to present the outcomes of three buccal mucosal graft (BMG) urethroplasty techniques in female patients with urethral strictures. METHODS: We included all patients who had BMG urethroplasty for female urethral strictures (FUS) disease between January 2015 and June 2020. Patient age, comorbidities, stricture etiology, stricture length, the number of previous treatments, preoperative and postoperative uroflowmetry data, postvoid residual volumes, and the operation and postoperative course details were documented. RESULTS: A total of 34 patients were included in this study. There were 8 patients in vaginal-sparing inlay BMG, 12 for ventral onlay BMG, and 14 for Aybek-Zumrutbas (AZ) technique groups. The mean age of the study population was 56.1 years. The length of urethral strictures varied between one and 4.5 cm. All patients had a previous history of endoscopic treatment or dilatations. The preoperative mean maximal flow rate (Qmax) was 6.9 ml/s. The median postoperative follow-up time was 24.6 months. Twelve months after surgery, the mean Qmax was 25 (range: 14-32) ml/s. There were no significant complications in any patients. The success rates were 83.3% for ventral onlay BMG, 87.5% for vaginal-sparing, and 100% for AZ technique. CONCLUSIONS: All three BMG urethroplasty techniques applied in this study had a success rate of over 80% in a median follow-up of approximately 2 years. In females, urethroplasty with BMG provided high rates of cure, and the recently described two techniques (vaginal-sparing inlay BMG, and AZ technique) showed promise in FUS treatment.

Individual-risk-score for urinary tract malignancy in patients with microscopic hematuria.

AIM: To determine the patients who can be safely exempted from undergoing unnecessary diagnostic procedures for microscopic hematuria (MH) evaluation by using the developed individual-risk-scoring system. MATERIALS AND METHODS: The patients who underwent a complete urological evaluation for MH were identified retrospectively. The risk factors for urinary malignancy which defined in the 2020 American Urological Association/Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction guidelines were recorded for each patient. Multivariable logistic regression was performed to establish a predictive risk-scoring system. The odds ratios obtained as a result of the logistic regression analysis were scored. RESULTS: A total of 1461 patients who had undergone a complete urological evaluation for MH were identified. The urinary malignancy rate was 3.4% (50 of the 1461 patients). According to the odds ratios, age >40 was calculated as 1 point; male gender, 2 points; smoking history, 4 points; presence of occupational risk factor, 1 point; and presence of macroscopic hematuria, 2 points. For the cut-off risk score, 5 points was found to be the most appropriate score according to the sensitivity and specificity levels. The patients with risk scores of 5 points or lower were considered to be in the low-risk group for urinary tract malignancy. CONCLUSION: The patients with a risk score of 5 points or above require complete urological evaluation. The results of the present study may reduce the number of patients undergoing unnecessary urological evaluation.

Is it necessary to have a guidewire down through the ureter during mini percutaneous nephrolithotomy? Single-centre experience with 1052 cases.

OBJECTIVES: In this study, it is aimed to identify the rate of successful placement of a guidewire down through the ureter during PNL and to compare the outcomes of different locations of guidewires in the collecting system following renal puncture in terms of success and complications rates. PATIENTS AND METHODS: Data of 1052 patients who underwent miniPNL in our institution between January 2014 and November 2020 were analysed. Patients were divided into three groups. Group I consisted of patients with the guidewire coiled within the punctured calyx, group II consisted of patients with the guidewire reaching the renal pelvis and group III consisted of patients with the guidewire passed down through the ureter. The groups were compared for successful tract creation and complication rates. RESULTS: There were 303 (28.8%) patients in group I, 330 (31.4%) patients in group II and 419 (39.8%) patients in group III. Successful tract dilation at the first attempt was established in 298 (94.7%) patients in group I, 328 (99.4%) patients in group II and in all of the 419 (100%) patients in group III. Successful tract creation was established in a second attempt in all of the patients failed in the first attempt. The groups were similar for stone-free and complication rates. CONCLUSIONS: Placement of guidewire down through the ureter could not be established in more than 60% of the cases. Location of guidewire prior to dilation did not affect the outcomes. Therefore, we suggest to proceed with tract creation even when the guidewire coils within the punctured calyx.

