Patellar Lateralization, Absence of Joint Hypermobility, and the Mechanism of Injury Are Associated With Osteochondral Fracture After First-time Acute Lateral Patellar Dislocation in Adolescents: An MRI-based Evaluation.

BACKGROUND: Although the risk factors for patellofemoral dislocation are clearly defined, risk factors for osteochondral fracture (OCF) after patellar dislocation are not as well defined. The aim of this study was to investigate the risk factors for OCF by evaluating patients with and without OCF after first-time acute patellar dislocation. METHODS: This multicenter study was conducted as a retrospective examination of the radiologic measurements on the magnetic resonance imaging of 306 patients. The patients were divided into the OCF group and non-OCF group, and OCFs were grouped according to whether the fracture was in the patella or femur. Patellar height, patellar lateralization, trochlear morphology, patellofemoral matching, and patella types were evaluated on patient magnetic resonance imaging. The presence of joint hypermobility in the patients was determined according to the Beighton scale score. The injury mechanisms of the patients were grouped as sports-related injuries, injuries resulting from simple falls, and injuries during daily activities. RESULTS: A total of 120 OCFs were detected in 108 (35.2%) patients, of which 96 (80%) were in the patella and 24 (20%) in the femur. The rate of OCF after sports-related injuries was found to be significantly higher than in other injury mechanisms ( P =0.001). More joint hypermobility was detected in patients without OCF ( P =0.041). The measurements of tibial tubercle-trochlear groove, tibial tubercle-posterior cruciate ligament distance and lateral patellar displacement were statistically higher in cases with OCF ( P =0.001). In patients with normal joint mobility, the rate of OCF localization in the patella was significantly higher ( P =0.035). No correlation was found between any other parameters and OCF ( P >0.05). The absence of joint hypermobility and the measurements of tibial tubercle-trochlear groove distance, tibial tubercle-posterior cruciate ligament distance, and lateral patellar displacement were independent risk factors for the incidence of OCF according to the logistic regression analysis. CONCLUSIONS: The absence of joint hypermobility and patellar lateralization are independent risk factors for the occurrence of OCF after first-time patellar dislocation. Sports-related injury is a nonindependent risk factor for the presence of OCF. In patients with normal joint mobility, the incidence of OCF in the patella is higher than in the femur. These important factors should be considered when evaluating patients and starting their treatment. LEVEL OF EVIDENCE: Level III-retrospective cohort study.

Foot and Ankle Forklift Injuries; Diagnosis to Treatment Options, Return to Work and Functional Outcomes.

As our tertiary-level trauma center is close to an industrial zone and associated international port, industrial injuries are seen more often than is expected in routine practice. The aim of this study was to present the demographic data, treatment options, and changes in work-life of patients with foot and ankle injuries due to a forklift accident, and to determine the factors affecting the clinical outcome. The study was conducted in our university hospital and included patients who presented with a foot and ankle injury resulting from a forklift accident. Data were collected including age, sex, dominant extremity, history of trauma, presence of fracture, management (surgical or conservative), complications, time of return to work, workforce loss, and the American Orthopaedic Foot and Ankle Society (AOFAS) and Short Form Health Survey (SF-36) scores at the final follow-up examination. Evaluation was made of 132 patients, comprising 113 (85.6%) males and 19 (14.4%) females with a mean age of 32 years (range 16-65 years). The most frequently recorded occupational group was shipyard workers (50%). The most common mechanism of injury was crushing under the forklift wheel (n = 63, 47.7%). The most frequently injured foot region was the forefoot (47%). A total of 90 (68.1%) patients continued to work in the same position on return to work. The lowest mean AOFAS score (73.4) and SF-36 (physical component) score (37.3) were determined in cases with mixed region injuries (p = .0001, p = .0001). The wearing of protective footwear had no effect on the rate of return to work (p = .195), workforce loss (p = .34) and AOFAS score (p = .166). This study is the largest series of patients with foot and ankle injuries related to forklift accidents. Forklift injuries can be treated conservatively or surgically according to the clinical condition of the patient. The main indicators of return to work and functional outcome are which foot region is injured and whether or not the injury causes a fracture.

Gilaburu extract (Viburnum opulus Linnaeus) is as effective as Tamsulosin in medical expulsive therapy of distal ureteral calculi.

