Early outcomes of robotic retroperitoneal partial nephrectomy: evaluating surgical success with margin, ischemia, and complication score.

OBJECTIVE: The objective of this study was to evaluate the minimum number of required cases for successful robotic retroperitoneal partial nephrectomy for an experienced surgeon in transperitoneal robotic surgery. METHODS: Our prospectively collected clinic database was evaluated retrospectively, and 50 patients who underwent robotic retroperitoneal partial nephrectomy by a single experienced surgeon from January 2019 to February 2023 were included in this study. Demographic and perioperative data and R.E.N.A.L. nephrometry scores were noted. margin, ischemia, and complication score was used to predict surgical success. Receiver operating characteristic curve analysis was used to determine how many cases were required to achieve margin, ischemia, and complication score positivity and to apply the off-clamp technique. Also, the first 25 patients were assigned to Group 1 and the second 25 patients to Group 2, and the data were compared between the groups. RESULTS: The patients' demographic data and tumor characteristics were similar in the groups. The off-clamp technique and sutureless technique rates in Group 2 were significantly higher than that in Group 1. Margin, ischemia, and complication score positivity was observed in 60% (n=15) of Group 1 and 96% (n=24) of Group 2. At receiver operating characteristic curve analysis, the 25th and later cases were statistically significant in terms of margin, ischemia, and complication score positivity. In terms of performing surgery with the off-clamp technique, the 28th and subsequent cases were statistically significant. CONCLUSION: A total of 25 or more cases appear to be sufficient to provide optimal surgical results in robotic retroperitoneal partial nephrectomy for an experienced surgeon.

Effects of Bladder Neck Plication on Climacturia After Robot-Assisted Laparoscopic Prostatectomy.

Purpose: The aim of this study is to investigate the effect of bladder neck plication during transperitoneal robot-assisted radical prostatectomy (tRARP) on orgasm-related incontinence (climacturia) and the relationship between International Index of Erectile Function 5 (IIEF-5) scores and climacturia. Materials and Methods: We evaluated 118 patients who underwent nerve-sparing tRARP in our clinic and survived the first postoperative year. Patients were divided into two groups: those who underwent bladder neck plication (Group 1, n = 58) and those who did not (Group 2, n = 60). Our study investigated whether there is a difference between the groups in terms of climacturia or if there is a relationship between IIEF-5 scores and climacturia. Results: Of the patients in Group 1, 10.3% had incontinence and 13.8% had climacturia. Of the patients in Group 2 who did not have bladder neck plication, 10% had incontinence and 15% had climacturia. There was no difference between the groups in terms of climacturia (P > .825). Three patients (5.2%) in Group 1 and four patients (6.6%) in Group 2 requested treatment. There was no statistically significant correlation between IIEF-5 scores and climacturia in both groups (Group 1, P > .208; and Group 2, P > .508). Conclusions: In our study, the frequency of climacturia in patients who underwent bladder neck plication during tRARP was consistent with the literature and did not show a statistically significant difference from patients who did not undergo bladder neck plication. It has been observed that bladder neck plication, which has no effect on long-term continence, does not contribute to prevention of climacturia. No correlation was found between IIEF-5 scores and climacturia.

Comparison of Early Urinary Continence, Oncological Outcomes, and Postoperative Complications in Retzius-Sparing and Standard Approach Robot-Assisted Radical Prostatectomy.

Background: The aim of the study is to compare the results of early urinary continence (UC), pathological results, console time (CT), and perioperative morbidity in patients who underwent transperitoneal robot-assisted radical prostatectomy (TR-RARP) and Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) surgeries in the treatment of clinically localized prostate cancer. Methods: A total of 120 patients, 60 (Group 1) with the TR-RALP technique and 60 (Group 2) with the RS-RALP technique, who had no statistical difference in their preoperative demographic data, were selected retrospectively. Perioperative and postoperative data, and continence rates in the first, third and sixth months were compared between the 2 groups. Results: There was no significant difference between the groups in terms of CT, hemoglobin change, and perioperative and postoperative data. There was a statistically significant difference between the 2 groups in favor of RS-RARP in terms of UC in the first and third months, whereas there was no statistically significant difference between the groups at month 6 (P = .001, P = .002, and P = .245, respectively). Conclusion: This study demonstrates that the RS-RARP technique is a promising approach to achieve early continence without compromising oncological principles and without increased complication rates.