Comparison of Microscopic Hematuria Guidelines as Applied in 1018 Patients With Microscopic Hematuria.

OBJECTIVE: To compare the 2012 American Urological Association (AUA) and 2020 AUA/Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) microscopic hematuria (MH) guidelines as applied in 1,018 patients with MH, to confirm of risk groups and to investigate the natural history of patients with MH. MATERIALS AND METHODS: Patients who had undergone a complete urological evaluation for MH according to the 2012 AUA MH guidelines were identified retrospectively. All the patients were then classified into low-, intermediate-, or high-risk for urinary tract malignancy according to the updated 2020 AUA/SUFU MH guidelines, for a second evaluation. The results of the first and second evaluations using the previous 2012 AUA and updated 2020 AUA/SUFU MH guidelines, respectively, were then compared. RESULTS: A total of 1018 patients with MH were identified. The urinary tract malignancy rate was 3.3% (34 of the 1,018 patients). According to the 2020 AUA/SUFU MH guidelines, there were 218 patients (21.4%) in the low-risk group, 447 patients (43.9%) in the intermediate-risk group, and 353 patients (34.6%) in the high-risk group. All the 34 patients with malignancy were from the intermediate- or high-risk group who require further urological evaluation. There was no patient with newly developed urinary tract malignancy at the median follow-up time of 28 months (12-58). CONCLUSION: The use of the updated 2020 AUA/SUFU MH guidelines may reduce the number of diagnostic procedures without compromising the diagnosis of life-threatening malignant lesions.

The effect of renal artery-only or renal artery-vein clamping during partial nephrectomy on short and long-term functional results: Is clamping technique important?

PURPOSE: To evaluate the effect of artery-only (AO) and artery-vein (AV) clamping during partial nephrectomy (PN) on short- and long-term renal function outcome. METHODS: Medical records of 154 patients in the AO group and 192 patients in the AV group who underwent open and minimally invasive (laparoscopic/robotic) PN between January 2011 and January 2018 were retrospectively assessed. Preoperative patient and tumor-specific characteristics in addition to perioperative factors and renal function outcomes were compared. The change in the estimated glomerular filtration rate (eGFR) from postoperative 1-3 days, 12 and 24 months after surgery was calculated. Acute kidney injury (AKI) was defined a as a > 25% reduction in eGFR. RESULTS: There were no statistically significant differences between the clamping techniques in terms of postoperative 1-3 days, 12 and 24 months eGFR change percentage and risk of progression to chronic kidney disease (CKD). No significant difference in short- and long-term renal functions was found between the minimally invasive or open AO and AV clamping subgroups at any time point. In multivariate analysis, the R.E.N.A.L score (AO group p = 0.026, AV group p < 0.001) and preoperative eGFR (AO group p < 0.001, AV group p = 0.010) were strong predictors of the acute kidney injury in both groups. Older age (AO group p = 0.045, AV group p = 0.010) and preoperative eGFR (AO group p = 0.008, AV group p = 0.002) were significantly associated with CKD progression at 2-year follow-up in both groups. CONCLUSION: AV clamping does not adversely affect postoperative renal function compared to AO clamping. Preoperative patient- and tumor-related factors are more important for renal function regardless of the clamping technique.

Is robotic-assisted sacrocolpo(hystero)pexy safe and effective in women over 65 years of age?

