A rare cause of hydronephrosis: Leiomyoma of the ureter and a literature review.

INTRODUCTION: Leiomyomas of the genitourinary tract are rare and their manifestation in the ureter is even rarer. To our knowledge, only 14 cases of leiomyoma of the ureter have been reported worldwide since 1955, therefore this case will be 15th. CASE PRESENTATION: We present a rare case of primary leiomyoma of the right ureter. Ureteroscopy did not show any abnormal findings in the ureteral mucosa. The primary leiomyoma was resected with distal ureterectomy and partial cystectomy that was followed with ureteroneocystostomy due to extraluminal mass that caused hydronephrosis and back pain. CONCLUSION: Although rare, we believe that leiomyoma should be considered in the differential diagnoses of well-circumscribed ureteral masses and kidney-sparing surgery should be performed.

Priapism – A rare side effect of alpha blockers: Report of 2 cases and literature review / Priapismo – Un efecto secundario raro de los alfabloqueantes: informe de dos casos y revisión de la literatura

Priapism is a prolonged unintended erectile state unrelated to sexual stimulation or sexual desire. There is a very rare relationship between the use of alpha blockers and the development of priapism. Here, we describe 2 cases of alpha blocker induced priapism and a literature review. One of these cases is related to the use of silodosin and the other is related to the use of tamsulosin. So far, 18 alpha blocker induced priapism cases have been reported. We are presenting the first case of silodosin induced priapism and the eighth case of priapism secondary to tamsulosin. Despite silodosin having a much greater affinity for the α1-a receptor than the α1-b receptor, as represented in this case it can cause this rare side effect. Before starting alpha blocker treatment, side effects such as priapism, which may be very rare but may cause serious problems, should be kept in mind. (AU)

El priapismo es un estado eréctil prolongado no intencionado y no relacionado con la estimulación o el deseo sexual. Existe una relación muy infrecuente entre el uso de alfabloqueantes y el desarrollo de priapismo. Describimos aquí dos casos de priapismo inducido por alfabloqueantes y una revisión de la literatura. Uno de estos casos guarda relación con el uso de silodosina, y el otro con el uso de tamsulosina. Hasta el momento se han reportado 18 casos de priapismo inducido por alfabloquantes. Presentamos aquí el primer caso de priapismo inducido por silodosina y el octavo caso de priapismo secundario a tamsulosina. A pesar de que silodosina tiene mucha mayor afinidad por el receptor α1-a que el receptor α1-b, según lo representado en este caso, puede causar este efecto secundario raro. Antes de iniciarse tratamiento con alfabloquantes deben tenerse en cuenta los efectos secundarios, tales como priapismo, que pueden ser muy raros pero pueden causar problemas graves. (AU)

The effect of vitamin D deficiency in children with overactive bladder related urinary incontinence

ABSTRACT Purpose: Overactive bladder (OAB) is a common syndrome associated with lower urinary tract symptoms (LUTS), especially urinary incontinence in children, which may affect the patient's quality of life (QoL). Vitamin D deficiency has been shown to be associated with OAB syndrome. This study evaluated the relationship between vitamin D status and OAB-related symptoms and QoL in children. Materials and Methods: The study included 52 pediatric patients with OAB-related urinary incontinence and 41 healthy children. LUTS were assessed using the Dysfunctional Voiding and Incontinence Symptoms Score (DVISS) questionnaire, and QoL was assessed using the Pediatric Incontinence Questionnaire (PINQ). Oral vitamin D supplementation was given to patients with OAB with vitamin D deficiency. Urinary symptoms and QoL were evaluated before and after vitamin D supplementation. Results: Vitamin D deficiency was more common in the OAB group (75%) than in the control group (36.6%). Logistic regression analysis revealed that vitamin D status (<20ng/mL) was a significant predictor of OAB. Both pre-treatment and post-treatment DVISS and PINQ scores showed a positive correlation. After vitamin D supplementation, 8 (23.5%) patients had a complete response and 19 (55.9%) patients had a partial response. Significant improvement in QoL was also achieved. Conclusions: Vitamin D deficiency is more common in children with urinary incontinence and OAB than in healthy children. Although vitamin D deficiency is not routinely evaluated for every patient, it should be evaluated in treatment-resistant OAB cases. Vitamin D supplementation may improve urinary symptoms and QoL in patients with OAB.