Early outcomes of robotic retroperitoneal partial nephrectomy: evaluating surgical success with margin, ischemia, and complication score

SUMMARY OBJECTIVE: The objective of this study was to evaluate the minimum number of required cases for successful robotic retroperitoneal partial nephrectomy for an experienced surgeon in transperitoneal robotic surgery. METHODS: Our prospectively collected clinic database was evaluated retrospectively, and 50 patients who underwent robotic retroperitoneal partial nephrectomy by a single experienced surgeon from January 2019 to February 2023 were included in this study. Demographic and perioperative data and R.E.N.A.L. nephrometry scores were noted. margin, ischemia, and complication score was used to predict surgical success. Receiver operating characteristic curve analysis was used to determine how many cases were required to achieve margin, ischemia, and complication score positivity and to apply the off-clamp technique. Also, the first 25 patients were assigned to Group 1 and the second 25 patients to Group 2, and the data were compared between the groups. RESULTS: The patients' demographic data and tumor characteristics were similar in the groups. The off-clamp technique and sutureless technique rates in Group 2 were significantly higher than that in Group 1. Margin, ischemia, and complication score positivity was observed in 60% (n=15) of Group 1 and 96% (n=24) of Group 2. At receiver operating characteristic curve analysis, the 25th and later cases were statistically significant in terms of margin, ischemia, and complication score positivity. In terms of performing surgery with the off-clamp technique, the 28th and subsequent cases were statistically significant. CONCLUSION: A total of 25 or more cases appear to be sufficient to provide optimal surgical results in robotic retroperitoneal partial nephrectomy for an experienced surgeon.

The Results of Peritoneal Re-Approximation Methods on Symptomatic Lymphocele Formation in Robot-Assisted Laparoscopic Radical Prostatectomy and Extended Pelvic Lymphadenectomy.

INTRODUCTION: To evlauate role of peritoneal re-approximation methods in the prevention of symphtomatic lymphocele formation in patients underwent transperitoneal robot-assisted laparoscopic prostatectomy (tRALP) and extendeded pelvic lympadenoctomy (ePLND). MATERIALS AND METHODS: Between January 2016 and April 2020, 120 consecutive patients who were administered anterior t-RALP and ePLND were analyzed retrospectively. In group 1 (n = 40), peritoneal approximation was not performed after t-RALP and ePLND application, peritoneal half re-approximation was performed in group 2 (n=40), and peritoneal full re-approximation was performed in group 3 (n=40). Operative parameters and symptomatic lymphocele rates were compared between the groups. RESULTS: There was no statistically significant difference between the groups in terms of mean age, body mass index and prostatespecific antigen levels, Gleason score on biopsy, D'amico risk groups, the mean number of lymph nodes removed, Clavien-Dindo complication grade and mean duration of the surgery. Patients with symptomatic lymphocele in Group 1, Group 2, and Group 3 were found to be 2 (5%), 3 (7.5%) and 5 (12.5%), respectively. There was no statistically significant difference between the groups in terms of symptomatic lymphocele formation. CONCLUSION: Half or full closure of the peritoneum does not affect the symptomatic lymphocele formation in patients who underwent tRALP and ePLND.

The Impact of COVID-19 Pandemic on Urological Emergencies, 8 Months Results of a Multicenter Retrospective Study From Turkey.

