The Status of Spermatogenesis in Germ Cell Tumor Bearing Testis and Its Association with Metastatic Disease.

INTRODUCTION: We aimed to evaluate the status of spermatogenesis detected by histological examination of non-tumoral testicular tissues in tumor bearing testis and its association with advanced stage disease. PATIENTS AND METHODS: We retrospectively reviewed patients with testicular germ cell tumors (TGCTs) that undergone radical orchiectomy. All non-tumoral areas of the orchiectomy specimens were examined for the status of spermatogenesis. Patients were divided into two groups as localized (stage I) and metastatic (stage II-III) disease and analyzed separately for seminomatous (SGCT) and nonseminomatous germ cell tumors (NSGCT). RESULTS: Four hundred fifty-four patients were included in our final analysis. Of those, 195 patients had SGCT, and 259 patients had NSGCT. Three hundred and six patients had localized disease at the time of diagnosis. Median (Q1-Q3) age was 31 (26 - 38) years and 102 (22.5%) patients had normal spermatogenesis, 177 (39.0%) patients had hypospermatogenesis and 175 (38.5%) patients had no mature spermatozoa. On multivariate logistic regression analysis, embryonal carcinoma >50% (1.944, 95 %CI 1.054-3.585, P = .033) and spermatogenesis status (2.796 95% CI 1.251-6.250, P = .012 for hypospermatogenesis, and 3.907, 95% CI 1.692-9.021, P = .001 for absence of mature spermatozoa) were independently associated with metastatic NSGCT. However, there was not any variables significantly associated with metastatic SGCT on multivariate logistic regression analysis. CONCLUSION: Our study demonstrated that only 22.5% of patients with TGCTs had normal spermatogenesis in tumor bearing testis. Impaired spermatogenesis (hypospermatogenesis or no mature spermatozoa) and predominant embryonal carcinoma are associated with advanced stage NSGCT.

Is testosterone deficiency a predictive factor for recurrence of urethral stricture?

BACKGROUND: Testosterone plays a vital role in maintaining tissue homeostasis, and testosterone deficiency may potentially influence the likelihood of urethral stricture recurrence. OBJECTIVES: To evaluate the prognostic value of testosterone levels in the recurrence after direct visual internal urethrotomy in primary short segment bulbar urethral strictures and its clinical reflections. MATERIALS AND METHODS: A total of 723 patients who underwent direct vision internal urethrotomy between January 2000 and October 2022 were retrospectively analyzed. After implying exclusion criteria, 116 patients with available data were enrolled. Patients were divided into two groups as recurrence and no recurrence. Age, stricture length, etiology, time of recurrence, diagnosis of previous diabetes mellitus, hypertension, smoking, body mass index, and total testosterone levels were recorded. Free testosterone and bioavailable testosterone values were calculated using total testosterone, albumin, and sex hormone binding globulin values. Hypogonadism was considered as a total testosterone level less than 300 ng/dL. Demographic characteristics and total testosterone, free testosterone, and bioavailable testosterone levels were compared between the two groups for statistical significance. The recurrence rates of patients with and without hypogonadism were compared. RESULTS: Recurrence was observed in 41.4% of the cases (n = 48). There was no statistically significant difference between the groups in terms of age, body mass index values, diabetes mellitus, hypertension, smoking status, presence of hypogonadism, and etiology (p = 0.745, 0.863, 0.621, 0.622, 0.168, 0.051, and 0.232). In terms of total testosterone levels and bioavailable testosterone levels, the recurrence group had significantly lower values (p = 0.018 and 0.04). There was no significant difference between the two groups in terms of stricture length (p = 0.071). Sixteen of 28 patients with hypogonadism had recurrence, whereas 32 of 88 patients without hypogonadism had recurrence (p = 0.051). DISCUSSION: Testosterone levels have potential to predict recurrence in primary short-segment bulbar urethral strictures. This study represents the inaugural analysis of the impact of testosterone deficiency on recurrence within the cohort of patients with primary short-segment bulbar urethral strictures. CONCLUSION: Testosterone levels and ratios may serve as predictive factors for identifying recurrent cases in primary short-segment bulbar strictures. For patients at a higher risk of recurrence, urethroplasty may be considered as an initial treatment option, even in cases of primary and short-segment strictures.

Assessment of YouTube Videos about Urethral Stricture and Its Management.