BACKGROUND: To compare the extract of Gilaburu (Viburnum opulus Linnaeus) and Tamsulosin as a medical expulsive therapy (MET) in patients with distal ureteral calculi of 10 mm or less. METHODS: Data of 86 patients were prospectively collected. The patients were divided into two groups. In the first group, Viburnum opulus 1000 mg peroral 3 × 2 and diclofenac 50 mg peroral on-demand (n = 43), in the second group Tamsulosin 0.4 mg peroral 1 × 1 and diclofenac 50 mg peroral on-demand (n = 43) was given for MET in patients with distal ureteral calculi. Stone expulsion rates, time until expulsion, additional analgesic requirement, need for emergency admission, need for additional treatment were evaluated. In addition, subgroup analyses of ≤5 and 5-10 mm were also performed. RESULTS: There was no difference between the groups in terms of stone expulsion rates and time until the expulsion in all stones. Additional analgesic requirement and need for emergency admission were found to be lower in the Viburnum opulus group (37.2% vs 65.1%, P = .017 and 11.6% vs 34.8%, P = .02, respectively). In subgroup analyses, while stone expulsion rates were similar in subgroups, it was found shorter in the time until expulsion, lower additional analgesic requirement and need for emergency admission in V. opulus group than Tamsulosin group in 5-10 mm stone size subgroup (7.1 ± 4.2 vs 11.8 ± 5.2, P = .005, 32.2% vs 77.7%, P = .001 and 12.9% vs 40.7%, respectively). CONCLUSION: V. opulus can be used effectively and safely for the treatment of MET in distal ureteral calculi.

Does COVID-19 Worsen the Semen Parameters? Early Results of a Tertiary Healthcare Center.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) is a global pandemic which may affect multiple organs and systems including testes and disrupt the gonadal functions. The current study aimed to evaluate the effect of COVID-19 on the semen parameters and sex-related hormone levels in infertile men. METHODS: The study included 21 patients who were evaluated in Ankara City Hospital, Andrology Clinic, for male infertility and have had the diagnosis of COVID-19. All the patients were evaluated in terms of semen parameters. The follicle-stimulating hormone, luteinizing hormone, and testosterone (T) levels were also evaluated in 8 of the patients. The results were presented through 2 dependent group analyses, based on the data of the patients collected before and after the diagnosis of COVID-19. RESULTS: None of the patients needed to be hospitalized at any time through the course of COVID-19. There was a significant decrease in semen volume, percentage of total motility, percentage of progressive motility, and normal sperm morphology after COVID-19 (3 [1-8] vs. 2.5 [1.5-5], p = 0.005; 48.6 ± 22.1 vs. 34.7 ± 20.7, p = 0.001; 35.1 ± 21.7 vs. 21.8 ± 15.9, p < 0.001; 6 [3-24] vs. 5 [3-18], p = 0.015; respectively). There was also a significant decline in T level of the patients after the diagnosis of COVID-19 (350.1 ± 115.5 vs. 289.8 ± 103.3, p = 0.009). CONCLUSION: COVID-19 may have unfavorable effects on the gonadal functions and may lead to further deterioration of the semen parameters in infertile men, which should be considered through the evaluation for infertility.

New behavior therapy in the treatment of acquired premature ejaculation: A comparative study of listening to music. / Nueva terapia conductual en el tratamiento de la eyaculación precoz adquirida: un estudio comparativo de escuchar música.

OBJECTIVES: Premature ejaculation (PE) is one of the most frequently seen causes of sexual dysfunction in males. The aim of this study is to investigate whether the music therapy is effective in the treatment of acquired PE and compare the intravaginal ejaculation latency time (IELT), premature ejaculation diagnostic tool (PEDT), and anxiety scores of patients with acquired PE symptoms that underwent music therapy to patients that were treated with 30 mg dapoxetine. MATERIALS AND METHODS: The study's inclusion criteria was as following: age range from 20-35, married, has regular sexual intercourse, non-smokers, and has no known comorbidities. All participants of the study were with acquired PE based on the International Society for Sexual Medicine criteria. Experimental group (group 1) included 60 patients that were asked to listen to relaxing music and meditate for 45 minutes before the sexual intercourse while continuing their daily routine. This group was selected randomly and prospectively from young healthy individuals. Meanwhile, control group (group 2) included 60 patients who were treated with 30 mg dapoxetine for PE and whose datas were collected from the hospital archive. The patients were evaluated before treatment and re-evaluated (PEDT, IELT, anxiety level) after 60 days. State-Trait Anxiety Inventory was used to assess state and trait anxiety. RESULTS: In both groups, a significant difference (p<0.001) was observed in pre and post-treatment IELT, PEDT, and anxiety scores. Although group 2 showed better improvement in both IELT and PEDT scores, there was no significant difference between two groups. CONCLUSION: Listening to music and other similar anxiety decreasing methods can be a part of treatment plan for PE.

