Our experience on Fournier's gangrene in a tertiary-stage care center and analysis of its relationship with blood count parameters.

BACKGROUND: Fournier's gangrene (FG) is rapidly progressing and life-threatening necrotizing fasciitis of genital and perineal regions. The aim of the study was to share our experience with FG and to analyze the relationship of clinical data with whole blood count parameters, inflammation cells, and systemic inflammation markers. METHODS: The digital medical records of the adult patients followed-up and treated with diagnosis of FG between January 2016 to December 2020 were retrospectively analyzed. Data were as age, gender, total length of hospital stay, predisposing factors, etiological factors, total number of debridement's, surgical procedures, and antibiotherapy were collected. Serum glucose levels, complete blood count parameter levels, serum inflammation indicators and C-reactive protein (CRP) levels measured at the initial day of hospital admission, post-debridement 1st and 7th days were measured. RESULTS: Thirty-six male patients were included, with a mean age of 56.42 (22-86) years. The most common predisposing factor was diabetes mellitus (n=13; 36.1%). The most frequently seen etiological cause was scrotal abscess (n=19; 52.8%). A statistically significant decrease was found in White blood cell count, neutrophil level, neutrophil-to-lymphocyte ratio (NLR) value and CRP level measured before debridement, post-debridement 1st and 7th days (p<0.05). There was a positive correlation between the number of debridement's and age, NLR, platelet-to-lymphocyte ratio, and CRP values at the initial admission time (p<0.05). CONCLUSION: The infections of urogenital region are the essential etiological origin of FG. As a rare urological emergency, significant changes were observed in clinical data and blood count parameters during the course of FG.

Post-chemotherapy modified template retroperitoneal lymph node dissection in patients with nonseminomatous germ cell tumours.

INTRODUCTION/BACKGROUND: Although a full bilateral template RPLND is thought to be the standard of care for the management of postchemotherapy retroperitoneal residual masses for nonseminomatous germ cell tumors (NSGCT), in the past decade modified templates have become increasingly popular. In this study, we aimed to present our oncological and perioperative outcomes of consecutive seventeen NSGCT patients who underwent a modified template unilateral PC-RPLND for retroperitoneal residual disease. MATERIALS AND METHODS: We retrospectively evaluated the medical records of 17 consecutive NSGCT patients who underwent modified template unilateral PC-RPLND in our university hospital between 2017 and 2020. All patients had normal serum tumour markers with residual disease in the retroperitoneum. Surgical characteristics including the size of the retroperitoneal residual mass, residual tumor pathology, removed lymph nodes, positive percentage of removed lymph nodes, accompanying operations, complications, mean operation time and hospital stay, and long-term results including survival and antegrade ejaculation were evaluated. RESULTS: Eleven patients underwent left and six right-sided surgery. Median residual lymph node diameter was 41mm. Median hospitalisation time was 3.5 days. Median follow-up time was 10.5 months. Necrosis/fibrosis was seen in 6 patients, and teratoma in 11 patients. No viable tumour was seen. No patients died in the follow-up period. None of the patients relapsed during follow-up. Ten/seventeen patients had antegrade ejaculation. CONCLUSIONS: Modified template unilateral PC-RPLND leads to very good oncological outcomes with decreased perioperative morbidity as well as better antegrade ejaculation rates. Low volume retroperitoneal disease seems to fit this procedure best.

The timing of micro-TESE: what is the ideal age for male and female partner to bring a child to home?

OBJECTIVE: The aim of this study was to analyze the results of microsurgical testicular sperm extraction (micro-TESE) and investigate the potential factors that may affect the successful sperm retrieval and timing of micro-TESE. METHODS: A total of 56 patients with nonobstructive azoospermia (NOA) who underwent micro-TESE procedure between January 2017 and December 2019 were retrospectively analyzed. The patient age, marriage duration, infertility duration, smoking, chronic illness, varicocele status, previous scrotal surgeries, and the presence of genetic disease were noted by an urologist for all patients. RESULTS: The mean age of patients was 33.28±4.4 (22-44) years. Our total sperm-retrieval rate was 55.4% (n:31). Sixteen (28.6%) pregnancies were achieved and 15 (26.8%) healthy live births could be managed. Only the marriage duration (p=0.016) and infertility duration (p=0.015) were detected to be the significant factors to manage successful sperm retrieval. Men with NOA younger than 35.2 years and having a female partner younger than 36.9 years seemed to have the best chance to have a living healthy baby. CONCLUSIONS: The fertility decreased by both male and female age and for men with NOA. The early visit to doctor seemed to have positive effect.