PURPOSE: To evaluate the reliability, transparency, usability and technical quality of videos about urethral stricture and its management in the most common video-sharing website "YouTube". METHODS: We performed a video search on YouTube using the keywords "Urethral Stricture", "Internal Urethrotomy" and "Urethroplasty". After excluding the videos that did not meet the inclusion criteria, demographic data of each video was recorded and assessed with the validated DISCERN questionnaire, the Journal of the American Medical Association Benchmark Score (JAMAs) and the Global Quality Score (GQS). Additionally, the Urethral Stricture Video Score was developed by two experienced surgeons to assess the technical aspects. Videos were also compared with a view to their source of upload. RESULTS: A total of 177 videos were analysed. Videos from "University" and "Other" had a significantly higher view ratio and video power index (VPI) than the rest (all p<0.05). For all mentioned scores, even though the video sources of "Society" and "University" had significantly higher scores than the rest (all p<0.05), all scores remained at a low to moderate level at each group. CONCLUSION: Even though universities, societies and organisations tend to upload better videos about the management of urethral stricture in terms of general quality, reliability, transparency and technical aspects, the online visual content about urethral stricture and its management needs to be improved in order to provide more reliable and qualified information for both clinicians and patients.

Predictive value of systemic immune-inflammation index in recurrent urethral strictures.

PURPOSE: To investigate the predictive value of systemic immune-inflammation index (SII) in recurrence of urethral stricture in patients undergoing internal urethrotomy. METHODS: In this two-center, retrospective study, 703 patients who had internal urethrotomy for urethral stricture were included. Demographic, clinical, and laboratory characteristics and operative data were obtained. Two groups were formed from the patients as non-recurrent urethral stricture (n = 490) and recurrent urethral stricture (n = 213). RESULTS: There was no significant difference in the mean age between the patients with and without recurrence. There was a significant difference in the mean SII values and albumin levels between the recurrence and non-recurrence groups (p = 0.001 and p = 0.006, respectively). Using a cut-off value of 252 for the SII; the sensitivity was 59.62%, the specificity was 70.41%, the positive predictive value was 46.69%, the negative predictive value was 80.05% and the accuracy was 67.14%, respectively. Statistically significant correlation was found between the presence of recurrence and the established cut-off value of the SII (p = 0.001 and p < 0.01, respectively). The risk of recurrence was stated that 3.514 times higher in patients with a SII value of ⩾252. CONCLUSION: Using the SII the inflammatory state of the urethral tissue can be evaluated. Thus the risk of recurrence after internal urethrotomy operation can be predicted. Open urethroplasty technique instead of DVIU in patients with high SII values may increase the surgical success rates.

Management and outcomes of urethral stricture: single centre experience over 13 years.

AIM: To present a comprehensive summary of the diagnosis, treatment and follow-up process of patients who underwent open urethroplasty in our tertiary referral center for the treatment of urethral stricture in the last 13 years. MATERIALS AND METHODS: Two hundred and forty-five (245) patients who underwent open urethroplasty between January 2008 and June 2021 were retrospectively analysed. Detailed history, physical examination, uroflowmetry, retrograde urethrography and/or voiding cystourethrography and/or urethroscopy were used throughout the preoperative diagnosis process. While evaluating the postoperative patency rates, the absence of preoperative voiding symptoms after the operation and Qmax 15 ml/sec and above were taken into account. RESULTS: Mean stricture length was 3.8 +/- 1.4 cm. Transurethral endoscopic interventions in 79 patients (32.2%), catheterisation in 55 patients (22.4%), trauma in 54 patients (22%), infection in 15 patients (6.2%), and idiopathology in 42 patients (17.2%) were the causes for the stricture. Buccal mucosal graft was used in 125 patients (51%), penile skin flap in 32 patients (13%), end-to-end anastomosis in 83 patients (33.8%) and Heineke-Mikulicz technique in 5 patients (2%). Mean follow-up period was 67.1 +/- 28.9 months. Success rates of patients were 84% (105) in buccal mucosal graft, 78.1% (25) in penile skin flap, 86.7% (72) with end-to-end anastomosis and 80% (4) with Heineke-Mikulicz technique. CONCLUSION: Among treatment options for urethral stricture, urethroplasty techniques is the most successful treatment. Consideration of the factors leading to the formation of the stricture, with the intraoperative findings and surgical experience will maximize the benefit the patient receives.

Biopsy with Ureterorenoscopy Before Radical Nephroureterectomy is Associated with Increased Intravesical Recurrence in Urothelial Cancer Located in the Kidney.