Objectives: We aimed to reveal the change of urological emergencies during the COVID-19 pandemic compared to the same period of the previous year. Methods: The number of admissions to the emergency department (ED), admissions to the urology outpatient clinic, emergency urological consultations, and urological and emergency urological surgeries during the periods April-November-2019 and April-November-2020 were recorded. The data of the COVID-19 period were compared with the previous year. Results: While the number of admissions to the urological outpatient clinic was 160,447 during the COVID period, it was 351,809 during the non-COVID period. The number of admissions to the ED decreased from 3.2 million to 2.4. The number of admissions to the urology outpatient clinic significantly decreased by 54% during the pandemic (p=0.001). Percutaneous cystostomy performed due to acute urinary obstruction decreased by 27.96%, double J stent, nephrostomy decreased by 16.61%, and ureterorenoscopy decreased by 12.26%. Urogenital trauma also decreased. On the contrary, surgical procedures performed due to penile fracture, gross hematuria, Fournier gangrene, and testicular torsion increased. Conclusion: During the COVID-19 pandemic, a significant decrease was observed in non-COVID patients' admissions to the emergency and urology department, and in urologic surgeries.

Effect of prostate and bony pelvic dimensions measured by preoperative magnetic resonance imaging on robot-assisted radical prostatectomy.

Bone pelvic dimensions and body habitus may have effects on robot-assisted radical prostatectomy (RARP). In this study, we examined the effects of body mass index, bone pelvis measurements and prostate measurements on console time (CT), decrease in postoperative hemogram level (DHL) and surgical margin(SM) in patients who underwent RARP for clinically localized prostate cancer in our institution. The data of transperitoneal RARP cases performed by a single surgeon between November 2016 and August 2020 were analyzed retrospectively. It was included in 125 patients who met the study criteria. Bone and soft tissue measurements were made on magnetic resonance imaging T2-weighted imaging in the mid-sagittal and transvers plane. In multivariate linear regression analyzes, only soft tissue width/transverse diameter of the prostate and CT were found to be correlated (p = 0.026). For the DHL, no pelvic dimension and body habitus had a significant association on multivariate linear regression analysis. In multivariate analyzes, a statistically significant difference was found only between pathological Gleason Score and SM (p = 0.008). Although we found statistically significant associations between prostate diameters and pelvic bone measurements and operative difficulties, we believe that further studies are needed to confirm these results. Such information can help identify patients with challenging anatomy and can be used in robotic surgery training to achieve optimal patient outcomes after RARP.

Predicting Strict Trifecta Outcomes after Robot-Assisted Partial Nephrectomy: Comparison of RENAL, PADUA, and C-Index Scores.

Nephrometry scores are designed to characterize tumors and stratify the surgical complexity. It remains unclear as to which nephrometry score can accurately predict the surgical outcomes. We aimed to assess the utility of radius, exophytic/endophytic, nearness, anterior/posterior, location (RENAL), preoperative aspects and dimensions used for anatomic classifications (PADUA), and centrality index (C-index) nephrometry scores for predicting the strict Trifecta achievement from a single institution series robotic-assisted partial nephrectomy (RAPN). We retrospectively identified the prospectively maintained robotic surgery database records of 91 patients who underwent RAPN between June 2015 and September 2020 in Antalya Training and Research Hospital. The main outcome of the study was the achievement of strict Trifecta (negative surgical margin, no major urologic complications, warm ischemia time ≤25 min, and ≥85% preservation of estimated glomerular filtration rate). A multivariable analysis was performed to identify the factors of strict Trifecta success. The mean patient age was 55.82 ± 13.37 years with a median clinical tumor size of 3.5 cm (IQR 2.5-4.9). The median RENAL, PADUA, and C-index score were 7(IQR 6-8), 8(IQR 7-10), and 2.01(IQR 1.64-2.72), respectively. A strict Trifecta could be achieved in 54 patients (59.3%). Clinical tumor size (P = 0.011), RENAL risk groups (low:reference; intermediate; P = 0.040; high; P = 0.009), PADUA risk groups (low:reference; intermediate; P = 0.044; high; P = 0.001) and C-index risk groups (low:reference; high; P = 0.015) were the independent predictors of strict Trifecta attainment in the multivariate analysis. None of the nephrometry scores were a superior predictor compared to other nephrometry scores in comparative analysis. RENAL, PADUA, and C-index scores were all independent predictors of a strict Trifecta achievement. Our comprehensive comparison of the three scores identified that none of the nephrometry scores proved to be inferior to others nephrometry scores.