The effect of vitamin D deficiency in children with overactive bladder related urinary incontinence.

PURPOSE: Overactive bladder (OAB) is a common syndrome associated with lower urinary tract symptoms (LUTS), especially urinary incontinence in children, which may affect the patient's quality of life (QoL). Vitamin D deficiency has been shown to be associated with OAB syndrome. This study evaluated the relationship between vitamin D status and OAB-related symptoms and QoL in children. MATERIALS AND METHODS: The study included 52 pediatric patients with OAB-related urinary incontinence and 41 healthy children. LUTS were assessed using the Dysfunctional Voiding and Incontinence Symptoms Score (DVISS) questionnaire, and QoL was assessed using the Pediatric Incontinence Questionnaire (PINQ). Oral vitamin D supplementation was given to patients with OAB with vitamin D deficiency. Urinary symptoms and QoL were evaluated before and after vitamin D supplementation. RESULTS: Vitamin D deficiency was more common in the OAB group (75%) than in the control group (36.6%). Logistic regression analysis revealed that vitamin D status (<20ng/mL) was a significant predictor of OAB. Both pre-treatment and post-treatment DVISS and PINQ scores showed a positive correlation. After vitamin D supplementation, 8 (23.5%) patients had a complete response and 19 (55.9%) patients had a partial response. Significant improvement in QoL was also achieved. CONCLUSIONS: Vitamin D deficiency is more common in children with urinary incontinence and OAB than in healthy children. Although vitamin D deficiency is not routinely evaluated for every patient, it should be evaluated in treatment-resistant OAB cases. Vitamin D supplementation may improve urinary symptoms and QoL in patients with OAB.

Priapism - A rare side effect of alpha blockers: Report of 2 cases and literature review.

Priapism is a prolonged unintended erectile state unrelated to sexual stimulation or sexual desire. There is a very rare relationship between the use of alpha blockers and the development of priapism. Here, we describe 2 cases of alpha blocker induced priapism and a literature review. One of these cases is related to the use of silodosin and the other is related to the use of tamsulosin. So far, 18 alpha blocker induced priapism cases have been reported. We are presenting the first case of silodosin induced priapism and the eighth case of priapism secondary to tamsulosin. Despite silodosin having a much greater affinity for the α1-a receptor than the α1-b receptor, as represented in this case it can cause this rare side effect. Before starting alpha blocker treatment, side effects such as priapism, which may be very rare but may cause serious problems, should be kept in mind.

Evaluation of the role of thiol / disulfide homeostasis in the etiology of idiopathic male infertility with a novel and automated assay.