OBJECTIVE: Diagnostic ureterorenoscopy is used to identify upper tract urothelial cancer before radical nephro ureterectomy, especially for uncertain lesions in imaging modalities or urine cytology. However, diagnostic ureterorenoscopy can potentially cause intravesical tumor spillage and can increase intravesical recurrence rates. We aimed to investigate the impact of diagnostic ureterorenoscopy before radical nephroureterectomy, with and without biopsy, on intravesical recurrence rates of patients with upper tract urothelial cancer. MATERIAL AND METHODS: Patients with localized upper tract urothelial cancer from 8 different tertiary referral centers, who underwent radical nephroureterectomy between 2001 and 2020, were included. Three groups were made: no URS (group 1); diagnostic ureterorenoscopy without biopsy (group 2); and diagnostic ure terorenoscopy with biopsy (group 3). Intravesical recurrence rates and survival outcomes were compared. Univariate and multivariate Cox regression analyses were performed to determine the factors that were asso ciated with intravesical recurrence-free survival. RESULTS: Twenty-two (20.8%), 10 (24.4%), and 23 (39%) patients experienced intravesical recurrence in groups 1, 2, and 3, respectively (P=.037) among 206 patients. The 2-year intravesical recurrence-free sur vival rate was 83.1%, 82.4%, and 69.2%, for groups 1, 2, and 3, respectively (P=.004). Cancer-specific survival and overall survival were comparable (P=.560 and P=.803, respectively). Diagnostic ureterore noscopy+biopsy (hazard ratio: 6.88, 95% CI: 2.41-19.65, P < .001) was the only independent predictor of intravesical recurrence in patients with upper tract urothelial cancer located in the kidney, according to tumor location. CONCLUSION: Diagnostic ureterorenoscopy+biopsy before radical nephroureterectomy significantly increased the rates of intravesical recurrence in tumors located in kidney. This result suggests tumor spillage with this type of biopsy, so further studies with different biopsy options or without biopsy can be designed.

[Evaluation of ischemia-modified albumin in obstructive renal injury.] / Evaluación de la albumina modificada por la isquemia en lesiones renales obstructivas.

OBJECTIVES: This study was aimed at assessing the ability of ischemia-modified albumin (IMA) to predict renal injury by associating biochemical, functional, and pathological findings with various degrees of ureteral obstruction. METHODS: Twenty-four rats were randomized into three groups, and their blood was sampled to determine the creatinine and IMA values and renal scintigraphy was done at the start and on postoperative day 7. In the sham group, the ureter was untouched; in the partial group, the ureter was gently embedded into the psoas muscle; and in the complete group, the ureter was compathologically, and all parameters were statistically evaluated. RESULTS: IMA was significantly associated with functional changes, creatinine values, and pathology scores (r = -0.729, r = 0.771, r = 0.827 respectively; p < 0.001). The postoperative IMA values of the partial and complete group were significantly higher than the respective preoperative values (p < 0.001, p < 0.001; p < 0.05, respectively). Additionally, the postoperative IMA values of the complete group were significantly higher than that of the sham and partial groups (p < 0.001, p = 0.001; p < 0.05, respectively). CONCLUSIONS: IMA, which is strongly associated with renal functional and pathological variations, appears to be a valuable parameter for predicting renal injury and may warn clinicians before the irreversible phases of obstructive uropathy occur. More extensive studies with human participants may prove advantageous.

OBJETIVOS: Este estudio intenta determinar la habilidad de la albumina modificada por la isquemia (IMA) para predecir el daño renal a través de asociar hallazgos patológicos, funcionales y bioquímicos con distintos grados de obstrucción.MÉTODOS: Se randomizaron 24 ratas en 3 grupos y se recogió su sangre para determinar la creatinina y IMA. Se realizó un renograma al inicio y en el día 7 del postoperatorio. En el grupo control, el uréter no se tocó, en el grupo parcial, el uréter se cosió en parte al músculo psoas y en el grupo completo el uréter se ligó completamente. La extensión de la lesión renal se graduó desde el punto de vista histológico, y todos los parámetros fueron estadísticamente evaluados. RESULTADOS: IMA estuvo estadísticamente asociada a cambios funcionales, valores de creatinina y grados histológicos (r = -0,729, r = 0,771, r = 0,827 respectivamente; p < 0,001). Los valores IMA postoperatorios en los grupos parcial y completa fueron significativamente más altos en relación a los valores preoperatorios (p < 0,001, p < 0,001; p < 0,05, respectivamente). Adicionalmente, los valores postoperatorios de IMA del grupo de obstrucción completa fueron significativamente más altos que el grupo control y parcial (p < 0,001, p = 0,001; p < 0,05, respectivamente). CONCLUSIONES: IMA, que está ampliamente asociado a la función renal y a las variaciones histológicas, parece ser un parámetro importante para predecir el daño renal y puede advertir a los clínicos antes de que se den las fases irreversibles de la uropatía obstructiva.Estudios más amplios con humanos pueden resultar ventajosos.