Examination of clinical data and semen analysis results of patients undergoing orchiectomy for testicular tumor.

OBJECTIVE: Testicular tumor constitutes 1% of male neoplasms. Infertility can be determined in patients with testicular tumors before orchiectomy due to the deterioration of spermatogenesis. The aim of this study was to show the clinical, radiological, and pathological characteristics and spermiogram results of patients with testicular tumor and their relationship with each other. METHODS: The data of patients who underwent orchiectomy due to testicular tumor between 2016 and 2019 were reviewed retrospectively. These data included sociodemographic data of the patients, pretreatment spermiogram characteristics, level of serum tumor markers, characteristics of the ultrasonography, type of orchiectomy, and histopathological examination. RESULTS: This study included 53 male patients, with a mean age of 33.51±12.86 years. The mean levels of all tumor markers were above the reference levels. The mean tumor size was 34.68±23.32 mm. Multiple localizations and microlithiasis were detected in 11.3 and 13.2% of the tumors, respectively. The most common masses were hypoechoic (n=37; 69.8%) and hypervascular (n=47; 81%). Spermiogram and cryopreservation were performed in 29 (54.7%) of 53 patients preoperatively. The mean sperm concentration before orchiectomy was 24.21×106 /mL and group A sperm motility 0.79%, group B sperm motility 39.10%, group C sperm motility 9.83%, and group D sperm motility 22.69% in testicular tumors. CONCLUSION: Spermatogenesis adversely affected before the treatment due to local and systemic effects of testicular cancer. Fertility expectations can be increased in the subsequent years by semen analysis and referral to cryopreservation.

The timing of micro-TESE: what is the ideal age for male and female partner to bring a child to home?

SUMMARY OBJECTIVE: The aim of this study was to analyze the results of microsurgical testicular sperm extraction (micro-TESE) and investigate the potential factors that may affect the successful sperm retrieval and timing of micro-TESE. METHODS: A total of 56 patients with nonobstructive azoospermia (NOA) who underwent micro-TESE procedure between January 2017 and December 2019 were retrospectively analyzed. The patient age, marriage duration, infertility duration, smoking, chronic illness, varicocele status, previous scrotal surgeries, and the presence of genetic disease were noted by an urologist for all patients. RESULTS: The mean age of patients was 33.28±4.4 (22-44) years. Our total sperm-retrieval rate was 55.4% (n:31). Sixteen (28.6%) pregnancies were achieved and 15 (26.8%) healthy live births could be managed. Only the marriage duration (p=0.016) and infertility duration (p=0.015) were detected to be the significant factors to manage successful sperm retrieval. Men with NOA younger than 35.2 years and having a female partner younger than 36.9 years seemed to have the best chance to have a living healthy baby. CONCLUSIONS: The fertility decreased by both male and female age and for men with NOA. The early visit to doctor seemed to have positive effect.

Is 'Omega Sign' anatomical endoscopic enucleation of the prostate technique reproducible?

We aimed to evaluate the learning curve of the surgically standardised 'Omega Sign' anatomical endoscopic enucleation (AEEP) of the prostate surgery technique for junior surgeons. This study is a retrospective comparison of cases that underwent AEEP by a mentor surgeon and three junior surgeons who have completed their learning curve. A video-based laser enucleation of the prostate assessment tool (LEAT) composed of 8 steps of the technique was used to assess a senior surgeon and junior surgeons' surgical compatibility and consistency. The surgeon who defined Omega Sign technique was determined as group 1, and cases by three junior surgeons were identified as group 2. The end points were to assess the reproducibility and repeatability and operative post-operative outcomes of the technique. 55 patients' videos were rated by five experienced endourologists. There was no significant difference in LEAT scores between the groups among all steps. The most symmetry was found in the 1st and 3rd steps. Inter-rater consistency was also high for each step, with no statistically significant difference between the evaluators. The standardised anatomical 'Omega Sign' technique is reproducible for the junior surgeons. The operative steps can be performed with high consistency, and the functional and perioperative outcomes are comparable with the senior surgeon.

Laser enucleation for prostates larger than 100 mL: Comparison of HoLEP and ThuLEP.