OBJETIVOS: La eyaculación precoz (EP) es una de las causas más frecuentes de disfunción sexual en los hombres. El objetivo de este estudio es investigar si la musicoterapia es eficaz en el tratamiento de la EP adquirida y comparar el tiempo de latencia de la eyaculación intravaginal (IELT), la herramienta de diagnóstico de la eyaculación precoz (PEDT) y las puntuaciones de ansiedad de pacientes con síntomas de EP adquirida que se sometieron a musicoterapia a pacientes que fueron tratados con 30 mg de dapoxetina.MATERIALES Y MÉTODOS: Los criterios de inclusión del estudio fueron los siguientes: rango de edad de 20 a 35 años, casado, tiene relaciones sexuales regulares, no fuma y no tiene comorbilidades conocidas. Todos los participantes del estudio fueron diagnosticados con EP adquirida según los criterios de la Sociedad Internacional de Medicina Sexual. El grupo experimental (grupo 1) incluyó a 60 pacientes a los que se les pidió que escucharan música relajante y meditaran durante 45 minutos antes de la relación sexual mientras continuaban con su rutina diaria. Este grupo se seleccionó de forma aleatoria y prospectiva entre individuos jóvenes sanos. Mientras tanto, el grupo de control (grupo 2) incluyó a 60 pacientes que fueron tratados con 30 mg de dapoxetina para EP y cuyos datos fueron recolectados del archivo del hospital. Los pacientes fueron evaluados antes del tratamiento y reevaluados (PEDT, IELT, nivel de ansiedad) después de 60 días. Se utilizó el Inventario de Ansiedad Estado-Rasgo para evaluar el estado y el rasgo de ansiedad. RESULTADOS: En ambos grupos, se observó una diferencia significativa (p<0,001) en las puntuaciones de IELT, PEDT y ansiedad antes y después del tratamiento. Aunque el grupo 2 mostró una mejora en las puntuaciones de IELT y PEDT, no hubo diferencias significativas entre los dos grupos.CONCLUSIÓN: Escuchar música y otros métodos similares para disminuir la ansiedad puede ser parte del plan de tratamiento para la EP.

Nueva terapia conductual en el tratamiento de la eyaculación precoz adquirida: un estudio comparativo de escuchar música / New behavioral therapy in the treatment of acquired premature ejaculation: a comparative study of listening to music

Objetivos: La eyaculación precoz (EP) es una de las causas más frecuentes de disfunción sexual en los hombres. El objetivo de este estudio es investigar si la musicoterapia es eficaz en el tratamiento de la EP adquirida y comparar el tiempo de latencia de la eyaculación intravaginal (IELT), la herramienta de diagnóstico de la eyaculación precoz (PEDT) y las puntuaciones de ansiedad de pacientes con síntomas deEP adquirida que se sometieron a musicoterapia a pacientes que fueron tratados con 30 mg de dapoxetina.Materiales y métodos: Los criterios de inclusión del estudio fueron los siguientes: rango de edad de 20 a 35 años, casado, tiene relaciones sexuales regulares, no fuma y no tiene comorbilidades conocidas. Todos losparticipantes del estudio fueron diagnosticados con EP adquirida según los criterios de la Sociedad Internacional de Medicina Sexual. El grupo experimental (grupo 1) incluyó a 60 pacientes a los que se les pidió que escucharan música relajante y meditaran durante 45 minutos antes de la relación sexual mientras continuaban con su rutina diaria. Este grupo se seleccionó deforma aleatoria y prospectiva entre individuos jóvenes sanos. Mientras tanto, el grupo de control (grupo 2) incluyó a 60 pacientes que fueron tratados con 30 mg de dapoxetina para EP y cuyos datos fueron recolectados del archivo del hospital. Los pacientes fueron evaluados antes del tratamiento y reevaluados (PEDT, IELT, nivel de ansiedad) después de 60 días. Se utilizó el Inventario de Ansiedad Estado-Rasgo para evaluar el estado y el rasgo de ansiedad. Resultados: En ambos grupos, se observó una diferencia significativa (p<0,001) en las puntuaciones deIELT, PEDT y ansiedad antes y después del tratamiento. Aunque el grupo 2 mostró una mejora en las puntuaciones de IELT y PEDT, no hubo diferencias significativas entre los dos grupos.(AU)

Objectives: Premature ejaculation (PE) is one of the most frequently seen causes of sexual dysfunction in males. The aim of this study is to investigate whether the music therapy is effective in the treatment of acquired PE and compare the intravaginal ejaculation latency time (IELT), premature ejaculation diagnostic tool (PEDT), and anxiety scores of patients with acquired PE symptoms that underwent music therapy to patients that were treated with 30 mg dapoxetine. Materials and Methods: The study’s inclusion criteria was as following: age range from 20-35, married,has regular sexual intercourse, non-smokers, and has no known comorbidities. All participants of the study were diagnosed with acquired PE based on the International Society for Sexual Medicine criteria. Experimental group (group 1) included 60 patients that were asked to listen to relaxing music and meditate for 45 minutes before the sexual intercourse while continuing their daily routine. This group was selected randomly and prospectively from young healthy individuals. Meanwhile, control group (group 2) included 60 patients who were treated with 30 mg dapoxetine for PE and whose datas were collected from the hospital archive. The patients were evaluated before treatment and re-evaluated (PEDT, IELT, anxiety level) after 60 days. State-Trait Anxiety Inventory was used to assess state and trait anxiety. Results: In both groups, a significant difference (p<0.001) was observed in pre and post-treatment IELT, PEDT, and anxiety scores. Although group 2 showed better improvement in both IELT and PEDT scores, there was no significant difference between two groups. Conclusions: Listening to music and other similar anxiety decreasing methods can be a part of treatment plan for PE.(AU)

Does the renal parenchymal thickness affect the efficacy of the retrograde intrarenal surgery? A prospective cohort study.