Evaluation of ischemia-modified albumin in obstructive renal injury / Evaluación de la albúmina modificada por isquemia en la lesión renal obstructiva

Objetives: This study was aimed at assessing the ability of ischemia-modified albumin (IMA)to predict renal injury by associating biochemical, functional, and pathological findings with various degrees of ureteral obstruction. Methods: Twenty-four rats were randomized into three groups, and their blood was sampled to determine the creatinine and IMA values and renal scintigraphy was done at the start and on postoperative day 7. In the sham group, the ureter was untouched; in the partial group, the ureter was gently embedded into the psoas muscle; and in the complete group, the ureter was completely ligated. The extent of renal injury was scoredpathologically, and all parameters were statistically evaluated. Results: IMA was significantly associated with functional changes, creatinine values, and pathology scores (r = -0.729, r = 0.771, r = 0.827 respectively; p < 0.001).The postoperative IMA values of the partial and complete group were significantly higher than the respective preoperative values (p < 0.001, p < 0.001; p < 0.05, respectively). Additionally, the postoperative IMA values of the complete group were significantly higher than that of the sham and partial groups (p < 0.001, p = 0.001; p < 0.05, respectively). Conclusions: IMA, which is strongly associated with renal functional and pathological variations, appears to be a valuable parameter for predicting renal injury and may warn clinicians before the irreversible phases of obstructive uropathy occur. More extensive studies with human participants may prove advantageous.(AU)

Objetivos: Este estudio intenta determinar la habilidad de la albumina modificada por la isquemia (IMA) para predecir el daño renal a través de asociar hallazgos patológicos, funcionales y bioquímicos con distintos grados de obstrucción. Métodos: Se randomizaron 24 ratas en 3 grupos y se recogió su sangre para determinar la creatinina y IMA. Se realizó un renograma al inicio y en el día 7 del postoperatorio. En el grupo control, el uréter no se tocó, en el grupo parcial, el uréter se cosió en parte al músculo psoas y en el grupo completo el uréter se ligó completamente. La extensión de la lesión renal se graduó desde el punto de vista histológico, y todos los parámetros fueron estadísticamente evaluados. Resultados: IMA estuvo estadísticamente asociada a cambios funcionales, valores de creatinina y grados histológicos (r = -0,729, r = 0,771, r = 0,827 respectivamente; p < 0,001). Los valores IMA postoperatoriosen los grupos parcial y completa fueron significativamente más altos en relación a los valores preoperatorios(p < 0,001, p < 0,001; p < 0,05, respectivamente). Adicionalmente, los valores postoperatorios de IMA del grupo de obstrucción completa fueron significativamente más altos que el grupo control y parcial (p < 0,001,p = 0,001; p < 0,05, respectivamente). Conclusiones: IMA, que está ampliamente asociado a la función renal y a las variaciones histológicas,parece ser un parámetro importante para predecir el daño renal y puede advertir a los clínicos antes de que se den las fases irreversibles de la uropatía obstructiva. Estudios más amplios con humanos pueden resultar ventajosos.(AU)

Renoprotective effect of platelet-rich plasma in obstructive uropathy.

PURPOSE: To investigate the effect of platelet-rich plasma (PRP) in reducing renal injury in ureteral obstruction. METHODS: Twenty-four Wistar Albino rats were randomized and divided into four groups as the donor (n = 6), sham (n = 6), saline (n = 6), and PRP (n = 6). Blood was obtained from the donor group by cardiac puncture and PRP was prepared. 2 cc blood was sampled from other groups to measure blood-urea nitrogen and creatinine levels. Baseline renal scintigraphy was performed. An abdominal midline incision was made and the left ureter was exposed in the sham group. Saline infusion was given to the kidneys of the saline group after left ureteral obstruction, while PRP was given to the PRP group. On postoperative Day 7, control biochemical and scintigraphic evaluations were performed and left nephrectomies were done. Left kidneys were evaluated histopathologically. RESULTS: DMSA measurements in the sham group were found to be significantly higher than the saline and PRP groups (p = 0.001 and p = 0.024, respectively). There were no significant differences between the saline and PRP groups (p = 0.525 and p > 0.05, respectively). Histopathologically, no significant difference was observed between the saline and PRP groups (p = 0.320), while the scores of the sham group were significantly higher than the saline and PRP groups (p = 0.02 and p = 0.001, respectively). CONCLUSION: Our study results suggest that PRP may be effective in preventing ureteral obstruction-induced renal injury.