INTRODUCTION AND HYPOTHESIS: The objective was to evaluate the safety and efficacy of robotic-assisted sacrocolpo(hystero)pexy in elderly patients with symptomatic apical pelvic organ prolapse and to compare the outcomes of open abdominal and robotic-assisted sacrocolpo(hystero)pexy in geriatric patients. METHODS: Elderly patients (≥65 years of age) who underwent open abdominal or robotic-assisted sacrocolpo(hystero)pexy for treatment of symptomatic grade 3 and 4 apical pelvic organ prolapse between November 2015 and May 2019 were evaluated retrospectively. The success rates of the procedures, the surgical outcomes, and the perioperative adverse events of both groups were compared. Perioperative adverse events were categorized according to the Clavien-Dindo classification. RESULTS: Forty-four patients underwent open abdominal sacrocolpo(hystero)pexy and 30 patients underwent robotic-assisted sacrocolpo(hystero)pexy. The mean age in the open abdominal sacrocolpo(hystero)pexy group was 68.4 ± 3.4 years and in the robotic-assisted sacrocolpo(hystero)pexy group it was 69.7 ± 4.1 years. The success rates in the open abdominal sacrocolpo(hystero)pexy and robotic-assisted sacrocolpo(hystero)pexy groups were 59% and 57% at median follow-up time of 28 months and 24 months respectively. Although the mean dosage of the analgesic (10.1 mg/24 h) and the mean length of hospital stay (2.1 days) were significantly lower and shorter for the robotic-assisted sacrocolpopexy group, the mean duration of operation was considerably longer (141.2 min). The rate of grade 2 or higher complications for open abdominal sacrocolpopexy was 16% (7 out of 44) and for robotic-assisted sacrocolpopexy it was 17% (5 out of 30). CONCLUSIONS: Anatomical outcomes and adverse events are similar in elderly patients undergoing open sacrocolpo(hystero)pexy and robotic-assisted sacrocolpo(hystero)pexy.

Comparison of retrograde ureterorenoscopy (URS) and percutaneous anterograde ureteroscopy for removal of impacted upper ureteral stones >10mm in the elderly population

ABSTRACT Purpose: We aimed to compare the success and complication rates of the anterograde and retrograde Ureterorenoscopy (URS) for impacted upper ureteral stones in patients > 65 years of age. Materials and Methods: Data of 146 patients >65 years of age and underwent anterograde URS (n=68) in supine position or retrograde URS (n=78) for upper ureteral impacted stones>10 mm between January 2014 and September 2018 were collected prospectively. The groups were compared for success and complication rates, duration of operation, hospital stay, and ancillary procedures. Results: Anterograde and retrograde URS groups were similar for demographic and stone related characteristics. The success rate of the anterograde URS group was significantly higher than the retrograde URS group (97.1% vs. 78.2%, p=0.0007). The complication rates were similar for the two groups (p=0.86). Clavien grade I and II complications were observed in 3 patients in each group. The mean hemoglobin drop was 0.5 g/dL in the anterograde URS group and blood transfusion was not performed in any of the patients. The mean duration of operation was 41.2±12.5 minutes in the mini-PNL group and 59.6±15.1 minutes in the RIRS group and the difference was statistically significant (p=0.02). The median duration of hospitalization was 1 day for both groups. Conclusions: Performing anterograde URS in supine position provided better success rates and similar complication rates compared to retrograde URS. Based on these results anterograde URS shall be considered as one of the primary treatment options for management of impacted upper ureteral stones in the elderly population.

Effect of Active Aspiration and Sheath Location on Intrapelvic Pressure During Miniaturized Percutaneous Nephrolithotomy.