Recently, with the advancements in laser technology, Holmium laser enucleation of the prostate (HoLEP) and Thulium laser enucleation of the prostate (ThuLEP) have come to the fore in the surgical treatment of benign prostatic hyperplasia (BPH). We aimed to evaluate and compare the outcomes of HoLEP and ThuLEP in patients with >100 ml prostate volume. Patients who underwent HoLEP and ThuLEP between July 2017 and March 2020 were reviewed retrospectively. The patients were divided into two groups as HoLEP (Group 1, n = 121) and ThuLEP (Group 2, n = 104). Perioperative parameters, functional outcomes, continence status, intra and post-operative complications were compared between groups in the post-operative 1st and 6th month. No significant difference was found in terms of total laser energy (TLE), morcellation efficiency (ME), enucleated tissue weight (ETW), complication rates (CR) and continence status of patients between both groups (p > .05). In favour of ThuLEP group, there were statistically significant differences regarding total operation time (TOT), laser efficiency (LE), enucleation time (ET) and enucleation efficiency (EE) between groups (p ≤ .05). HoLEP and ThuLEP can be used safely and effectively in prostates larger than 100 ml.

Examination of clinical data and semen analysis results of patients undergoing orchiectomy for testicular tumor

SUMMARY OBJECTIVE: Testicular tumor constitutes 1% of male neoplasms. Infertility can be determined in patients with testicular tumors before orchiectomy due to the deterioration of spermatogenesis. The aim of this study was to show the clinical, radiological, and pathological characteristics and spermiogram results of patients with testicular tumor and their relationship with each other. METHODS: The data of patients who underwent orchiectomy due to testicular tumor between 2016 and 2019 were reviewed retrospectively. These data included sociodemographic data of the patients, pretreatment spermiogram characteristics, level of serum tumor markers, characteristics of the ultrasonography, type of orchiectomy, and histopathological examination. RESULTS: This study included 53 male patients, with a mean age of 33.51±12.86 years. The mean levels of all tumor markers were above the reference levels. The mean tumor size was 34.68±23.32 mm. Multiple localizations and microlithiasis were detected in 11.3 and 13.2% of the tumors, respectively. The most common masses were hypoechoic (n=37; 69.8%) and hypervascular (n=47; 81%). Spermiogram and cryopreservation were performed in 29 (54.7%) of 53 patients preoperatively. The mean sperm concentration before orchiectomy was 24.21×106 /mL and group A sperm motility 0.79%, group B sperm motility 39.10%, group C sperm motility 9.83%, and group D sperm motility 22.69% in testicular tumors. CONCLUSION: Spermatogenesis adversely affected before the treatment due to local and systemic effects of testicular cancer. Fertility expectations can be increased in the subsequent years by semen analysis and referral to cryopreservation.

Evaluation of static and dynamic Pupillometry changes in men using Silodosin for benign prostatic hypertrophy.

BACKGROUND: Intraoperative floppy iris syndrome is a variant of the small pupil syndrome that has been observed during cataract surgery in some patients currently or previously treated with α1 adrenergic blockers. It is important for cataract surgeons to predict the probable complications preoperatively. Our study aims to evaluate the static and dynamic pupil characteristics of patients treated with silodosin-a selective α1 adrenergic blocker-for benign prostate hypertrophy (BPH) and to compare these values with healthy subjects using an automatic quantitative pupillometry system. METHODS: A total of 74 BPH patients treated with silodosin for six months (group 1) and 30 healthy subjects (group 2) were enrolled in this prospective multidisciplinary cross-sectional study. Static and dynamic pupillometric measurements were obtained under optimized conditions, and the results were compared between the two groups. RESULTS: Seventy-four male patients with a mean age of 63,35 ± 7,21 (46-77) years with BPH treated with silodosin and 30 normal male subjects with a mean age of 63,07 ± 4,73 (52-71) years were analyzed. There were statistically significant differences between the groups with regard to scotopic pupil diameter (PD), high photopic PD, and low photopic PD (p < 0.001, for each one). The patient group had statistically significant higher values of amplitude and velocity of pupil contraction and lower values of duration of pupil contraction and latency as well as duration and velocity of pupil dilation. CONCLUSION: The static and dynamic pupil characteristics of subjects treated with silodosin for BPH are different from those of healthy eyes. In addition, our results may have shed light on the risk for intraoperative floppy iris syndrome (IFIS) before cataract surgery; thus, surgeons can be alert and take precautions.