Identifying the predictors of estimated glomerular filtration rate after partial nephrectomy with a nonlinear regression model.

PURPOSE: To evaluate the effect of partial nephrectomy on renal function and to identify predictors of estimated glomerular filtration rate (eGFR) at 6 months after partial nephrectomy. METHODS: Medical data of 154 consecutive patients who underwent partial nephrectomy for a renal mass between January 2015 and March 2020 were retrospectively analysed. The primary outcome measure was eGFR at 6 months postoperatively. An ordinary least regression analysis using a restricted cubic spline for continuous variables was performed to examine the association between primary outcome measure and candidate predictors. RESULTS: Of the patients, 66 (42.9%) were females and 88 (57.1%) were males with a median age of 60 (range, 50 to 67) years. The median baseline eGFR was 90.40 (range, 74.96 to 102.97) mL/min/1.73 m2 , while the median eGFR at 6 months was 77.12 (range, 61.06 to 91.93) mL/min/1.73 m2 (P < .001). Baseline eGFR (regression coefficient (ß) = 22.7, 95%CI: 18.8 to 26.5, P < .001) was found to be most significant predictor with the postoperative eGFR levels at 6 months. In addition, advanced tumour size (ß = -3.17, 95%CI: -5.33 to -1.01, P < .001) and presence of hypertension (ß = -3.48, 95%CI: -6.96 to -0.003, P = .049) were also found to be inversely associated with the postoperative eGFR levels at 6 months. CONCLUSION: Baseline eGFR values, tumour size, and presence of hypertension are significant predictors of eGFR values in the mid-term in patients undergoing partial nephrectomy.

Evaluation of dynamic thiol-disulphide homeostasis in obstructive uropathy.

PURPOSE: To evaluate the ability of thiol-disulphide homeostasis to predict renal injury in ureteral obstruction by matching renal scintigraphy and pathological findings in an experimental rat model. METHODS: 24 rats were randomized and divided into 3 groups as sham, partial and complete. Blood samples for biochemical evaluations and dimercaptosuccinic acid (DMSA) renal scintigraphy were performed at the beginning and on the 7th day postoperatively. Only a midline abdominal incision was done in sham group. Left ureter of partial group was dissected and gently buried into the psoas muscle. In complete group, left ureter was dissected and ligated. RESULTS: Statistically significant association was found between left kidney function loss percentage, native thiol, total thiol and creatinine alterations and pathological EGTI (Endothelial, Glomerular, Tubular, Interstitial) scores (r = - 0.867, r = - 0.815, r = 0.745, r = - 0.911; p = 0.000). Statistically significant difference was detected between groups in terms of postoperative native thiol and total thiol values (p = 0.000, p = 0.001). There was also a significant difference in preoperative and postoperative comparisons of these parameters in partial and complete obstruction groups (p = 0.012, p = 0.018). There was a significant difference in terms of postoperative disulphide/native thiol and native thiol/total thiol ratios in complete obstruction group compared to other groups (p1 = 0.011, p2 = 0.040; p1 = 0.015, p2 = 0.028). CONCLUSIONS: Association with scintigraphic and pathological results empowers the value of this parameter. Disulphide/native thiol and native thiol/total thiol ratios indicate complete obstruction. These findings may shed light to more comprehensive studies.

Open radical cystectomy is a reliable surgery with acceptable complication rates in elderly male patients: a retrospective, tertiary hospital-based study.