Idiopathic male infertility (IMI) is the absence of a reason to explain a patient's infertility, and it occurs at a frequency of %31. In this study we aimed to investigate the oxidant/antioxidant status of patients with IMI and compare their results to those of healthy controls.A total of 79 patients with IMI (group 1) and 90 healthy individuals (group 2) were included in the study. We used Erel & Neselioglu's thiol/disulfide homeostasis test. Collective and individual measurements of oxidative/antioxidative balance components were carried out by this novel thiol/disulfide homeostasis test. Serum antioxidant (total thiol (toSH), native thiol (SH)) and oxidant (disulfide (SS)) levels of all study participants were measured. The results from both groups were compared and analyzed statistically. After toSH, SH, and SS levels were determined, SS/toSH% and SS/SH% levels for each group were analyzed separately and compared statistically.The toSH, SH levels, and SS/SH%, SS/toSH% ratios were significantly different between the groups (p < 0.05).While antioxidant parameters (toSH and SH values) decreased in group1, oxidant parameters (SS/SH%, SS/toSH%) increased significantly. Although SS values were higher in group 1, the difference was not significant (p = 0.214). The SH cutoff value of 507.15 µmol/L predicted the probability of IMI development with 72.2% sensitivity and 74.4% specificity and toSH cutoff value of 545.45 µmol/L predicted IMI development with 70.9% sensitivity and 73.3 specificity (p < 0.001). Multivariate logistic regression analysis showed that the only independent risk factor for the development of IMI is SH. Patients with IMI had a significant change in their thiol/disulfide homeostasis, which suggests the involvement of this imbalance in the pathophysiology of IMI. Furthermore, these results also support the notion of the involvement of oxidative stress in sperm dysfunction. It also points to the possibility of using antioxidants in IMI treatment.Abbreviations: IMI: idiopathic male infertility; toSH: total thiol; SH: native thiol; SS: disulfide; OS: oxidative stress; ROS: reactive oxygen species; DCF: dichlorofluorescein; MiOXSYS: male infertility oxidative system; MOSI: male oxidative stress infertility; LC: L-carnitine; LAC: L-acetylcarnitine; Vit: vitamin; OAT: oligoasthenozoospermia; TMSC: total motile sperm count; WHO: World Health Organization; BMI: body mass index; DTNB: 5,5'-dithiobis-2-nitrobenzoic acid; CV: coefficient variation; ROC: receiver operating characteristic; PR: progressive, NP: non-progressive.

Effects of severe hydronephrosis on the outcomes of percutaneous nephrolithotomy with one-shot dilation method.

OBJECTIVE: To investigate the effect of the presence of severe hydronephrosis on percutaneous nephrolithotomy (PNL) outcome in patients who underwent PNL operation with one-shot dilatation technique. MATERIALS AND METHODS: Medical data of 989 patients underwent PNL operation in our clinic between 2012 and 2018 were retrospectively reviewed. We included 373 of the patients underwent PNL operation due to renal pelvic stone, who were older than 18 years of age, who did not have any urinary tract abnormality, and had no previous history of open renal stone operation. Patients were divided into two groups according to the presence of severe hydronephrosis and absence of hydronephrosis. These two groups were compared in terms of age, gender, body mass index (BMI), number of stones, stone burden, operation duration, fluoroscopy time, hospitalization time, hemoglobin and creatinine change, complications, and stone free rate. RESULTS: There was no statistically significant difference between the groups in terms of age, gender, BMI, stone number, stone size, stone density, operation duration, fluoroscopy time, and hospitalization duration. The mean change in hemoglobin was 1.5 g/dL in group 1 and 1.1 g/dL in group 2. This difference was statistically significant (p = 0.006). Postoperative blood transfusion was required for 3 patients (2.1%) in group 1 and 12 patients (5.1%) in group 2. This difference was statistically significant (p < 0.001). CONCLUSION: Only the presence of severe hydronephrosis was found to be associated with the change in hemoglobin and postoperative blood transfusion.

Comparison of NeoAlis™ disposable circumcision device and sleeve technique in circumcision: Results from a referral health-care center in Turkey.