Renal autotransplantation due to iatrogenic ureter injury: A case report.

Hardy and colleagues carried out 'Renal autotransplantation' for the first time in 1963 to treat severe ureter injury and it has evolved as a method used for complex treatment of trauma, renal artery diseases or ureteral stenosis. In case of proximal ureter injury, approximately 2/3 of which is iatrogenic, if the end-to-end anastomosis is not possible, renal autotransplantation, ileal ureter interposition or nephrectomy are alternative treatments. As technology advances, the use of ureterorenoscopy (URS) increases and in parallel with this iatrogenic injuries that occur during the process have increased as well. These types of injuries are generally in form of simple perforations (2-6%), but from time to time ureter avulsions are also observed (0.3%). In this article, a case is presented where renal autotransplantation is made following development of ureter avulsion during ureterorenoscopy process carried out due to right ureteral calculi and treatment options are discussed in the light of literatures.

The effects of bladder neck sparing with an additional anterior urethral fixation on postoperative continence after robot-assisted radical prostatectomy.

OBJECTIVE: Urinary incontinence remains one of the main problems affecting the quality of life after radical prostatectomy. Along with the improved understanding of the precise anatomy of the prostate, urethra and their surrounding structures, minimally invasive surgical techniques have been refined and described, aiming to improve functional outcomes without oncological compromise. This study aimed to investigate the impacts of anterior urethral fixation (AUF) and bladder neck sparing (BNS) on the early continence success after Robot-assisted Radical Prostatectomy (RALP). METHODS: This retrospective study included 120 patients who underwent RALP between January 2018 and June 2019. Patients were allocated to one of two groups; group 1 (n=60) underwent RALP with BNS, group 2 (n=60) underwent RALP with both AUF and BNS. The patient continence status was measured at baseline on day 7 and in the 1st, 3rd, and 6th months postoperatively. RESULTS: Concerning Incontinence Impact Questionnaire-7 form, statistically significant better results in group 2 were recorded in all visits, but the last (month 6) (p=0.023). Following catheter removal, postmicturition symptoms, including incomplete emptying and post-micturition dribble rate, were significantly higher in group 1 after catheter removal and in the 1st month (13.3% vs. 0 p=0.006). This difference was not recorded at the next visits (months 3 and 6). CONCLUSION: Our findings showed that the combination of AUF and BNS significantly increases early continence rates and decreases post-mictional symptoms after RALP without hampering oncologic outcomes.

Comparison of outcomes of Holmium enucleation of the prostate for small- and moderate-sized prostates.

There is an ongoing discussion in the literature on the surgical treatment option for small prostate size benign prostate hyperplasia (BPH) patients. This study aimed to evaluate the efficacy of Holmium laser enucleation of the prostate (HoLEP) surgery in small (<30 ml) and moderate (30-80 ml) prostate size as accepted in European Association of Urology guideline. We retrospectively analysed our database between May 2016 and May 2019 and patients who underwent HoLEP surgery. Patients who have prostate size <80 ml were included the study. These patients were divided into two group: group 1 with prostate size <30 ml (n: 64) and group 2 with prostate size 30-80 ml (n: 101). Enucleation time (ET), morcellation time (MT), total operation time (OT), enucleation efficiency (EE), morcellation efficiency (ME), intra- and post-operative complications were analysed. While EE and Hb drop were better in favour of group 2; PSA drop, ET, MT, OT and ME were superior in favour of group 1. In group 1, intra-operative complications were higher (6 vs. 2; p < .05) and post-operative complications did not differ statistically between groups (p = .14). No statistically significant finding was found between groups regarding incontinence. In conclusion, HoLEP is a reliable method in terms of its results in patients with small prostates.

Impact of diabetes mellitus on urinary continence after holmium laser enucleation of the prostate due to lower urinary tract symptoms: a retrospective study.