Objective: This study aims to evaluate safety of radical cystectomy (RS)+pelvic lymph node dissection (PLND)+ileal conduit urinary diversion (ICUD) in male patients aged >65 years versus ≤65 years.Materials and Methods: Eighty-five male patients who underwent RS + PLND + ICUD for bladder cancer were retrospectively analyzed. The patients were divided into two groups according to age: ≤65 years (Group 1, n = 40) versus >65 years (Group 2, n = 45). Data including baseline demographic and clinical characteristics of the patients, length of hospital stay, and complications within 90 days of surgery, and Grade ≤ II and Grade ≥ III complications according to the Clavien-Dindo (C-D) classification were recorded. Groups were compared in terms of demographic features and development of complications within 90 day after surgery statistically.Results: The median length of hospital stay was statistically significantly longer in Group 2 than Group 1 [10 (7-17) days vs. 9 (6-14) days, respectively; p < .05]. There was no statistically significant difference in the rehospitalization rate within 90 days of surgery between the groups (p > .05).Conclusion: Our study results suggest that RS + PLND + ICUD is a safe procedure in male patients aged ≥65 years.

Is neutrophil to lymphocyte ratio a predictive factor for recurrence of urethral stricture?

SUMMARY INTRODUCTION Due to spongiofibrosis and inflammatory processes underlying the pathogenesis of urethral stricture, it is possible that the neutrophil-lymphocyte ratio (NLR) may give essential information about the course of the disease and recurrence possibilities. Our study aims to evaluate the correlation between NLR and recurrence rates. METHODS A total of 512 patients who underwent direct visual internal urethrotomy (DVIU) due to urethral stricture in our clinic between February 2010 and January 2018 were evaluated retrospectively. RESULTS The median follow up for non-recurrent and recurrent groups after DVIU was 30 and 36 months, respectively. During the follow-up, 280 (54.7%) of the patients had recurrences, and 232 (45,3%) had no recurrences. The mean time for recurrence after DVIU was 6,5±1,4 months, with a range of 1-36 months. The mean NLR in the non-recurrence group was 2,02±0,87, with a median of 1.9, and 3,66±2,30, with a median of 3 in the recurrence group. A highly significant statistical difference was observed between two groups in terms of neutrophil count and NLR (p: 0.000 - both). The area under curve value for NLR was 0.767, with a standard error of 0.021 (95% CI 0.727-0.808). The cut-off value of NLR was determined as 2.25, with a 70% sensitivity and 67,7% specificity. CONCLUSION By using NLR, the inflammatory features of the urethral tissue can be predicted, and possible recurrences after surgery can be estimated. Consequently, open urethroplasty techniques can be used in cases with a significant NLR value instead of the recurrent endoscopic procedure.

RESUMO INTRODUÇÃO Devido à espongiofibrose e processos inflamatórios subjacentes à patogênese da estenose uretral, pode-se pensar que a relação de linfócitos neutrofílicos (NLR) pode fornecer informações essenciais sobre o curso da doença e as possibilidades de recorrência. O objetivo do nosso estudo é avaliar a correlação entre NLR e taxas de recorrência. MÉTODOS Quinhentos e doze pacientes submetidos à uretrotomia interna visual direta (DVIU) devido à estenose uretral em nossa clínica entre as datas de fevereiro de 2010 e janeiro de 2018 foram avaliados retrospectivamente. RESULTADOS A mediana de acompanhamento para os grupos não recorrentes e recorrentes após a DVIU foi de 30 e 36 meses, respectivamente. Durante o seguimento, 280 (54,7%) dos pacientes tiveram recidivas e 232 (45,3%) não tiveram recidivas. O tempo médio de recorrência após a DVIU foi de 6,5±1,4 mês, com variação de 1-36 meses. A média da RNL no grupo sem recorrência foi de 2,02±0,87 com mediana de 1,9 e 3,66±2,30 com mediana de 3 no grupo com recidiva. Uma diferença estatística altamente significativa foi observada entre dois grupos em termos de contagem de neutrófilos e NLR (p: 0,000 - ambos). A área sob o valor da curva para NLR foi de 0,767 com um erro padrão de 0,021 (IC 95% 0,727-0,808). Valor de corte de NLR determinado como 2,25 com uma sensibilidade de 70%, especificidade de 67,7%. CONCLUSÃO Ao utilizar a RNL, as características inflamatórias do tecido uretral podem ser previstas e possíveis recidivas após a cirurgia podem ser estimadas. Dessa forma, técnicas de uretroplastia aberta podem ser usadas em casos com valor significativo de NLR em vez de procedimento endoscópico recorrente.

Renal angiomyolipoma.

