External validation of the T.O.HO. score as predictor of success after retrograde intrarenal surgery.

BACKGROUND: To assess the effectiveness of T.O.HO. (Tallness, Occupied lesion, Houndsfield unit evaluation) score in predicting the retrograde intrarenal surgery (RIRS) success and to validate this scoring system. METHODS: The age, sex, previous stone surgery, hospitalization, surgery duration, postoperative complication, stone length, stone location, stone density, stone number, lateralization, presence of hydronephrosis, and presence of preoperative stent datas of 611 patients who underwent RIRS in our clinic between January 2013 and January 2021 were retrospectively assessed. The patients were divided into two groups as successful and unsuccessful. The T.O.HO scores of all patients were calculated. RESULTS: The success rate was 72.5%. Compared to the unsuccessful group, stone length and stone density were lower, surgery duration was shorter and there were less lower pole stones in the successful group (p < 0.001). No significant difference was found between the two groups in terms of the other parameters. The T.O.HO. score was significantly lower in the successful group compared to the unsuccessful group (p < 0.001). According to the multivariate logistic regression analysis, stone length (OR: 0.905; 95% Cl: 0.866-0.946; p < 0.001), lower pole location (OR: 0.546; 95% Cl: 0.013-0.296; p < 0.001), stone density (OR: 0.999; 95% Cl: 0.998-1; p = 0.044) and the T.O.HO. score (OR: 0.684; 95%Cl: 0.554-0.844; p < 0.001) were found as the independent risk factors for RIRS success. ROC curve analysis showed that the T.O.HO. score could predict the RIRS success with 7.5 cut-off point (AUC: 0.799, CI: 0.76-0.839; p < 0.001). CONCLUSION: The T.O.HO. score can predict RIRS success with a high rate of accuracy.

A novel urethra compression technique using Turkish continence device for male urinary incontinence

Background/aim: The male sling operation and artificial urinary sphincter implantation are common methods for treating urinary incontinence. However, there are some drawbacks to these methods such as infection, urethral erosion, pain, inefficiency, and the technical difficulty of the operations. Here we describe a new device we have named the Turkish Continence Device (TCD) which has advantages over these other methods. The aim of this study was perform experiments with the TCD prototype in vivo and ex vivo to determine efficiency, convenience of implantation, and negative effects. Materials and methods: We implanted the prototype device in male goats and sheep, compressing the posterior urethra, and then fixed it by sutures on the lateral sides of the cavernosal bodies, bilaterally. Then we recorded urodynamic findings and performed urinary imaging. Additionally we measured urethral closure pressure ex vivo. Results: The balloon volume for efficient urethral closure pressure using the new device was under 1 mL. It compressed the urethra towards the corpus cavernosum perfectly, because the wings of the prototype device are fixed near the tunica of the cavernosal bodies on each side. Conclusion: A smaller device with smaller arms/wings would be efficient for obtaining enough pressure on the urethra. Additionally, the technique for implanting the device is very simple and would likely be learned quickly.

The importance of periprostatic fat tissue thickness measured by preoperative multiparametric magnetic resonance imaging in upstage prediction after robot-assisted radical prostatectomy.

PURPOSE: We analyzed the surgical results of patients who were treated and followed up for prostate cancer in our clinic to predict the relationship between periprostatic adipose tissue and patients with and without pathologically upstaged disease. MATERIALS AND METHODS: The study included patients who had undergone robot-assisted radical prostatectomy and preoperative multiparametric prostate magnetic resonance imaging between 18 February 2019 and 1 April 2022. The patients were divided into two groups, and the surgical and transrectal ultrasound-guided biopsy pathology results were compared according to tumor grade and distribution in 124 patients who met the selection criteria. We analyzed the relationships between upgrading/upstaging and periprostatic adipose tissue thickness (PPATT) and subcutaneous adipose tissue thickness (SATT) as measured in magnetic resonance imaging. RESULTS: The median PPATT was 4.03 mm, whereas the median SATT was 36.4 mm. Upgrading was detected in 45 patients (36.3%), and upstaging was detected in 42 patients (33.9%). A receiver operating characteristic regression analysis revealed that a PPATT >3 mm was a predictive factor for upstaging after radical prostatectomy (area under curve=0.623, 95% confidence interval [CI] 0.519-0.727, p=0.025). Multivariate logistic regression analyses revealed that prostate specific antigen density ≥0.15 ng/mL/cm3 (odds ratio [OR] 5.054, 95% CI 2.008-12.724, p=0.001), International Society of Urological Pathology grade ≥4 (OR 9.369, 95% CI 2.109-21.626, p=0.003) and higher PPATT (OR 1.358, 95% CI 1.081-1.707, p=0.009) were independent risk factors for upstaging after radical prostatectomy. CONCLUSIONS: We believe that the PPATT may be a predictive indicator for upstaging after robot-assisted laparoscopic radical prostatectomy.