INTRODUCTION: Diabetes mellitus (DM) is known as a risk factor of stress urinary incontinence after Holmium laser enucleation of the prostate (HoLEP). We aimed to compare the postoperative continence status of patients with and without DM, after HoLEP surgery. MATERIAL AND METHODS: A total of 214 patients who underwent HoLEP between January 2017 and January 2020 were retrospectively assessed. Functional outcomes, perioperative total operation time (TOT)(min), enucleation time (ET)(min), enucleation efficiency (EE)(g/min), enucleated tissue weight (ETW)(g), morcellation efficiency (ME)(g/min), morcellation time (MT)(min), continence status, intraoperative and postoperative complications according to Clavien-Dindo classification were recorded. RESULTS: A total of 96 patients had DM additional to benign prostate hyperplasia (BPH) (Group 1), while 118 patients had only benign prostate hyperplasia without DM (Group 2). When comparing preoperative and postoperative functional outcomes, a statistically significant improvement was observed in both groups from baseline to the 1st and 6th month follow-up (p ≤0.001). There were no statistically significant differences between groups in postoperative stress urinary incontinence at postoperative months 1 and 6 (1.7% vs 2.1%, p = 1 and 0.8% vs 1%, p = 1; respectively). There was no significant difference between groups in intraoperative and postoperative complications (p >0.05). CONCLUSIONS: HoLEP is safe to perform in patients with DM at low complication and urinary incontinence rates.

The "Omega Sign": a novel HoLEP technique that improves continence outcomes after enucleation.

PURPOSE: Holmium-laser enucleation of the prostate (HoLEP) has been a promising prostate surgery since its first introduction. Although there are 10 different HoLEP techniques in the literature, stress urinary incontinence (SUI) is common, because surgery is not performed based on the topographic anatomy of the external sphincter. We have developed a new HoLEP method named as the ''Omega Sign technique", which is based on the topographic anatomy of the external sphincter and could provide better continence outcomes by decreasing SUI rates. MATERIALS AND METHODS: The data of 400 patients who underwent HoLEP by a single surgeon between May 2016 and February 2019 were retrospectively reviewed. The patients were divided into two groups, the first underwent the Gilling's technique (Group 1) and the second the novel ''Omega Sign'' technique (Group 2). Continence status and post-micturition symptoms (PMS) were evaluated according to the standards recommended by the international continence status. RESULTS: The data of 400 HoLEP procedures between May 2016 and February 2019 were analyzed, comparing Group 1 (n = 200) and Group 2(n = 200). SUI rate was significantly lower in Group 2 at the day of catheter removal and first month (p < 0.005). In addition, urge urinary incontinence (UUI) rate and PMS were significantly lower in Group 2. CONCLUSIONS: We could demonstrate improved continence results, comparable functional outcomes and equally minimal complications with the standard HoLEP technique. We believe that, the novel 'Omega sign' technique decreases SUI rates and will become standardised and easy to understand, thereby bringing and creating a shorter learning curve.

HoLEP after prostate biopsy: does it have any impact?

PURPOSE: Holmium laser enucleation of the prostate (HoLEP) has recently become the recommended treatment for prostate in all sizes in benign prostate hyperplasia surgery. A recent prostate biopsy performed prior to the HoLEP procedure can make surgeons concerned about the surgery. We aimed to investigate the per- and postoperative outcomes of the HoLEP procedure in patients who underwent prostate biopsy and to evaluate the most appropriate surgery time after biopsy. METHODS: The data of 160 patients who underwent HoLEP by a single surgeon between March 2017 and December 2019 were retrospectively reviewed. The patients were divided into two groups, Group 1 consisted of 80 patients without prostate biopsy and Group 2 consisted of 80 patients with prior prostate biopsy. All HOLEP procedures in group 2 were performed at least 2 weeks following biopsy. Per- and postoperative outcomes, complications were evaluated. RESULTS: No significant differences were found between groups in terms of by enucleation time, efficiency of laser, efficiency of enucleation, hospitalization time, and catheterization removal time. Only morcellation time was shorter in biopsy naïve patients. There were no statistical differences in postoperative outcomes. Previous prostate biopsy did not affect the continence status in our study group. There were not any Clavien grade 4 or higher complications. Urinary tract infection was higher in early post-biopsy period, there was no difference among the groups. CONCLUSiON: Our study confirms that HoLEP is a safe and efficient surgical procedure for the patients with prior prostate biopsy. We believe that it can be safely performed 2nd week following prostate biopsy.

The clinical features and treatment options of intratesticular epidermoid cysts. / Las características clínicas y opciones de tratamiento de los quistes epidermoides intratesticulares.