INTRODUCTION: Angiomyolipoma is one of the most common benign solid renal tumors. We investigated the characteristics of renal angiomyolipomas and the clinical outcomes of patients in the last thirteen years. METHODS: The medical records of the patients who underwent nephrectomy were reviewed retrospectively from July 2005 to May 2018. The laboratory data, radiology, and pathology reports were recorded. Patients diagnosed with angiomyolipoma were included in the study. RESULTS: A total of 28 patients were included in the study, eight of them male. The mean age of the patients was 55.89+14.49 years. The patients were treated with open and laparoscopic techniques. Partial nephrectomy was performed in 12 patients(42.85%). After pathological examination, 23 patients were diagnosed as fat rich, four patients as fat poor, and one as epithelioid angiomyolipoma. There were no recurrences in the follow-up 91.21+48.31 months. CONCLUSION: Angiomyolipoma is a rare renal tumor in daily urology practice. Clinicians must be aware of its complications and manage patients well.

Renal angiomyolipoma

SUMMARY INTRODUCTION Angiomyolipoma is one of the most common benign solid renal tumors. We investigated the characteristics of renal angiomyolipomas and the clinical outcomes of patients in the last thirteen years. METHODS The medical records of the patients who underwent nephrectomy were reviewed retrospectively from July 2005 to May 2018. The laboratory data, radiology, and pathology reports were recorded. Patients diagnosed with angiomyolipoma were included in the study. RESULTS A total of 28 patients were included in the study, eight of them male. The mean age of the patients was 55.89+14.49 years. The patients were treated with open and laparoscopic techniques. Partial nephrectomy was performed in 12 patients(42.85%). After pathological examination, 23 patients were diagnosed as fat rich, four patients as fat poor, and one as epithelioid angiomyolipoma. There were no recurrences in the follow-up 91.21+48.31 months. CONCLUSION Angiomyolipoma is a rare renal tumor in daily urology practice. Clinicians must be aware of its complications and manage patients well.

RESUMO OBJETIVO O angiomiolipoma é um dos tumores renais benignos sólidos mais comuns. Investigamos as características dos angiomiolipomas renais e os desfechos clínicos dos pacientes nos últimos treze anos. MÉTODOS Os prontuários dos pacientes, para os quais a nefrectomia foi realizada, foram revisados retrospectivamente de 2008 a 2018. Os dados laboratoriais, relatórios de radiologia e patologia foram registrados. Os pacientes diagnosticados como angiomiolipoma foram incluídos no estudo. RESULTADOS Vinte e oito pacientes foram incluídos no estudo, oito deles do sexo masculino. A média de idade dos pacientes foi de 55,89 + 14,49 anos. Os pacientes foram tratados com técnicas abertas e laparoscópicas. Nefrectomia parcial foi realizada em 12 pacientes (42,85%). Depois de exame patológico, 23 pacientes foram diagnosticados como ricos em gordura, quatro pacientes como gordurosos e um paciente como angiomiolipoma epitelioide. Nenhum paciente teve recorrências no seguimento. CONCLUSÕES O angiomiolipoma é um tumor renal raro na prática urológica diária. Os médicos devem estar cientes das complicações e gerenciar bem os pacientes.

Surgical management of renal cell carcinoma with associated tumor thrombus extending into the inferior vena cava: A 10-year single-center experience.

OBJECTIVE: Renal cell carcinoma (RCC) is a tumor that has a tendency of vascular invasion by extending to the inferior vena cava (IVC) after the renal vein. The total resection of the renal tumor and tumor thrombus is considered the optimal treatment. In our study, we aimed to present the results related to 34 consecutive cases of RCC with tumor thrombus. MATERIAL AND METHODS: Of the 442 patients diagnosed with renal tumors between January 2008 and January 2018, 34 (7.6%) had tumor thrombus over the renal vein extending to the IVC. The data of the 34 patients with tumor thrombus were retrospectively reviewed and included in the study. All the 34 patients underwent radical nephrectomy with tumor thrombectomy. The presence of thrombus was evaluated using contrast-enhanced abdominal tomography, magnetic resonance imaging, or color Doppler ultrasonography. The level of thrombus was classified using the Mayo Clinic tumor thrombus classification. Surgery was performed transperitoneally through a modified Chevron incision and mostly in collaboration with other clinics. Complications were classified according to the Clavien system. RESULTS: Of the 34 patients, 22 were males and 12 were females. The mean follow-up period was 36±27.2 months in patients who had a mean age of 61±10.9 years. The mean tumor size was 10.5±3.3 cm. The number of patients according to the thrombus levels I, II, and III were 20, 9, and 5, respectively. The average blood loss was 744±285.4 mL. Radical surgery for all patients who had direct invasion to the vena cava wall and/or level II and III was performed by gastrointestinal and cardiothoracic surgeons. Cardiopulmonary bypass was not performed in any patient. Minor complications (Clavien grades 1-2) were seen in 8 (23.5%) patients, while 2 (5.8%) patients had major complications (Clavien grades 3-5). The mean follow-up period was 36 months (range, 6-72 months). The overall 5-year survival rate was 85.2%. CONCLUSION: We think that radical nephrectomy and caval thrombectomy is a safe and effective method in patients with RCC without tumor exceeding the diaphragmatic level. We believe that the surgical success rate can be increased using a multidisciplinary approach in selected cases.