BACKGROUND: Circumcision has been one of the most commonly performed surgical procedures worldwide since ancient times. Given the popularity of this procedure, the aim of this study was to evaluate the effectiveness, reliability, and results of circumcision performed using the NeoAlis™ clamp and compare them with those obtained using the sleeve technique. STUDY DESIGN: The results of 2259 patients circumcised using the two techniques were evaluated retrospectively. The patients who were circumcised using the plastic NeoAlis™ device were classified as group 1 and those circumcised using the sleeve technique were designated as group 2. The groups were compared in terms of operation time, results, cost, complications, and cosmetic satisfaction scores. RESULTS: A total of 1947 patients who met the inclusion criteria were included in the study. Group 1 consisted of 1454 patients, while group 2 comprised 493 patients. The total rate of complications, excluding bleeding in the form of oozing that stopped spontaneously, was 9.5% (n = 185). In group 1, the operation time was shorter, tolerability of local anesthesia was higher, satisfaction questionnaire scores were higher, cost was lower, and rates of early adhesion and meatal stenosis were lower. All of these parameters were significantly different from those in group 2. Notably, secondary phimosis was significantly higher in group 1. Although the bleeding that stopped with follow-up was significantly higher in group 2, there was no significant difference between the groups in terms of bleeding that required surgical intervention. DISCUSSION: Our study, which reports the results of circumcisions performed using the NeoAlis clamp, has the largest sample size in the literature. Moreover, this is the only study in the literature wherein the results of sleeve circumcision, which is a time-tested surgical procedure, and the results of NeoAlis clamp circumcision, which we applied to a large number of patients, were compared with each other and with the literature. The retrospective design that focused on relatively short-term (one month) results is the major limitation of this study. CONCLUSION: Mass circumcision performed with a plastic clamp technique is safe, timesaving, easily teachable, and cosmetically advantageous.

An investigation of the effects of amniotic fluid on experimental ischemia/reperfusion damage in rat testes.

INTRODUCTION: Various agents have been tested as preventive treatments for ischemia/reperfusion (IR) damage. In this study, we have investigated for the first time in the literature the efficacy of injection of amniomax (AMX) into testicular parenchyma, which is a commercial medium of rat amniotic fluid, in preventing testicular IR damage related to testicular torsion. OBJECTIVE: This study aims to evaluate whether or not amniomax has an effect on experimental IR damage in rat testes using biochemical and histopathological methods based on data in the literature. Even if testicular torsion is repaired surgically in early term injury because of de IR damage still occurs. Is it possible to reduce the ischemia reperfusion injury with amniotic fluid and increase the success of treatment? STUDY DESIGN: 40 male Wistar albino rats were included. Four groups were formed with 10 rats in each group: Sham, Ischemia/Reperfusion (IR), injection 1 min before detorsion (AMX-BD), injection 1 min after detorsion (AMX-AD). Total Oxidant Status (TOS) and Oxidative Stress Index (OSI) were computed for oxidative stress, and Total Antioxidant Status (TAS) levels were computed for the antioxidant system, for both serum and tissue. Necrosis and microcalcification levels were assessed in the evaluation of testicular histology. P < 0.05 was considered statistically significant. RESULTS: AMX-AD group has low necrosis degree than IR, Mean serum and tissue levels of TAS, TOS, and OSI parameters were respectively determined as; for TAS: 0.64 ± 0.11 and 0.96 ± 0.25 mmol Trolox Equivalent/L; for TOS: 6.71 ± 0.87 and 9.40 ± 1.03 µmol H2O2 equivalent/L; for OSI: 11.94 ± 3.74 and 10.70 ± 4.23 arbitrary unit. DISCUSSION: Our study has investigated for the first time in the literature the efficacy of amniotic fluid in preventing testicular IR damage, and used amniomax (AMX) for this purpose. The limitation of our study may be the small number of rat in the groups. CONCLUSION: We think an injection after detorsion is more favorable considering that the AMX-AD group demonstrated significantly lower levels of TOS in serum and tissue and OSI in serum, and significantly higher serum levels of TAS compared to the AMX-BD group, as well as the fact that the morphological protection effect was only observed for injections performed immediately after detorsion.

A risk grouping algorithm for predicting factors of persistently elevated prostate-specific antigen in patients following robot-assisted radical prostatectomy.