OBJECTIVES: In this study, we aimed to define the clinico-radiological data and treatment options for intratesticular epidermoid cysts (IEC). MATERIALS AND METHODS: We retrospectively reviewed the medical records of the patients that under went surgery for testicular mass between 1995 and 2017. Data of the patients whose histopathological evaluation revealed IEC were recorded.  RESULTS: A total of 20 patients with IEC were identified.While three of 20 patients were excluded due to incomplete data, the remaining 17 patients with pathologically proven IEC were reviewed and analyzed in the study. The mean patient age was 22.2 years (range, 17-29 years). All patients were presented with painless testicular swelling and/or mass. Serum tumor markers of all patients were within the ranges. Four patients treated with radical orchiectomy (23.5%), while 13 patients under went partial orchiectomy (76.5%). The mean size ofthe IEC was 17.7x15.1 mm (range, 26x10 mm). IEC swere mostly located in the middle pole of the testes (10of 17 patients, 58.8%). CONCLUSIONS: This study is designed in retrospective nature, but the patient population is one the largest reported in the literature. According to our study, we can easily state that partial orchiectomy can be performed safely after FSA in patients that have IECs.

OBJETIVOS: En este estudio, nuestro objetivofue definir los datos clínico-radiológicos y las opciones de tratamiento de los quistes epidermoides intratesticulares (CEI). MATERIALES Y MÉTODOS: Revisamos retrospectivamente los registros médicos de los pacientes que se sometieron a cirugía para la masa testicular entre 1995 y 2017. Entre ellos se registraron los datos de los pacientes cuya evaluación histopatológica reveló IEC. RESULTADOS: Se identificaron un total de 20 pacientes con IEC. Mientras que tres de los 20 pacientes fueron excluidos debido a los datos incompletos, los 17pacientes restantes con IEC patológicamente probada se revisaron y analizaron en el estudio. La edad media de los pacientes fue de 22,2 años (rango, 17-29años). A todos los pacientes se les presentó hinchazón y/o masa testicular indolora. Los marcadores tumorales séricos de todos los pacientes estaban dentro de los rangos. Cuatro pacientes tratados con orquiectomía radical (23,5%), mientras que 13 pacientes se sometieron a orquiectomía parcial (76,5%). El tamaño medio de la IEC fue de 17,7x15,1 mm (rango, 26x10 mm). Los IEC se encontraban principalmente en el polo medio de los testículos (10 de 17 pacientes, 58,8%). CONCLUSIONES: Este estudio está diseñado de forma retrospectiva, pero la población de pacientes es una de las más numerosas que se han publicado en la literatura. Según nuestro estudio, podemos afirmar fácilmente que la orquiectomía parcial se puede realizar de manera segura después de la FSA en pacientes que tienen CEI.

Holmium laser enucleation of the prostate for the treatment of size-independent BPH: A single-center experience of 600 cases.

OBJECTIVE: Holmium laser enucleation of the prostate (HoLEP) is an endourologic minimal invasive intervention of benign prostate hyperplasia (BPH). The interest on HoLEP is increasing in the literature. The aim of the present study was to evaluate the learning curve and our preliminary results. MATERIAL AND METHODS: A retrospective analysis on 600 patients with BPH who underwent HoLEP between July 2015 and April 2019 was performed. Perioperative measures including enucleation efficiency (EE), morcellation efficiency (ME), and percentage of resected tissue weight (PRW) were recorded. Hospitalization time (HT) and catheterization time (CT) were measured. Functional outcomes, Clavien-Dindo classification complications, and continence status were assessed at 1-, 3-, and 6-month follow-up. RESULTS: The mean age, prostate size, and prostate-specific antigen levels of the patients were 64.54 years, 91 g, and 4.54 ng/mL, respectively. There were 38.3% of patients with ≥100 g prostate size. The measured EE, ME, and PRW were 1.12 g/min, 4 g/min, and 72%, respectively. The mean HT and CT were 24.53 h and 21.50 h, respectively. Functional outcomes showed significant improvement at 1-, 3-, and 6-month follow-up. Intraoperative and postoperative complications were comparable with the literature. The most common perioperative complication was superficial bladder mucosal injury (n=8, 1.33%). Only one patient had persistent stress urinary incontinence at 6-month follow-up. CONCLUSION: As mentioned in the literature, HoLEP indications are independent from prostate size. Our results showed similarity with the literature on functional outcomes, complication rates, and continence status. With its superior results, our HoLEP series from Turkey supports that HoLEP will replace transurethral resection of the prostate as the known current gold standard.

Does preoperative use of silodosin affect the stages of f-urs Procedure? / ¿Afecta el uso de silodosin preoperatorio los pasos de la ureteroscopia flexible?