Retrograde intrarenal surgery (RIRS) is one of the minimally invasive main treatment modalities in renal stone disease. There are many factors which affect stone-free rate (SFR). Our study was based on the hypothesis that higher renal parenchymal thickness (RPT) which may include higher average number of nephrons provides better diuresis. We investigated the efficacy of RPT on success of RIRS. This study is a single-centered prospective surgical cohort study. A total of 383 patients were analyzed. Regularly followed 304 patients with unilateral kidney stone at single pole or renal pelvis and who underwent single-session RIRS were included in the final analysis, and the patients' preoperative and postoperative 1st and 3rd months' data were evaluated. RPT was measured on the non-contrast computed tomography (CT) images. ROC analysis was performed to estimate the cutoff value of RPT for SFR. Univariate and multivariate logistic regression analyses were used to model the relationship between RPT and SFR after RIRS. ROC analysis revealed the best cutoff value of the RPT for predicting residual stone as 19 mm for both the 1st and 3rd month visits with Youden indexes of 0.397 and 0.406, respectively. To the best of our knowledge, this is the first study which evaluated the effect of RPT on the efficacy of RIRS. RPT measurement is a cost-effective method that can be easily performed on routinely applied non-contrast CT and may have predictive value for the surgical success in patients with nephrolithiasis.

Questionnaire-guided evaluation of the effectiveness of long-term intravesical 0.2% chondroitin sulfate therapy in interstitial cystitis.

INTRODUCTION AND HYPOTHESIS: To investigate the long-term feasibility, safety and effectiveness of intravesical chondroitin sulfate therapy in patients with one or more forms of chronic cystitis. METHODS: The study included 62 female patients with interstitial cystitis/painful bladder syndrome (IC/PBS) who received intravesical chondroitin sulfate (40 ml/80 mg) therapy between 2014 and 2018. A total of 15 doses of intravesical treatment were applied, once weekly in the first month and once monthly from the second month onward. A 3-day voiding diary, a visual analog scale (VAS), the O'Leary Sant Indexes (ICSI/ICPI), the Pelvic Pain and Urgency/Frequency Symptom (PPUFS) Scale and PPUF Bother scores were recorded and evaluated through prospective comparison before treatment and at the first month and first year. Patients were also assessed using the Global Response Assessment (GRA) at the end of the first month and first year to assess the effectiveness of responses to treatment. RESULTS: In the first month of treatment, 0.2% chondroitin sulfate was ineffective in 22.5% of patients, with mild improvement observed in 40.0% and moderate-good improvement in 37.0%. Evaluation at the end of the first year revealed mild improvement in 21.0% of patients and moderate-good improvement in 79.0%. Statistically significant improvements were observed in all scoring systems at 1 and 12 months compared with pre-treatment values (p < 0.001). CONCLUSION: Long-term intravesical chondroitin sulfate therapy is a safe and highly successful therapeutic modality that produces significant improvement in patients' quality of life and symptoms in the treatment of IC/PBS.

Robot Assisted Radical Cystectomy Outcomes in Micropapillary and Plasmacytoid Variants.

PURPOSE: To compare the patients who underwent robot assisted radical cystectomy (RARC) and extended pelvic lymph node dissection (EPLND) and whose pathology result was reported as micropapillary variant (MV), plasmacytoid variant (PV) and pure urothelial carcinoma (PUC). MATERIALS AND METHODS: The data of 133 patients who underwent RARC and EPLND with the postoperative pathology results reported as MV, PV and PUC were analyzed. According to the postoperative pathology results, patients were divided into two groups in initial analyses as variant pathologies group (n=14) and PUC group (n=119). In secondary analyses, patients were divided into three groups as MV group (n=7), PV group (n=7) and PUC group (n=119). The operative data, oncologic outcomes and complications were compared between the groups. RESULTS: Median operation time and estimated blood loss were significantly increased in variant pathologies group (P <0.001 and P = .001, respectively). The postoperative pathological T stage, positive surgical margin rate and lymph node involvement were also significantly increased in variant pathologies (P = .001, P = 0.004, P <0.001, respectively). Kaplan-Meier analysis revealed significant decrease in OS and CSS times in PV group compared to PUC group (P = .048 and P = .016, respectively). CONCLUSION: MV and PV are rarely seen variant pathologies with higher pathological T stages. RARC is a minimally invasive surgical technique that can be performed successfully by an experienced surgical team with low morbidity rates and similar oncological results, even in challenging cases.