Comparison of effects of tamsulosin and silodosin on subfoveal choroidal thickness and pupil size diameters in patients with prostatic hyperplasia.

PURPOSE: To compare the effects of selective α-1 adrenoceptor antagonists on subfoveal choroidal thickness (SFCT) and pupil diameter size (PDS). METHODS: This prospective study included 87 patients diagnosed with benign prostatic hyperplasia who were treated with tamsulosin hydrochloride (n = 41) or silodosin (n = 46). SFCT measurements were obtained using spectral domain optic coherence tomography (SD-OCT), and PDS measurements were obtained under mesopic, photopic and scotopic conditions using a photography-based topography system. SFCT and PDS were evaluated at baseline and 3-, 6- and 12-mo follow-ups. RESULTS: The initial mean SFCT was 270.53 ± 21.48 µm in tamsulosin group and 271.95 ± 24. 73 in silodosin group (P = 0.078). There was no statistically significant change in SFCT at the 3-mo visit. At the 6-mo follow-up, the mean SFCT was 281.34 ± 22.09 µm in tamsulosin group and 272.5 ± 22.4 µm in silodosin group. At the 12th month, the mean SFCT in tamsulosin group was 290.80 ± 17.27 µm, and it was 270.80 ± 13.14 µm in silodosin group. There was statistically significant difference in at 6th and 12-mo visits (P = 0.014 and P = 0.00). During the follow-up, both drugs induced a similar significant decrease in PDS under all conditions. CONCLUSIONS: Tamsulosin hydrochloride caused a significant increase in SFCT. In contrast, SFCT did not increase in silodosin group. The decreases in PDS achieved using both drugs were similar. This should be kept in mind when choroidal disease and its response to treatment are followed by CT imaging.

Effects of Listening to Binaural Beats on Anxiety Levels and Pain Scores in Male Patients Undergoing Cystoscopy and Ureteral Stent Removal: A Randomized Placebo-Controlled Trial.

Purpose: To investigate the effects of pure binaural beats on anxiety and pain scores in male patients undergoing diagnostic cystoscopy (DC) and ureteral stent removal (USR) under local anesthesia. Materials and Methods: This was a prospective, randomized placebo-controlled study. Patients in the DC group (DCG) and USR group (USRG) were divided into three subgroups according to interventions applied; DCG-1 and USRG-1, patients listened to binaural beats; DCG-2 and USRG-2, patients listened to classical music; and DCG-3 and USRG-3, patients wore headphones, but were not exposed to audio (control group). The State-Trait Anxiety Inventory (STAI) and Visual Analog Scale (VAS) were used for measuring anxiety and pain scores, respectively. Demographic data, initial STAI, tolerance rate of interventions, terminal STAI (STAI-T), differences of STAI (delta STAI, STAI-D), and VAS scores were compared. Results: Between July 2019 and March 2020, a total of 252 and 159 eligible male patients for DCG and USRG were included, respectively. After exclusions, remaining patients were DCG-1, n = 61; DCG-2, n = 73; DCG-3, n = 75; USRG-1, n = 41; USRG-2, n = 50; and USRG-3, n = 52. The tolerance rate in binaural beat groups was significantly lower than in other groups (p < 0.05 for all). There were significant decreases in terms of STAI-T when DCG-1 and DCG-2 were compared with DCG-3 and USRG-1 and USRG-2 were compared with USRG-3 (p < 0.05 for all). There were significant decreases in STAI-D scores when DCG-1 and DCG-2 were compared with DCG-3 and when USRG-1 and USRG-2 were compared with USRG-3 (p < 0.001 for all). Binaural beat groups had significantly lower VAS scores than other groups and classical music groups had significantly lower VAS scores than control groups (p < 0.05 for all). Conclusions: Listening to pure binaural beats may be a simple and effective method to reduce anxiety levels and pain scores associated with the DC and USR procedures in males.

Is Retzius-sparing robot-assisted laparoscopic radical prostatectomy effective in early continence? A single-center experience of the first 50 patients.