OBJECTIVES: To evaluate the effect of silodosin on stages of the flexible ureterorenoscopy (F-URS) procedures. METHODS: Between November 2015 and August 2017, a total of 76 patients suffering from 10-30 mm kidney stone were enrolled in this randomized prospective study. Patients were randomly divided into 2 groups for treatment: Group 1 had F-URS with preoperative daily uptake of 8 mg silodosin for 10 days, and group 2 had F-URS without silodosin uptake. None of the patients had preoperative JJ stenting. Stages of the F-URS was defined as entrance to bladder time (ETBT) with a semirigid ureterorenoscope (R-URS), entrance to ureteric orifice time (ETUOT) with R-URS using a guide wire and proceeding 2 cm inside the ureter, application of access sheath time (AAST) using the guide wire advanced through R-URS, F-URS time (FURST) + lithotripsy with laser time (LT), and total operation time (OT). We compared the time of each stage between two groups. RESULTS: There were 38 patients group1 and 2, respectively. There was one ureteral access sheath (UAS) application failure in group 1, and 3 failures in group 2 (p = 0.307). The ETBT, ETUOT, and AAST were significantly short in group 1 than group 2 (p = 0.001,0.007,0.002). CONCLUSIONS: Although preoperative use of silodosin facilitated only an insignificant positive effect on UAS placement failure, it eased the F-URS procedure by reducing the ETBT, ETUOT, and AAST in seconds. More studies are needed to make an exact conclusión

OBJETIVOS: Evaluar el efecto de la silodosina en las etapas de los procedimientos de ureterorrenoscopia flexible (F-URS). MÉTODOS: Entre noviembre de 2015 y agosto de 2017, un total de 76 pacientes con cálculos renales de 10-30 mm se inscribieron en este estudio prospectivo aleatorizado. Los pacientes se dividieron aleatoriamente en 2 grupos para el tratamiento: el grupo 1 tenía F-URS con captación diaria preoperatoria de 8 mg de silodosina durante 10 días, y el grupo 2 tenía F-URS sin captación de silodosina. Ninguno de los pacientes tenía stent JJ preoperatorio. Las etapas del F-URS se definieron como entrada al tiempo de la vejiga (ETBT) con un ureterorrenoscopio semirrígido (R-URS), entrada al tiempo del orificio ureteral (ETUOT) con R-URS usando una guía y 2 cm dentro del uréter. Aplicación del tiempo de vaina de acceso (AAST) utilizando el cable de guía avanzado a través de R-URS, tiempo de F-URS (FURST) + litotricia con tiempo de láser (LT) y tiempo total de operación (OT). Comparamos el tiempo de cada etapa entre dos grupos. RESULTADOS: Hubo 38 pacientes grupo 1 y 2, respectivamente. Hubo una falla en la aplicación de la cubierta de acceso ureteral (UAS) en el grupo 1 y 3 fallas en el grupo 2 (p = 0,307). ETBT, ETUOT y AAST fueron significativamente cortos en el grupo 1 que en el grupo 2 (p = 0,001, 0,007, 0,002). CONCLUSIONES: Aunque el uso preoperatorio de silodosina facilitó solo un efecto positivo insignificante en la falla de colocación de UAS, alivió el procedimiento de F-URS al reducir el ETBT, ETUOT y AAST en segundos. Se necesitan más estudios para llegar a una conclusión exacta

Does preoperative use of silodosin affect the stages of F-URS procedure? / ¿Afecta el uso de silodosin preoperatorio los pasos de la ureteroscopia flexible?

OBJECTIVES: To evaluate the effect of silodosin on stages of the flexible ureterorenoscopy (F-URS) procedures. METHODS: Between November 2015 and August 2017, a total of 76 patients suffering from 10-30 mm kidney stone were enrolled in this randomized prospective study. Patients were randomly divided into 2 groups for treatment: Group 1 had F-URS with preoperative daily uptake of 8 mg silodosin for 10 days, and group 2 had F-URS without silodosin uptake. None of the patients had preoperative JJ stenting. Stages of the F-URS was defined as entrance to bladder time (ETBT) with a semirigid ureterorenoscope (R-URS), entrance to ureteric orifice time (ETUOT) with R-URS using a guide wire and proceeding 2 cm inside the ureter, application of access sheath time (AAST) using the guide wire advanced through R-URS, F-URS time (FURST) + lithotripsy with laser time (LT), and total operation time (OT). We compared the time of each stage between two groups. RESULTS: There were 38 patients group1 and 2, respectively. There was one ureteral access sheath (UAS) application failure in group 1, and 3 failures in group 2 (p=0.307). The ETBT, ETUOT, and AAST were significantly short in group 1 than group 2 (p=0.001,0.007,0.002). CONCLUSIONS: Although preoperative use of silodosin facilitated only an insignificant positive effect on UAS placement failure, it eased the F-URS procedure by reducing the ETBT, ETUOT, and AAST in seconds. More studies are needed to make an exact conclusion.