OBJECTIVE: To evaluate the effects of location of the tip of percutaneous sheath and nephroscope in the collecting system together with active aspiration on the Intrapelvic pressure measurements (IPP) during miniaturized percutaneous nephrolithotomy (miniPNL). MATERIALS AND METHODS: The data of 20 patients underwent miniPNL in supine position was collected prospectively. IPP measurements were done with an 8 Fr urodynamic pressure measurement catheter in 4 different settings with respect to location of tip of sheath and nephroscope. All 4 settings were repeated with active aspiration. Totally measurements were done and compared in 8 different settings for 90 seconds in each patient. RESULTS: Highest mean IPP measurements were recorded in setting II (35.3 ± 11.8 cm H2O) where the sheath was located in the calyx and the tip of the nephroscope was in the renal pelvis. When active aspiration was applied, the mean pressure measurements were significantly lower than the counterpart settings without aspiration (all P values <.0001). When the active aspiration was applied, intrarenal pressure measurements did not exceed 40 cm H2O in any settings in any of the patients. CONCLUSION: Location of the tip of the sheath and the nephroscope has significant effect on IPP measurements. Active aspiration significantly lowers the IPP and keeps it <40 cm H2O. Endourologists should be aware of possible alterations in IPP during miniPNL and active aspiration should be kept in mind as an effective solution to decrease the risk of complications related to high IPP.

The evaluation of acute kidney injury due to ischemia by urinary neutrophil gelatinase-induced lipocalin (uNGAL) measurement in patients who underwent partial nephrectomy.

PURPOSE: To investigate the role of urinary neutrophil gelatinase-induced lipocalin (uNGAL) measurement in the early diagnosis of acute kidney injury that may occur after intraoperative ischemia in patients undergoing partial nephrectomy (PN). METHODS: This prospective study included 86 patients who underwent open laparoscopic or robotic partial nephrectomy between May 2017 and May 2019. During the surgery, whether the patients had ischemia or not, type of vascular clamping and the ischemia time were noted. The definition of acute kidney injury (AKI) was classified according to Acute Kidney Injury Network (AKIN) criteria. Urine samples were collected preoperatively and 3 h after renal pedicle clamp removal and uNGAL was measured. RESULTS: AKI was recorded in 34 (39.5%) of 86 patients after PN. Of the 34 patients, 26 (76.4%) had level 1 and 8 (23.6%) had level 2 AKI. uNGAL levels increased significantly as an early reflection of AKI in patients who underwent intraoperative total or renal artery clamping (p = 0.024). There was no significant postoperative increase in uNGAL in the non-ischemic group (p = 0.163). uNGAL expression was detected well before serum creatinine increase. Patients with AKI after PN had higher uNGAL expression (p = 0.008) However, there was no correlation between the level of AKI and uNGAL expression (r = 0.201, p = 0.066). CONCLUSION: Ischemic acute kidney injury after nephron-sparing surgery can be detected early by uNGAL measurement. In future studies comparing outcomes of different surgical techniques on renal functions after PN, uNGAL levels may be used.

Comparison of retrograde ureterorenoscopy (URS) and percutaneous anterograde ureteroscopy for removal of impacted upper ureteral stones >10mm in the elderly population.

PURPOSE: We aimed to compare the success and complication rates of the anterograde and retrograde Ureterorenoscopy (URS) for impacted upper ureteral stones in patients > 65 years of age. MATERIALS AND METHODS: Data of 146 patients >65 years of age and underwent anterograde URS (n=68) in supine position or retrograde URS (n=78) for upper ureteral impacted stones>10 mm between January 2014 and September 2018 were collected prospectively. The groups were compared for success and complication rates, duration of operation, hospital stay, and ancillary procedures. RESULTS: Anterograde and retrograde URS groups were similar for demographic and stone related characteristics. The success rate of the anterograde URS group was significantly higher than the retrograde URS group (97.1% vs. 78.2%, p=0.0007). The complication rates were similar for the two groups (p=0.86). Clavien grade I and II complications were observed in 3 patients in each group. The mean hemoglobin drop was 0.5 g/dL in the anterograde URS group and blood transfusion was not performed in any of the patients. The mean duration of operation was 41.2±12.5 minutes in the mini-PNL group and 59.6±15.1 minutes in the RIRS group and the difference was statistically significant (p=0.02). The median duration of hospitalization was 1 day for both groups. CONCLUSIONS: Performing anterograde URS in supine position provided better success rates and similar complication rates compared to retrograde URS. Based on these results anterograde URS shall be considered as one of the primary treatment options for management of impacted upper ureteral stones in the elderly population.