OBJECTIVE: After radical prostatectomy, prostate-specific antigen(PSA) value measuring ≥0.1 ng/mL is defined as persistent PSA(pPSA) and in many studies, it was found to be associated with aggressive disease and poor prognosis. Our aim in this study is to point out the pathological and clinical factors affecting pPSA among the patients who underwent robot-assisted radical prostatectomy(RARP) in an experienced academic centre and to make a useful risk grouping algorithm that can predict pPSA value based on operative data. METHODS: We examined records of 1273 patients who underwent RARP retrospectively. Preoperative, operative and postoperative data were collected. Based on the PSA values (ng/mL) measured after 4-to-8 weeks of RARP, patients were divided into two groups as pPSA group (Group1)(n = 97) with PSA values ≥0.1 ng/mL and undetectable PSA group (Group2)(n = 778) with PSA values <0.1 ng/mL. Later on, Group1 was further divided into Group1a (PSA:0.1-0.2 ng/mL) and Group 1b (PSA≥0.2 ng/mL) to evaluate biochemical recurrence(BCR). RESULTS: Multivariate logistic regression analyses of the collected data revealed that preoperative PSA≥20 ng/mL, operation time, a postoperative international society of urological pathology (ISUP) grade of ≥4, pT 3-4 and pN were independently associated with pPSA. Based on these results, a risk grouping algorithm predicting pPSA was developed. By looking at the risk grouping algorithm pPSA was found in 98.9% of the cases with a preoperative PSA value of ≥20 ng/mL, an operation time of 150 min, a postoperative ISUP grade of 4-5, a positive lymphovascular invasion (LVI) status, pT3-T4, and pN+; while pPSA was found in 25.5% of the cases with a preoperative PSA value of <20 ng/mL, an operation time of 100 min, a postoperative ISUP grade of <4-5, a negative LVI status, pT<3-4 and pN-. The estimated BCR-free survival time was 16.3 months in Group 1a and 57.0 months in Group2 (P < .001). Adjuvant treatment ratio was 64.9% in Group1 and 7.1% in Group2 (P < .001). CONCLUSION: For the patients who underwent RARP, factors associated with aggressive disease can predict the PSA persistence. To plan our treatment modalities accurately, an applicable risk grouping algorithm in daily practice would be useful.

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)

The effect of the first wave of COVID-19 pandemic on urology practice and anxiety scores of patients awaiting surgery.

OBJECTIVE: We aimed to determine the effect COVID-19 pandemic on the daily urology practice of the level 3 centre located in one of the most affected regions in Turkey. We also aimed to assess anxiety and depression levels of patients whose procedures and surgeries had to be postponed due to COVID-19-related restrictions. METHODS: The number of patients admitted to the outpatient clinic, outpatient procedures, emergency consultation requests, hospitalised patients and the total number of surgeries between March 10, 2020 and June 15, 2020 were evaluated. These numbers were compared with the same period of 2019. Subsequently, patients who could not be operated or whose elective surgeries were postponed between March 10, 2020 and June 15, 2020 were determined(n:96). These patients were asked to fill out Beck Depression Inventory(BDI) and State-Trait Anxiety Inventory(STAI). The presence of difference between the baseline anxiety levels and the anxiety levels during the COVID-19 pandemic was investigated. Afterwards, these patients were divided into two groups based on planned procedures as oncological group (group1) and non-oncological group (group2). The presence of a difference between the anxiety and depression levels between the groups was investigated. RESULTS: There was a drastic decline in number of patients in all assessed parameters. The least amount of change was seen in the number of emergency consultations. The evaluation of anxiety and depression scores of the patients showed a significant difference between their STAI-S and STAI-T scores (51.8 ± 9.3, 38.2 ± 7.5, respectively)(P < .001). STAI-S scores of the patients were found to be compatible with severe anxiety. The patients' mean BDI score was found to be 15 ± 8.9, which indicated mild depression. However, the age and STAI-S values were significantly higher in group1. CONCLUSION: We noted that anxiety and depression levels increased in patients whose operations were delayed because of pandemic-related restrictions, especially in oncological patients. We believe that an important contribution can be made to the protection of public health by planning advance psychosocial interventions for high-risk groups during pandemics.