Distribution of psychogenic and vascular impotence in a tertiary health-care center's cohort: a retrospective study using penile Doppler imaging / Distribución de la impotencia psicógena y vascular en la cohorte de un centro sanitario de tercer nivel: estudio retrospectivo con imágenes Doppler peneanas

PURPOSE: In this study, we retrospectively reviewed the penile color Doppler ultrasound (PCDU) scans of the patients who had admitted to our clinic with erectile dysfunction and aimed to evaluate the contribution of penile Doppler scan results to the clinical decisions. MATERIAL-METHOD: The data of patients admitted to our outpatient clinic with complaints of erectile dysfunction (IIEF-5 score<22 or IIEF-EF score<26) between January 2005 and January 2018 were retrospectively evaluated. Patients whose testosterone level is lower than 280ng/ml or who had undergone radical prostatectomy were excluded from the analysis. RESULTS: Three thousand ninety patients were included in the study. The mean age of our patients was 55.05±13.05 years. In total, 2139 (69%) patients had normal PCDU findings, 351 (11%) patients had arterial insufficiency, 531 (17%) patients had venous insufficiency, and 69 (2%) patients had arterial insufficiency with concurrent venous leakage. When the patients were divided into 2 groups ≤40 years (Group 1) old and >40 years (Group 2) old; normal PCDU findings were found in 432 patients (84%) of the Group 1 patients and normal PCDU findings in 1707 (66%) patients of the Group 2 patients (p < 0.0001). There were arterial insufficiency findings in 24 (4.7%) and 327 (12.7%) patients of the Group 1 and 2, respectively (p = 0.002). CONCLUSION: The etiology is psychogenic in the majority of patients who present with ED complaints to the urology clinic. With age, the prevalence of psychogenic ED is decreasing but still more than organic

OBJETIVO: En este estudio, revisamos retrospectivamente las ecografías Doppler a color del pene (PCDU) de los pacientes que ingresaron en nuestra clínica con disfunción erectile, el objetivo era evaluar la contribución de los resultados de la ecografía Doppler peneana a las decisiones clínicas. MATERIAL Y MÉTODO: Los datos de los pacientes ingresados en nuestra clínica ambulatoria con quejas de disfunción eréctil (puntuación IIEF-5<22 o puntuación IIEF-EF<26) entre enero de 2005 y enero de 2018 se evaluaron retrospectivamente. Los pacientes cuyo nivel de testosterona fuera inferior a 280ng/ml o a los cuales se les hubiera realizado una prostatectomía radical se excluyeron del análisis. RESULTADOS: En el estudio se incluyó a 3.090 pacientes. La media de edad de nuestros pacientes fue de 55,05±13,05 años. En total, en 2.139 pacientes (69%) hubo hallazgos normales en la PCDU; en 351 (11%) se observó insuficiencia arterial; en 531 (17%) insuficiencia venosa y en 69 (2%) insuficiencia arterial con reflujo venoso simultáneo. Cuando los pacientes se dividieron en 2 grupos, ≤40 años (grupo 1) y >40 años (grupo 2), se encontraron hallazgos normales de la PCDU en 432 pacientes (84%) de los pacientes del grupo 1 y hallazgos normales de PCDU en 1.707 pacientes (66%) del grupo 2 (p < 0,0001). Hubo hallazgos de insuficiencia arterial en 24 (4,7%) y 327 (12,7%) pacientes de los grupos 1 y 2, respectivamente (p = 0,002). CONCLUSIÓN: La etiología es psicógena en la mayoría de los pacientes que presentan quejas de en la clínica de urología. Con la edad, la prevalencia de la DE psicógena va disminuyendo, pero todavía es más psicógena que orgánica

Which is the best radiological imaging method for predicting actual prostate weight?

In this study, we compared the weight of the prostate specimen removed after robotic radical prostatectomy with the prostate weight measured pre-operatively by four different imaging modalities. Pre-operative prostate weight before robotic radical prostatectomy was measured by Transabdominal Ultrasonography (TAUS), Transrectal Ultrasonography (TRUS), Abdominal Tomography (CT) and MultiparametricProstate Magnetic Resonance imaging (mpMRI). Of the 170 patients enrolled in the study, the mean age was 65.2 ± 7.08 (46-84) years and mean prostate-specific antigen (PSA) 9.6 ± 7.7 (1.8-50). The mean post-operative actual prostate weight was 63.1 ± 30 gr. The mean pre-operative prostate volumes measured by TAUS, TRUS, CT and MPMRI were 64.5 ± 28.5, 49.1 ± 30.6, 54.5 ± 30.5 and 68.7 ± 31.7 ml, respectively (p < .001). Post-operative actual prostate weight correlated with prostate weight measured by TAUS, TRUS, CT and mpMRI (r coefficient 0.776, 0.802, 0.768 and 0.825 respectively). The best of these was mpMRI. Although prostate weight measured by different imaging methods has a high correlation to predict actual prostate weight, actual prostate weight is best predicted by measurements with mpMRI. However, errors and deviations that may occur with these imaging methods should be taken into consideration.

The change in Thiol-Disulphide Homeostasis levels as an oxidative stress marker after varicocelectomy: Is there a relationship with sperm parameters?