Reliability and validity of Turkish versions of the interstitial cystitis symptom index and interstitial cystitis problem index.

AIM: To validate the Turkish versions of the interstitial cystitis symptom index (ICSI) and interstitial cystitis problem index (ICPI) for use in Turkish speaking patients with bladder pain syndrome/interstitial cystitis (BPS/IC). METHODS: After translation of the original ICSI and ICPI into the Turkish language, Turkish versions of ICSI and ICPI were self-administered to all participants. Test-retest reliability (intraclass correlation coefficient) was evaluated at 2 weeks intervals in the BPS/IC group. Internal consistency was evaluated using Cronbach's alpha. Scores of ICSI and ICPI was compared between BPS/IC and control groups to examine discriminant validity. Criterion validity was examined via investigating the correlations between bladder diary data (24-hour frequency and nocturia), visual analogue scale (VAS) scores, and results to the corresponding questions in ICSI and ICPI. RESULTS: Results of 79 patients with BPS/IC and 50 control patients were analyzed. Both indices showed high internal consistency (Cronbach's α for ICSI and ICPI was 0.879 and 0.923, respectively). The test-retest reliability of ICSI and ICPI was high for total scores and subdomains of both indices (intraclass correlation coefficient was 0.722 for ICSI and 0.777 for ICPI). Scores of both indices were significantly higher in BPS/IC group than the control group (P < .001). Statistically significant correlations were found between 24-hour frequency, nocturia, VAS scores, and corresponding questions in the indices. A statistically significant and strong correlation was observed between ICSI and ICPI scores (P < .001, rS = .632). CONCLUSION: Turkish versions of ICSI and ICPI are reliable, consistent, and valid instruments to evaluate symptoms of Turkish speaking patients with BPS/IC.

Neonatal Bladder-derived Mesenchymal Stem Cells Ameliorate Bladder Dysfunction in Diabetic Rat Models.

PURPOSE: To evaluate the effect of a new mesenchymal stem cell type derived from the neonatal bladder (nMSC-B) on diabetic bladder dysfunction (DBD). MATERIALS AND METHODS: nMSC-B were harvested from neonatal male Sprague-Dawley rat's bladder and expanded in culture. nMSC-B were transferred to Type-1 diabetic rats which were induced by a single dose 45 mg/kg Streptozocin (STZ). Stem cells were transferred via intraperitoneally (IP) (DM-IP group, n:6) and by direct injection to the detrusor (DM-D group, n:6) at 12th week following diabetes and compared with Phosphate Buffered Saline (PBS) injected diabetic rats (DM-PBS group, n:6) and age-matched PBS injected non-diabetic normal rats (NR-PBS group, n:6). All rats were evaluated histopathologically and functionally four weeks after the stem cell treatment. RESULTS: nMSC-B showed improvement in both voiding function and bladder structure. The maximum voiding pressure (MVP) values in the DM-PBS group were lower compare to DM-IP, DM-D and NR-PBS groups (13.27 ± 0.78 vs 16.27 ± 0.61, 28.59 ± 2.09, 21.54 ± 1.00, respectively, P < .001). There was a significant improvement for MVP values in stem cell-treated groups. Immunohistochemical examination revealed decreased bladder smooth muscle (SM), increased fibrosis and desquamation in urothelia in diabetic groups compared to normal group(P < .001). We detected recovery in the stem cell groups. This recovery was more evident in DM-D group.  No statistical difference was observed in SM and fibrosis between DM-D and NR-PBS groups (P = .9). CONCLUSION: It was shown that nMSCBs provided amelioration of DBD. We think that nMSC-B constitutes an effective treatment method in DBD.