OBJECTIVE: In this study, we aimed to present the perioperative and postoperative outcomes and early continence rates of the first 50 patients who underwent Retzius-sparing robot-assisted laparoscopic radical prostatectomy (RS-RALP) in our clinic for prostate adenocarcinoma. MATERIAL AND METHODS: Between December 2018 and December 2019, 50 patients who underwent RS-RALP by 2 surgeons in our clinic were enrolled in the study. Preoperative, perioperative, and postoperative clinical data were analyzed retrospectively. Procedure-specific complications were graded according to the Clavien-Dindo classification. The continence status of the patients was recorded in the 1st week, 1st month, and 3rd month after catheter removal. Zero pads or 1 safety pad per day was accepted as total continence. RESULTS: The mean age of the patients was 66.6 (57-75) years. According to the D'Amico classification, 36% of patients were at low risk, 48% at intermediate risk, and 16% at high risk. Bilateral or unilateral nerve-sparing procedure was performed in 76% of the patients. There were no intraoperative complications. A total of 9 (18%) patients had a postoperative complication (7 with grade 1, 1 with grade 2, and 1 with grade 3 complications). Whereas 32% of the patients had an extraprostatic extension, 22% had seminal vesicle invasion. The overall positive surgical margin rate was 26%. At 1 week, 1 month, and 3 months after surgery, 64%, 80%, and 92% of men who underwent RS-RALP were continent, respectively. CONCLUSION: Our study showed that this new surgical technique can be a safe and feasible method because high rates of early continence were achieved in the patients who underwent RS-RALP without increasing the risk of complications.

Preoperative Inflammation Markers and De Ritis Ratio in Predicting Clinical Presentation and Prognosis of Patients with Testicular Germ Cell Tumors.

OBJECTIVE: To evaluate the importance of neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), neutrophil-to-monocyte ratio (NMR) and De Ritis ratio (DRR) in predicting clinical presentation and prognosis of patients with testicular germ cell tumors (TGCTs). STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Antalya Training and Research Hospital Antalya, Turkey, from January 2009 to March 2020. METHODOLOGY: The characteristics and the results of biochemical and pathological examinations of patients who underwent radical orchiectomy were recorded. NLR, LMR, PLR, NMR, and DRR were calculated. The relationship among inflammation markers and DRR and clinical presentation and prognosis of TGCT was evaluated. RESULTS: Data of 99 patients were eligible for the study. Median age was 32 (27-39)  years. Average size of the tumor was 5 (2.7 - 7) cm. Average duration of follow-up was 35.4 (8-62) months. Higher NLR and lower LMR were significantly correlated with higher rates of advanced-stage cancer, metastasis, and retroperitoneal lymph node invasion (RPLNI) (p<0.05). Based on the optimal cut-off values, there was a significantly higher rate of S stage, RPLNI, and metastatic disease in the high NLR group (p<0.05). Kaplan-Meier survival analysis found a statistically significantly lower mean survival rate in the high NLR group (p<0.05). There was no statistically significant difference between the DRR groups in the above-mentioned parameters (p>0.05). CONCLUSION: Preoperative NLR can be used as an inexpensive and easily accessible marker to predict clinical presentation at diagnosis and mortality rates during follow-up of patients with TGCT. Preoperative LMR can also be associated with the clinical picture at the time of diagnosis of TGCT. Key Words: De ritis ratio, Lymphocyte-to-monocyte ratio, Neutrophil-to-lymphocyte ratio, Neutrophil-to-monocyte ratio, Platelet-to-lymphocyte ratio, Testicular  germ cell tumor.

Preoperative Inflammation Markers in Predicting Biochemical Recurrence after Robot-assisted Radical Prostatectomy.