One of the most important causes of varicocele-related infertility is oxidative stress (OS). One of the markers considered as an indicator of OS is thiol-disulphide homeostasis (TDH). Based on the hypothesis that OS should decrease after varicocelectomy in the light of this information, in our current study, we investigated the relationship between TDH levels and sperm parameters. The data of 56 infertile varicocele men were prospectively analysed. The post-operative total and native thiol levels were significantly higher than those pre-operative total and native thiol levels (477.7 & 436.7 nmol/L, 417.6 & 372.1 nmol/L). Positive correlation was found between total thiol change and change in semen volume (ρ: .277, p: .039), ratio of spermatozoa with normal morphology (ρ: .342, p: .01), progressive (ρ: .334, p: .012) and nonprogressive motility (ρ: .385, p: .003). Positive correlation was also found between native thiol change and semen volume (ρ: .349, p: .008), ratio of spermatozoa with normal morphology (ρ: .362, p: .006), progressive (ρ: .297, p: .026) and nonprogressive motility (ρ: .368, p: .005). Change in the level of TDH was found as positively correlated with progressive and nonprogressive motility change. According to these results, OS decreases with varicocelectomy in infertile patients and TDH can be used as a useful method for measuring OS.

Distribution of psychogenic and vascular impotence in a tertiary health-care center's cohort: A retrospective study using penile Doppler imaging.

PURPOSE: In this study, we retrospectively reviewed the penile color Doppler ultrasound (PCDU) scans of the patients who had admitted to our clinic with erectile dysfunction and aimed to evaluate the contribution of penile Doppler scan results to the clinical decisions. MATERIAL-METHOD: The data of patients admitted to our outpatient clinic with complaints of erectile dysfunction (IIEF-5 score<22 or IIEF-EF score<26) between January 2005 and January 2018 were retrospectively evaluated. Patients whose testosterone level is lower than 280ng/ml or who had undergone radical prostatectomy were excluded from the analysis. RESULTS: Three thousand ninety patients were included in the study. The mean age of our patients was 55.05±13.05 years. In total, 2139 (69%) patients had normal PCDU findings, 351 (11%) patients had arterial insufficiency, 531 (17%) patients had venous insufficiency, and 69 (2%) patients had arterial insufficiency with concurrent venous leakage. When the patients were divided into 2 groups ≤40 years (Group 1) old and >40 years (Group 2) old; normal PCDU findings were found in 432 patients (84%) of the Group 1 patients and normal PCDU findings in 1707 (66%) patients of the Group 2 patients (p<0.0001). There were arterial insufficiency findings in 24 (4.7%) and 327 (12.7%) patients of the Group 1 and 2, respectively (p=0.002). CONCLUSION: The etiology is psychogenic in the majority of patients who present with ED complaints to the urology clinic. With age, the prevalence of psychogenic ED is decreasing but still more than organic.

Complete blood count and penile colour doppler ultrasonography findings in erectile dysfunction: Is there a relationship?

The aim of this study was to evaluate the relationship between penile colour doppler ultrasonography (PCDUS) and complete blood count parameters in patients with erectile dysfunction (ED). The data of the patients who applied to our outpatient clinic with ED (IIEF-5 score <22 or IIEF-EF score <26) between January 2007 and May 2017 were retrospectively analysed. The patients who had available PCDUS results and complete blood count (CBC) values were included in the study. Patients were divided into two groups having normal (n = 530 [68.9%]) or abnormal (n = 240 [31.1%]) PCDUS findings (group 1 versus group 2 respectively). Subsequently, group 2 was divided into three subgroups according to presence of arterial insufficiency (group 2a; n = 85 [11%]), venous insufficiency (group 2b; n = 140 [18.2%]) and both of arterial and venous insufficiency (group 2c; n = 15 [1.9%]), and the four groups were compared in terms of CBC parameters. There was no statistically significant difference between the 4 groups, and between the patients with normal and abnormal PCDUS findings in terms of CBC values. CBC values were not associated with PCDUS findings in patients with ED.

Robotic radical prostatectomy in 93 cases: Outcomes of the first ERUS robotic urology curriculum trained surgeon in Turkey.