Evaluation of germ-cell neoplasia in situ entity in testicular tumors.

OBJECTIVE: Germ-cell neoplasia in situ (GCNIS) is accepted as the precursor of the testicular tumors. The aim in our study is to compare the lymphadenopathy and metastasis parameters in patients diagnosed with testicular tumor with or without GCNIS based on pathological evaluation. MATERIAL AND METHODS: Data from 108 patients who underwent orchiectomy for testicular tumor between January 2007 and December 2014 in our clinic were retrospectively analyzed and included in the study. Patients were divided into two groups based on the pathology reports as GCNIS or not. Groups were compared regarding lymphadenopathy, metastasis, tumor marker levels, tumor size, lymphovascular invasion, rete testis invasion. Mann-Whitney U test was used for statistical evaluation. RESULTS: Mean age of the patients included in the study were calculated as 34.6±9.3 years. Eighty-five (78.7%) patients had GCNIS, while 23 (21.3%) of them had not. In terms of metastasis, lymphadenopathy, marker levels, tumor size, lymphovascular invasion and rete testis invasion, no statistical significant difference were observed between two groups (p>0.05). CONCLUSION: In our study, no statistical significant difference was observed on the prognostic factors concerning the GCNIS entity, which is reported frequently in testicular tumor pathologies. For presently these findings show us that GCNIS cannot be used as a prognostic factor.

Is neutrophil to lymphocyte ratio a predictive factor for recurrence of urethral stricture?

INTRODUCTION: Due to spongiofibrosis and inflammatory processes underlying the pathogenesis of urethral stricture, it is possible that the neutrophil-lymphocyte ratio (NLR) may give essential information about the course of the disease and recurrence possibilities. Our study aims to evaluate the correlation between NLR and recurrence rates. METHODS: A total of 512 patients who underwent direct visual internal urethrotomy (DVIU) due to urethral stricture in our clinic between February 2010 and January 2018 were evaluated retrospectively. RESULTS: The median follow up for non-recurrent and recurrent groups after DVIU was 30 and 36 months, respectively. During the follow-up, 280 (54.7%) of the patients had recurrences, and 232 (45,3%) had no recurrences. The mean time for recurrence after DVIU was 6,5±1,4 months, with a range of 1-36 months. The mean NLR in the non-recurrence group was 2,02±0,87, with a median of 1.9, and 3,66±2,30, with a median of 3 in the recurrence group. A highly significant statistical difference was observed between two groups in terms of neutrophil count and NLR (p: 0.000 - both). The area under curve value for NLR was 0.767, with a standard error of 0.021 (95% CI 0.727-0.808). The cut-off value of NLR was determined as 2.25, with a 70% sensitivity and 67,7% specificity. CONCLUSION: By using NLR, the inflammatory features of the urethral tissue can be predicted, and possible recurrences after surgery can be estimated. Consequently, open urethroplasty techniques can be used in cases with a significant NLR value instead of the recurrent endoscopic procedure.

Diagnosis and Treatment of Paratesticular Adenomatoid Tumors.

Paratesticular adenomatoid tumor (PAT) is the most common paratesticular tumor. It is still a concern for today's urologists because it cannot be distinguished from malignant testicular tumors by clinical symptoms, routine examination and imaging methods. Because of the predominant benign nature of paratesticular masses, testicular preservative treatments get to the foreground. However, the fact that virtually all of the solid scrotal masses are malignant and are treated with radicel ingainel orchiectomy (RIO) remains a cause of concern. In this study, we discuss the diagnosis and treatment of 12 paratesticular adenomatoid tumors treated between 2012 and 2017 in two centres. We suggest that a frozen section should be done with the help of an experienced pathologist; and a meticulous microscopic evaluation should be the gold standard in case of a benign tumor suspicion.