Efficacy of plasma atherogenic index in predicting malignancy in the presence of Prostate Imaging-Reporting and Data System 3 (PI-RADS 3) prostate lesions.

PURPOSE: Plasma atherogenic index (PAI) was shown to be positively correlated with the presence of malignity in patients with suspicious findings for renal cell cancer and colon cancer in reported studies. In this study, we aimed to evaluate whether there is an association with the presence of malignity in patients PI-RADS 3 prostate lesions and PAI. METHODS: This retrospective study reviewed the data of 139 patients who underwent transrectal ultrasonography-guided systematic and cognitive fusion prostate biopsy for PI-RADS 3 lesions in multiparametric magnetic resonance imaging. The patients were divided to two groups as malign (n = 33) and benign (n = 106). The association between age, body mass index, comorbidities, smoking status, prostate-specific antigen (PSA), PSA density, free/total PSA, prostate weight, lesion diameter, triglyceride value, high-density lipoprotein-cholesterol value, PAI value data and presence of malignity were investigated by descriptive, multivariate and receiver-operating characteristic (ROC) analysis. RESULTS: PSA, PSAD, lesion diameter and PAI value were statistically significantly higher in the malignant group compared to the benign group, and the free/total PSA ratio was lower. In multivariate logistic regression analysis, PSA > 9.9 ng/ml, free/total PSA < 12.1%, lesion diameter > 13.5 mm and PAI > 0.13 were identified as independent risk factors for presence of prostate malignancy. CONCLUSION: PAI was found to be a predictive parameter for prostate cancer in PI-RADS 3 prostate lesions. Our study can open new thoughts about PAI as metric to assess the prostate cancer risk.

Feasibility of E-PASS score to predict postoperative complications in laparoscopic nephrectomy.

PURPOSE: To evaluate the usefulness of E-PASS score to predict postoperative complications after laparoscopic nephrectomy. METHODS: Between 2008 and 2020, 424 patients (179 patients: simple nephrectomy, 158 patients: radical nephrectomy, 87 patients: donor nephrectomy) who underwent laparoscopic nephrectomy in our clinic, were included in the study. Patient groups separated according to the presence of postoperative complications were compared retrospectively regarding demographic, clinical, intraoperative, and postoperative data, comorbidities, and E-PASS scores (PRS, SSS, and CRS). The relationship between postoperative complications and E-PASS scores was examined. RESULTS: Postoperative complications occurred in 43 (10.1%) of the patients. Age, previous abdominal/retroperitoneal surgery, radical nephrectomy rate of surgeries, operation time, amount of bleeding, need for blood transfusion, rate of conversion from laparoscopic surgery to open surgery, hospitalization time, E-PASS PRS, SSS, and CRS were statistically significantly higher in the group with postoperative complications. The cutoff value of the E-PASS CRS was - 0.2996 to predict the development of postoperative complications (AUC = 0.706; 95% CI 0.629-0.783; p < 0.001). According to multivariate analysis, presence of previous abdominal/retroperitoneal surgery (OR 2.977; 95% CI 1.502-5.899; p = 0.002), laparoscopic radical nephrectomy (OR 2.518; 95% CI 1.224-5.179; p = 0.012), conversion from laparoscopic surgery to open surgery (OR 4.869; 95% CI 1.046-22.669; p = 0.044) and E-PASS CRS > - 0.2996 (OR 2.816; 95% CI 1.321-6.004; p = 0.007) were found to be independent risk factors predicting postoperative complications. CONCLUSION: The E-PASS scoring system is an effective and convenient system for predicting postoperative complications after laparoscopic nephrectomy.