OBJECTIVE: To evaluate the importance of preoperative neutrophil-to-lymphocyte ratio (NLR),  lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), and neutrophil-to-monocyte ratio (NMR) in prostate cancer patients, who underwent robot-assisted radical prostatectomy (RARP). STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Urology Department, Antalya Training and Research Hospital, Turkey, between March 2015 and September 2019. METHODOLOGY: Four hundred and fifty-four patients underwent RARP were scanned. Clinical characteristics and pathological features of patients were recorded. Patients were excluded, if they had persistent PSA; a history of any autoimmune or inflammatory disease; anti-inflammatory agents use; blood transfusion within 3 months; or a follow-up time shorter than 3 months. Systemic inflammation markers were calculated and correlated with patients' data and biochemical recurrence (BCR). Biochemical recurrence was defined as two repetitive measurements of PSA levels ≥0.2 ng/mL at 3  months after the radical prostatectomy. Mann-Whitney U-test, Fisher's exact test, and Pearson Chi-square test, ROC curve, Kaplan-Meier survival analyses, and Cox proportional hazard regression model were used as statistical methods. RESULTS:   Four hundred and two patients were eligible. The median age at RP was 65.5 (61-69) years and median PSA of the patients was 8.3 (5.76-12.61)  ng/ml. Median NLR, LMR, PLR, and NMR were 2 (1.55-2.61), 3.86 (3.14-5), 105.69 (85-134.29), 7.82 (6.25-9.71); and  optimal cut-off values were 2.33, 3.75, 106.6, and 8.75, respectively. Low LMR was found as  an important predictor of biochemical recurrence (hazard ratio, HR=1.769, 95% confidence interval, CI=1.091 - 2.868, p=0.021). A significant association was found between lower LMR and decreased BCR -free survival (p <0.001). CONCLUSION: Pretreatment low LMR might be a simple and inexpensive index, which reflects the host systemic immunity and can predict independently BCR after RARP. Key Words: Biochemical recurrence, Lymphocyte-to-monocyte ratio, Neutrophil-to-lymphocyte ratio, Neutrophil-to-monocyte ratio, Platelet-to-lymphocyte ratio, Prostate cancer.

Comparison of a Visual Prostate Symptom Score and International Prostate Symptom Score: A Prospective Multicenter Study and Literature Review.

OBJECTIVE: To evaluate the correlation between Visual Prostate Symptom Score (VPSS) and the International Prostate Symptom Score (IPSS) and uroflowmetry parameters in men with lower urinary tract symptoms (LUTS) with literature review. METHODS: Patients were pooled from 4 different urology clinics in Turkey and divided into 3 groups according to their educational level. The scores of IPSS and the VPSS questionnaire, assistance requirement, and completion time of the questionnaires were recorded. Maximum flow rate (Qmax) and average flow rate (Qave) were determined with uroflowmetry test and the results are recorded. RESULTS: A total of 342 patients were evaluated (group 1, n = 168; group 2, n = 108; group 3, n =66). Median age of all groups was 61 (40-89). There was a significantly higher rate of the completion of VPSS than IPSS without assistance in total (P < .001). Educational level was not found as an independent factor with assistance requirement to complete VPSS while university educational level was found as an independent factor to complete IPSS (odds ratio = 9.735, P < .001).There was a significantly lower completion time for VPSS in all groups when compared to IPSS (P < .001 for all groups). Significant positive correlations were found between VPSS and IPSS questions (P < .001). There were significant negative correlations between total score and weak stream question of VPSS and Qmax and Qave, separately (P < .001). CONCLUSION: VPSS can be more practical than IPSS to evaluate LUTS in men with low educational levels and/or in large populations. Some modifications are needed to increase the availability of VPSS.

Comparision of Brucella and Non-Brucella Epididymo-orchitis.