OBJECTIVE: This study presents the surgical, oncological, and functional outcomes of the first 93 robotic radical prostatectomy (RARP) procedures performed in Erzurum, Turkey. These procedures were performed by a single surgeon who had completed the European Association of Urology Robotic Urology Section (ERUS) RARP curriculum in an ERUS-certified training center in Ankara. MATERIAL AND METHODS: The study present the results of 93 RARP procedures performed by a single surgeon. The surgeon performing the operations completed an ERUS training program structured for RARP by two robotic surgeons holding ERUS training certificates in an ERUS-approved academic robotic surgery training center in Ankara. The RARP cases performed by the surgeon after completion of the training between April 2016 and August 2018 were retrospectively evaluated. RESULTS: The mean patient age was 63.62±7.04 years, and the mean preoperative serum prostate-specific antigen level was 8.34±4.96 ng/mL. Preoperatively, 82 and 4 patients had prostate biopsy Gleason scores of 3+3 and 4+3, respectively. Bilateral neurovascular bundle (NVB) sparing, unilateral NVB-sparing, and non-NVB-sparing surgery were performed in 21, 13, and 59 cases, respectively. The mean prostate weight was 85.34±47.57 g. Posterior rhabdosphincter reconstruction was performed in 60 (64.5%) cases. Mean console time, intraoperative blood loss, duration of hospital stay, and urethral catheter removal time were 170.49±36.50 min, 100.70±34.08 cc, 6.84±2.28 days, and 7.40±3.11 days, respectively. During the perioperative period (0-30 days), five minor (prolonged drain output, n=3; rectocele, n=1; gout arthritis, n=1) and six major (inguinal hernia, n=1; incisional hernia, n=2; anastomotic urinary leakage, n=2; myocardial infarction, n=1) complications were identified. No complication was detected during postoperative days 31-90. Postoperative pathological stages included pT2a, pT2b, and pT2c disease in 77 (82.8%), 9 (9.7%), and 7 (7.5%) patients, respectively. The positive surgical margin (SM) rate was 10.7% (n=10), including patients with pT2a (n=6) and pT2c (n=2) diseases. Eleven (11.8%) patients underwent pelvic lymph node (LN) dissection. The mean LN yield was 16.45±4.29. The mean length of follow-up was 11.17±8.01 months. Biochemical recurrence was observed in two patients, one of whom received maximal androgen blockage (MAB), and the other one received pelvic radiotherapy+MAB. All the patients with at least one-year follow-up (n=48, 51.6%) were fully continent (0 pads/day). Of the 40 (43%) patients with no preoperative erectile dysfunction (ED) and with at least three-month follow-up, 18 (45%) had no ED, with or without any additional medication including phosphodiesterase-5 (PDE5) inhibitors. CONCLUSION: RARP is a safe minimally invasive procedure with acceptable morbidity, excellent operative, pathological and oncological outcomes, and satisfactory functional results. The ERUS RARP curriculum provides effective and sufficient training.

Robotic Radical Cystectomy with Intracorporeal Studer Pouch Formation for Bladder Cancer: Experience in Ninety-Eight Cases.

Aim: To report the outcomes of robot-assisted radical cystectomy (RARC) with bilateral extended pelvic lymph node dissection (BEPLND) and intracorporeal Studer pouch formation for bladder cancer. Materials and Methods: Overall 98 patients (92 males, 6 females) were included. Patient demographics, operative and postoperative variables, pathological parameters, complications, and functional outcomes were evaluated. Results: Mean age and American Society of Anesthesiologists score and body mass index were 60.9 years, 1.7 and 26 kg/m2, respectively. Neoadjuvant chemotherapy was given to 18 patients. Mean operation time, intraoperative estimated blood loss, and mean lymph node (LN) yield were 8.22 hours, 314.6 mL, and 28.3, respectively. Mean hospitalization time was 13.6 days. There were one perioperative and one postoperative deaths, both due to cardiac arrest on postoperative 21st and 60th days. Drains were removed at a mean of 10 days. Surgical margins were positive in two patients. Postoperative pathological stages were reported as pT0 (n = 21), pTis (n = 7), pT1 (n = 7), pT2a (n = 14), pT2b (n = 14), pT3a (n = 15), pT3b (n = 11), and pT4a (n = 9). Positive LNs were found in 21 patients. Prostate cancer was incidentally detected in 23 patients. Twenty-five patients received adjuvant chemotherapy. At a mean follow-up period of 25.1 months, 13 patients died from metastatic disease and 7 from cardiac disease. According to the modified Clavien-Dindo system, 30 minor and 20 major complications were identified in the perioperative (0-30 days) period, and 6 minor and 7 major complications were detected in the postoperative (31-90 days) period. According to the available data of the 60 patients, 37 were fully continent, 14 had mild, 6 had moderate, and 4 had severe daytime incontinence. Conclusions: Due to our experience, RARC with BEPLND and intracorporeal Studer pouch reconstruction procedures are complex procedures with acceptable morbidity, excellent surgical and pathological outcomes, and satisfactory oncologic and functional results.

The evaluation of prostate lesions with IVIM DWI and MR perfusion parameters at 3T MRI.