Prone versus Barts "flank-free" modified supine percutaneous nephrolithotomy: a match-pair analysis

Background/aim: In this study, we aimed to compare the results of prone and Barts "flank-free" modified supine percutaneous nephrolithotomy (PCNL) operations in our clinic. Materials and methods: The data from patients that underwent Barts "flank-free" modified supine PCNL (BS-PCNL) (n = 52) between June 2018 and July 2020 and prone PCNL (P-PCNL) (n = 286) between April 2014 and June 2018 were retrospectively evaluated. Of those 286 patients, 104 patients whose sex, age, body mass index, American Society of Anesthesiology score, stone localization, stone size, and hydronephrosis matched the BS-PCNL group in a 1:2 ratio were included in the study. The groups were compared in terms of intraoperative outcome, complication rates, and stone-free rates. Results: The mean age of all patients (58 females, 98 males) included in the study was 41.8 ± 15.2 years, and the mean body mass index (BMI) was 24.7 ± 2.9 kg/m2. The mean operation time was significantly shorter in the BS-PCNL group than in the P-PCNL group (80.2 ± 15.1 min vs. 92.4 ± 22.7 min and p = 0.01). There was no significant difference between the two groups in terms of fluoroscopy time, intraoperative complications, postoperative complications, and stone-free rates. Conclusion: Our study shows that BS-PCNL is an effective and safe method that significantly reduces the operation time and should be considered as one of the primary treatment options for patients scheduled for PCNL.

Effectiveness of the caverno-dorsal vein shunt (Barry shunt) on prolonged ischaemic priapism and its effect on the post-operative long-term erectile function.

Ischaemic priapism is the most common form of priapism and requires urgent treatment. In this study, we evaluated the effectiveness of the caverno-dorsal vein shunt on resolution of ischaemic priapism and on the post-operative long-term erectile function in patients presenting with priapism. The study included 10 patients admitted to our hospital for priapism between 2010 and 2018. The median age of the patients was 31 (24-66) years. The median priapism time was 13.5 (7-38) hours. The blood gas measurements were taken from the corpus cavernosum, and the drainage of the corpus cavernosum was performed as an emergency intervention. Then, the corpus cavernosum was irrigated with 0.01% adrenaline 5 times in 20-min intervals. The caverno-dorsal vein shunt procedure was performed in cases without regression of priapism. Two months after, the operation shunt was closed. Detumescence occurred in all patients. Eight of 10 patients maintained their erectile function. In 2 patients, severe erectile dysfunction occurred at post-operative 2 months following a priapism attack and penile prosthesis implantation was performed in these 2 patients. Our study showed that caverno-dorsal vein shunt procedure is effective in providing detumescence and maintaining potency in cases with ischaemic priapism. In our opinion, caverno-dorsal vein shunt can be considered as the first treatment of choice for refractory low-flow priapism.

Vaginocutaneous fistula: A rare long-term complication of transobturator tape procedure for stress urinary incontinence.

INTRODUCTION: Synthetic mid-urethral slings are currently the most common performed surgical procedure for the treatment of female stress urinary incontinence. The transobturator mid-urethral sling technique has been widely accepted owing to its high success and low complication rates. Although complications are rarely seen, it may cause significant morbidity. CASE PRESENTATION: We report a case of vaginocutaneous fistula following transobturator mid-urethral sling procedure and a successful reconstruction with transvaginal sling excision and fistula closure. CONCLUSION: Vaginocutaneous fistula is a known but rarely seen long-term complication of transobturator tape. With an increased use of mesh, various delayed complications can be seen in the long-term follow-up. This case showed us the need for longer and detailed studies that evaluate the effectiveness and safety of the transobturator tape procedure.

Thiol/Disulfide Homeostasis in Patients With Erectile Dysfunction.