OBJECTIVE:  To find parameters for differential diagnosis between Brucella epididymo-orchitis (BEO) and non-brucella epididymo-orchitis (NBEO) cases with comparison of BEO and NBEO in terms of inflammatory markers, full urinalysis (FU) for pyuria, and abscess formation (AF). STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Agri State Hospital Urology and Infectious Disease Clinics, between January 2014 and  November 2017. METHODOLOGY: Data of the patients, who were diagnosed with epididymo-orchitis, were divided in BEO and NBEO groups on the basic of serum agglutination test. Parameters including age, white blood cell neutrophil, lymphocyte, monocyte, platelet, mean platelet volume, C-reactive protein (CRP), neutrophil/lymphocyte ratio, monocyte/lymphocyte ratio, platelet / lymphocyte ratio, and FU. The values were statistically compared. RESULTS: One hundred and thirty-eight (138) patients were found eligible for the study. Twenty-three (23) of these patients (16.66%) had BEO, and 115 (83.33%) had NBEO. BEO vs. NBEO cases were significantly different regarding mean age (26.17 ±8.15 vs. 48.53 ±21.78 years, p=0.0001) and frequency of pyuria (3,13.04%) vs. 89 (77.39%, p=0.001). However CRP values i.e. 6.07 ±6.59 vs. 6.07 ±5.85 mg/dl (p=0.999) was not significantly different. CONCLUSION: BEO cases are often younger and do not have pyuria or abscess formation. High frequency of pyuria was found in NBEO cases. CRP levels cannot be used in the differential diagnosis between BEO and NBEO cases. Key Words: Abscess formation, Brucella epididymo-orchitis, C-reactive protein, Orchiectomy, Pyuria.

Effects of methylphenidate on the lower urinary tract in patients with attention deficit hyperactivity disorder and without voiding dysfunction.

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is characterised by a range of symptoms, such as excessive mobility, difficulty in maintaining attention and inadequate impulse control. Methylphenidate (MPH) is widely prescribed as a treatment for ADHD. In the literature, studies investigating the effects of MPH on the lower urinary tract (LUT) are limited. OBJECTIVE: The aim of the study was to evaluate MPH-induced LUT symptoms (LUTSs) in patients with ADHD without a diagnosis of voiding dysfunction (VD). STUDY DESIGN: After ethical committee approval, volunteers aged 7-17 y were divided into two groups, with group 1 composed of individuals diagnosed with ADHD but not VD and group 2 (control) composed of healthy individuals. Lower urinary tract symptoms and quality of life, in addition to uroflowmetry test results and postvoiding residual volume (PVRV), were evaluated in both groups at baseline and again 4 wk later. The individuals in group 1 were treated with MPH after baseline screening. The dysfunctional voiding scoring system questionnaire was used for scoring LUTSs. Postvoiding residual volume was measured by ultrasound. Bladder capacity (BC) was calculated as the sum of voided volume (VV) and PVRV. The means of the maximum flow rate (Q max), mean flow rate (Q mean), VV, PVRV and BC were recorded. RESULTS: After exclusions, there were 43 participants in group 1 and 39 participants in group 2. There was no significant difference between the mean age of groups (p = 0.727). Compared with the baseline, VV and BC increased significantly in group 1 (p = 0.001 and p = 0.002, respectively) at the 4-wk follow-up. There was no significant difference in these parameters in group 2. DISCUSSION: This study demonstrated that VV and BC increased after MPH treatment in patients with ADHD without a diagnosis of VD. The mechanism underlying this effect is unclear, but it may be associated with dopaminergic and noradrenergic effects. CONCLUSION: The findings of the present study can inform further studies on the mechanism underlying the effect of MPH on the LUT. In a future study, the authors suggest evaluating the effects of MPH in a urodynamic study in patients with ADHD diagnosed with VD.

Comparision effects of solifenacin, darifenacin, propiverine on ocular parameters in eyes: A prospective study

ABSTRACT Objective To evaluate the effects of solifenacin, darifenacin, and propiverine on nasal-, subfoveal-, temporal choroidal thicknesses (NCT, SFCT, TCT), intraocular pressure (IOP) and pupil diameter (PD). Materials and Methods Patients with overactive bladder (OAB) diagnosed according to The International Continence Society were administered with solifenacin, darifenacin or propiverine on a daily basis between November 2017 and May 2018. NCT, SFCT, TCT, IOP, and PD of these patients were measured and compared as initial, fourth and twelfth weeks. Results A total of 165 patients (330 eyes) with OAB were evaluated. Solifenacin (n=140) significantly reduced IOP from 17.30±2.72 mmHg to 16.67±2.56 mmHg (p=0.006) and 16.57±2.41 mmHg (p=0.002), at the fourth and twelfth weeks, respectively. Darifenacin (n=110) significantly reduced NCT from 258.70±23.96 μm to 257.51±22.66 μm (p=0.002) and 255.36±19.69 μm (p=0.038), at the fourth and twelfth weeks, respectively. Propiverine (n=80) significantly increased PD from 4.04±0.48 mm to 4.08±0.44 mm (p=0.009) and 4.09±0.45 mm (p=0.001), at the fourth and twelfth weeks, respectively. Conclusion These findings can help to decide appropriate anticholinergic drug choice in OAB patients. We finally suggest further well-designed randomized prospective studies with a larger population to evaluate the anticholinergic-related complications in eyes.