PURPOSE: The purpose of our study was to analyze the difference between IVIM DWI and perfusion parameters of malignant lesions and benign lesions-normal prostate tissue. METHODS: This prospective study included 31 patients who had multiparametric prostate MRI with IVIM DWI due to elevated prostate-specific antigen level and clinical suspicion between February 2015 and September 2016. RESULTS: For peripheral zone, the mean values of Ktrans, Kep, iAUC, χ2 and f were significantly higher in malignant lesions, and the mean values of Dt were significantly lower in malignant lesions (p 0.00, p 0.02, p 0.00, p 0.02 and p 0.00, respectively). For transitional zone, the mean values of Ktrans, Ve, iAUC, χ2 and f were significantly higher in malignant lesions, and the mean values of Dp and Dt were significantly lower in malignant lesions (p 0.00, p 0.00, p 0.00, p 0.00, p 0.00, p 0.02 and p 0.00, respectively). For whole prostate gland, the mean values of Ktrans, Kep, Ve, iAUC, χ2 and f were significantly higher in malignant lesions, and the mean values of Dp and Dt were significantly lower in malignant lesions (p 0.00, p 0.03, p 0.00, p 0.00, p 0.00, p 0.01, p 0.04 and p 0.00, respectively). CONCLUSIONS: Restricted diffusion-pseudodiffusion and increased perfusion parameters are important to differentiate prostate cancer from benign pathologies. It is also important to keep in mind that transitional zone and peripheral zone tumors may have different perfusion and diffusion parameters. Future studies are needed to confirm our findings.

Does Presence of a Median Lobe Affect Perioperative Complications, Oncological Outcomes and Urinary Continence Following Robotic-assisted Radical Prostatectomy?

PURPOSE: To evaluate of the presence of a median lobe(ML) affect perioperative complications, positive surgical margins(PSM), biochemical recurrence(BCR) and urinary continence(UC) following robotic-assisted radical prostatectomy(RARP). MATERIALS AND METHODS: Data of 924 consecutive patients who underwent RARP for prostate cancer (PCa) and who have at least 1-year follow-up were evaluated retrospectively. All patients were divided into two groups: Group 1(n=252) included patients with ML and Group 2 (n=672) included patients without ML. The primary endpoint of this study was to compare complication rates between two groups. The secondary endpoints were to compare PSM, BCR and UC rates. RESULTS: Both groups were statistically similar in terms of demographics and variables about PCa. Mean prostate volume was higher in Group 1 vs. Group 2 (69± 31 vs. 56±23 mL, p<.001). Total operative time was longer in Group 1 vs. Group 2 (144±38 vs. 136±44 min, p=.01). Biochemical recurrence, PSM, perioperative and postoperative complication rates of our population were 13.6%, 14.9%, 1.7% and 8.7%, respectively. There were no statistical differences in terms of perioperative complication, PSM and BCR rates between the groups(p>0.05). At the first month after RARP, total continence rate was statistically significant lower in Group 1 vs. Group 2 (49.2% and 56.5%, p=.03), respectively. However, there were no significant differences in terms of continence rates at 3rd month, 6th month and 1st-year follow-up. CONCLUSIONS: Due to our experience, the presence of ML does not seem to affect perioperative complication, intraoperative blood loss, PSM and BCR following RARP. However, the presence of ML seems to be a disadvantage in gaining early UC following RARP.

Management of ureteric duplications identified during robotic cystectomy and intracorporeal urinary diversion.

Ureteral duplication is rarely seen malformation that could be diagnosed during radiological imaging. Herein, we present 5 patients with ureteral duplication who underwent robotic radical cystectomy with intracorporeal urinary diversion for bladder cancer. Preoperative computerized tomography did not show presence of a ureteral duplication in any patient and all were identified intraoperatively. A Wallace type uretero-ureteral anastomosis was performed in all patients. During the follow-up period, we did not detect any ureterointestinal anastomotic strictures or complication related to the presence of a ureteral duplication following robotic cystectomy. We conclude that ureteral duplication might be missed during preoperative radiological imaging, might be a surprising and challenging issue for the robotic surgeon that could be safely managed intraoperatively.

Could spinal anesthesia be a choice for retrograde intrarenal surgery.

OBJECTIVE:: In this study, we aimed to compare cases of retrograde intrarenal surgery performed under spinal or general anesthesia through investigating relevant parameters for the first time in the literature. MATERIAL AND METHOD:: In total, 86 patients with diagnosis of kidney stone who were treated by retrograde intrarenal surgery were included in this randomized controlled prospective study. In total, 43 of these operations were performed under spinal anesthesia (group I) and 43 were performed under general anesthesia (group II). The groups were compared in terms of demographic features, American Society of Anesthesiologists score, duration of operation, complication rates, postoperative visual analogue scale, postoperative hospitalization period, stone-free rates, and cost value ratios. RESULTS:: There were no significant differences between the two groups in terms of demographic findings, preoperative stone loads, postoperative stone-free rates, complication rates and postoperative hospitalization periods (p > 0.05). Postoperative visual analogue scale scores and cost value ratios were found statistically significantly lower in the spinal anesthesia group (group I) when compared with the general anesthesia group (group II; p < 0.001). CONCLUSION:: Performing retrograde intrarenal surgery in the presence of spinal anesthesia is equally effective with general anesthesia. Spinal anesthesia also appears to be a more advantageous method due to statistically significantly lower mean postoperative pain scores and treatment cost value ratios.