BACKGROUND: Although there are no sufficient data on association between oxidative stress and erectile dysfunction (ED), numerous studies have reported that imbalance between the formation of reactive oxygen species and body's antioxidant defenses may play a role in the pathogenesis of ED. AIM: The aim of this study was to determine and compare the oxidant and antioxidant status in patients with ED and healthy controls with a novel automated assay for thiol/disulphide homeostasis test. METHODS: Our study included 123 patients with ED and 90 healthy individuals. ED was evaluated by asking questions 1-5 and 15 of the International Index of Erectile Function form. In this study, we used Erel and Neselioglu's thiol/disulfide homeostasis test, which is one of the novel methods that can measure both variables of the oxidative/antioxidative balance individually and collectively. OUTCOMES: This method measured serum antioxidant (total thiol [toSH], native thiol [SH]) and oxidant (disulfide [SS]) levels. The statistical comparisons were performed between patients with ED (ED+ group) and without ED (ED- group) first and then within the ED+ group. After toSH, SH, and SS levels were determined; SS/toSH%, SS/SH%, and SH/toSH% levels were analyzed separately and compared statistically. RESULTS: We found a significant difference between ED- and ED+ groups in terms of toSH, SH, SS/toSH%, and SS/SH% ratios. SS parameters were increased in patients with ED, but there was no significant difference in terms of SS and SH/toSH% values. CLINICAL IMPLICATIONS: Clarification of the factors involved in the etiology of ED such as oxidative/antioxidative balance may open new grounds in the early diagnosis and treatment of the disease. STRENGTHS & LIMITATIONS: It is a prospective, randomized clinical study with the use of a novel, reliable, and fully automated technique. The limitations of the study are use of a subjective tool such as the International Index of Erectile Function, obtaining blood samples from the peripheral vein instead of penile cavernosal tissue, and relatively small sample size. CONCLUSION: The results of this study showed that thiol/disulfide homeostasis is altered in ED, and this imbalance may be a factor in its pathophysiology. We determined that as ED gets more severe, toSH and SH parameters decrease, whereas SS parameter increases. Micoogullari U, Karatas OF, Kisa E, et al. Thiol/Disulfide Homeostasis in Patients With Erectile Dysfunction. J Sex Med 2020;17:1934-1941.

Comparison of suture material for vesico-urethral anastomosis in robotic radical prostatectomy.

INTRODUCTION: The aim of this study was to compare outcomes after vesicourethral anastomosis (VUA) with barbed suture (BS) and non-barbed monofilament suture (NBS) in robot-assisted laparoscopic radical prostatectomy (RALRP) in a match - pairs design. MATERIAL AND METHODS: Medical recordings of 385 consecutive patients with prostate carcinoma have been evaluated, and 70 patients who have undergone RALRP-BS were compared with 70 patients with RALRP-NBS in a matched - pairs design. Preoperative clinical parameters (age, prostate-specific antigen, clinical stage, Gleason score of the prostate biopsy, and prostate volume) and operative data (operation, docking, console, posterior reconstruction (PR), anastomosis times, duration of catheter, length of hospital stay, estimated blood loss, time to perform the anastomosis and its quality) were evaluated, as well as postoperative parameters (pathological stage, Gleason score, specimen weight, follow-up duration, biochemical recurrence, complication rates, and duration of postoperative analgesic treatment). RESULTS: No statistically significant difference was found for pre-operative parameters between the two groups. Although, anastomosis time, quality of anastomosis, duration of urethral catheter and total anesthesia time were significantly less in the RALRP-BS group than in the RALRP-NBS group (P <0.01). Other peri- and postoperative parameters were not statistically significant between the two groups. Pathological data and the follow-up period and complication rates were similar between the two groups. CONCLUSIONS: This study showed that, RALRP-BS is a safe, efficient and cost-effective PR and VUA during RALRP than compared with RALRP-NBS. Shorter anastomosis time, operative time and posterior reconstruction time, while it may be equivalent with regard to estimated blood loss (EBL), catheterization time and early continence rates at 4-6 weeks.