OBJETIVOS: Evaluar el efecto de la silodosina en las etapas de los procedimientos de ureterorrenoscopia flexible (F-URS).MÉTODOS: Entre noviembre de 2015 y agosto de 2017, un total de 76 pacientes con cálculos renales de 10-30 mm se inscribieron en este estudio prospectivo aleatorizado. Los pacientes se dividieron aleatoriamente en 2 grupos para el tratamiento: el grupo 1 tenía F-URS con captación diaria preoperatoria de 8 mg de silodosina durante 10 días, y el grupo 2 tenía F-URS sin captación de silodosina. Ninguno de los pacientes tenía stent JJ preoperatorio. Las etapas del F-URS se definieron como entrada al tiempo de la vejiga (ETBT) con un ureterorrenoscopio semirrígido (R-URS), entrada al tiempo del orificio ureteral (ETUOT) con R-URS usando una guía y 2 cm dentro del uréter. Aplicación del tiempo de vaina de acceso (AAST) utilizando el cable de guía avanzado a través de R-URS, tiempo de F-URS (FURST) + litotricia con tiempo de láser (LT) y tiempo total de operación (OT). Comparamos el tiempo de cada etapa entre dos grupos. RESULTADOS: Hubo 38 pacientes grupo 1 y 2, respectivamente. Hubo una falla en la aplicación de la cubierta de acceso ureteral (UAS) en el grupo 1 y 3 fallas en el grupo 2 (p=0,307). ETBT, ETUOT y AAST fueron significativamente cortos en el grupo 1 que en el grupo 2 (p=0,001, 0,007, 0,002). CONCLUSIONES: Aunque el uso preoperatorio de silodosina facilitó solo un efecto positivo insignificante en la falla de colocación de UAS, alivió el procedimiento de F-URS al reducir el ETBT, ETUOT y AAST en segundos. Se necesitan más estudios para llegar a una conclusión exacta.

The effect of prostatic tissue density on the perioperative outcomes of Holmium laser enucleation of prostate (HoLEP): a pilot study.

PURPOSE: To evaluate the effect of prostate tissue density (PTD) on perioperative Holmium laser enucleation of prostate (HoLEP) outcomes. METHODS: Two hundred fourteen patients underwent HoLEP between December 2016 and August 2018 (group 1: PTD < 1 g/mL and group 2: PTD ≥ 1 g/mL). Enucleation time (ET), morcellation time (MT), total operation time (TOT), total laser energy (TLE), efficiency of laser (EL), efficiency of enucleation (EE), efficiency of morcellation (EM), enucleation rate (ER), and enucleated tissue weight (ETW) were recorded. RESULTS: The mean ages of the groups 1, 2 were 61.36±5.92 and 63.1±7.52 years, respectively. TOT (76.4 vs 86.21 min), ET (69.18 vs 79.94 min), EE (0.80 vs 0.91 g/min), and ETW (55.8 vs 70.23 g) were not significantly different between the two groups. However, the MT was longer in group 2 (11.27 ± 8.57 min and 7.22 ± 5.46 min, p = 0.0001). Furthermore, EM was higher in group 1 (9.81 ± 5.61 g/min and 7.45 ± 4.14 g/min, p = 0.0003). The EL and TLE were similar in both groups. PTD positively correlated with MT (ρ = 0.272, p = 0.0005) and negatively correlated with EM (ρ = - 0.315, p = 0.0001). No correlations were identified between the PTD and EL or EE. CONCLUSIONS: PTD is a factor that influences the HoLEP on perioperative outcomes. The PTD particularly affects the morcellation phase of the surgery. Patients with higher PTD will have a longer duration of MT and lesser EM. Future studies with the use of different imaging methods will give insight into the duration and difficulty of the HoLEP.