Comparision effects of solifenacin, darifenacin, propiverine on ocular parameters in eyes: A prospective study.

OBJECTIVE: To evaluate the effects of solifenacin, darifenacin, and propiverine on nasal-, subfoveal-, temporal choroidal thicknesses (NCT, SFCT, TCT), intraocular pressure (IOP) and pupil diameter (PD). MATERIALS AND METHODS: Patients with overactive bladder (OAB) diagnosed according to The International Continence Society were administered with solifenacin, darifenacin or propiverine on a daily basis between November 2017 and May 2018. NCT, SFCT, TCT, IOP, and PD of these patients were measured and compared as initial, fourth and twelfth weeks. RESULTS: A total of 165 patients (330 eyes) with OAB were evaluated. Solifenacin (n=140) signifi cantly reduced IOP from 17.30±2.72 mmHg to 16.67±2.56 mmHg (p=0.006) and 16.57±2.41 mmHg (p=0.002), at the fourth and twelfth weeks, respectively. Darifenacin (n=110) signifi cantly reduced NCT from 258.70±23.96 µm to 257.51±22.66 µm (p=0.002) and 255.36±19.69 µm (p=0.038), at the fourth and twelfth weeks, respectively. Propiverine (n=80) signifi cantly increased PD from 4.04±0.48 mm to 4.08±0.44 mm (p=0.009) and 4.09±0.45 mm (p=0.001), at the fourth and twelfth weeks, respectively. CONCLUSION: These findings can help to decide appropriate anticholinergic drug choice in OAB patients. We finally suggest further well-designed randomized prospective studies with a larger population to evaluate the anticholinergic-related complications in eyes.

Comparison of long-term kidney functions after radical nephrectomy and simple nephrectomy.

OBJECTIVE: To determine if there is a difference in proceeding to CKD between patients who had undergone radical nephrectomy (RN) and simple nephrectomy (SN) for different indications by comparing the short- and long-term renal function. MATERIALS AND METHODS: We retrospectively analyzed the records of all patients who underwent nephrectomy (either for malign or benign indications) in our clinic between January 2007 and September 2017. The patients were divided into 2 groups according the type of surgery: 1) Radical nephrectomy Group, 2) Simple Nephrectomy Group. Renal function was evaluated with Glomerular Filtration Rate (GFR) calculated using the MDRD formula. RESULTS: A total of 276 patients were included in the study. There were 202 patients in RN Group and 74 patients in SN Group. The mean age of the patients in RN Group and SN Group were age 59,2 ± 11,5 and 49,9 ± 15,1 years, respectively (p = 0.001). GFR levels of patients in RN Group versus SN Group were as follows: Preoperative period: 84.9 vs. 81 mL/min/1.73 m2; postoperative 1st day: 60.5 vs. 84.4 mL/min/1.73 m2, postoperative 1st month 58.9 vs. 76 mL/min/1.73 m2, postoperative 1st year: 59.5 vs. 74.1 mL/min/1.73 m2; at last control 60.3 and 76.1 mL/min/1.73 m2. While preoperative GFR was found to be similar in two groups (p = 0.26), postoperative GFR values were found to be significantly lower in Group RN (p < 0.001). In comparison of the decrease in GFR in two groups at last follow-up, significantly higher decrease was observed in RN Group, 29% vs. 6%, (p < 0.05). CONCLUSION: The decrease in GFR exists more common and intensive after RN compared to SN. In long-term, compensation mechanisms that develop after sudden nephron loss like radical nephrectomy deteriorates kidney function more than gradual nephron loss as in benign etiologies which indicates simple nephrectomy.