Does surgical position affect infective complications in percutaneous nephrolithotomy?

The downward orientation of the access sheath during supine percutaneous nephrolithotomy (PCNL) allows the faster evacuation of fluids and stone fragments. It theoretically can contribute to the reduction of the high intrarenal pressure-associated complications. We aimed to investigate whether there is a difference between prone and supine PCNL in terms of infective complications. This retrospective study includes 182 patients who underwent supine and prone PCNL due to kidney stones in our clinic between April 2020 and May 2022. Demographic (age, sex, body mass index, comorbidities), radiological (cumulative stone burden, stone density, number of stones, stone localization, stone laterality, presence of hydronephrosis), clinical (previous stone surgery, previous urinary tract) and perioperative (prone or supine position, surgery duration, hospitalization, success, non-infective and infective complications) data of all patients were evaluated. All patients were divided into two groups, the prone position group, and the supine position group. These two groups were compared in terms of pre and postoperative data above. Infective complications were observed in 16 (18%) patients in the prone position group and in 7 (7.5%) patients in the supine position group, and this difference was statistically significant (p = 0.034). Surgery duration (OR = 1.041; 95% CI 1.021-1.061; p < 0.001), number of stones (OR = 4.09; 95% CI 1.093-7.309; p = 0.036), previous urinary tract infection (OR = 6.272; 95% CI 1.936-9.317; p = 0.002) and prone position (OR = 4.511; 95% CI 1.265-7.087; p = 0.02) were found as independent risk factors for infective complications. Prone position was proved as an independent predictor of postoperative infectious events. Supine PCNL will be further adopted as the standard PCNL approach by a continuously growing proportion of endourologists.

The Impact of Living Donor Nephrectomy With Multiple Renal Arteries on Graft Function and Complications in Renal Transplantation.

BACKGROUND: The aim of this study was to investigate the early outcome of living donor kidney transplantation using allografts with a single artery and multiple arteries. METHODS: From February 2018 to December 2019, a total of 62 patients underwent living donor nephrectomy at our institution: 20 multiple artery donor nephrectomies (MADNs) and 42 single artery donor nephrectomies (SADNs). All operations were performed by the same surgeon as the laparoscopic procedure. The MADN and SADN groups were compared regarding donor and recipient hospital stay, operative time, warm ischemia time, and postoperative complications with Clavien-Dindo classification. Graft function was evaluated considering episodes of acute tubular necrosis during the first week, delayed graft function, serum creatinine (SCr), and glomerular filtration rate for 6 months after transplantation. RESULTS: Sixty-two patients were included in this study. There was no difference in terms of age, sex, body mass index, nephrectomy side, smoking status, preoperative SCr, or preoperative glomerular filtration rate between the 2 groups. Warm ischemia time and operation time were statistically significantly higher in the MADN group (P < .001 and P < .001). Regarding graft function, the prevalence of acute tubular necrosis did not differ between groups. There was also no significant difference in the acute rejection or mortality rates after transplantation. Although SCr levels were lower in multiple renal artery recipients, there was no statistical difference during the 6 months of follow-up. Recipient morbidity and mortality were not different between the 2 groups. CONCLUSIONS: Renal allograft transplantation with multiple renal arteries can be performed with reasonable complications and acceptable results.

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.

Spontaneous splenic rupture due to uremic coagulopathy and mortal sepsis after splenectomy.

Nontraumatic spontaneous splenic rupture (NSSR) has been encountered much more rarely compared with the traumatic splenic rupture. Although NSSR generally emerges in dialysis patients on account of such causes as the use of heparin during hemodialysis, uremic coagulopathy, infections, and secondary amyloidosis. Herein, we aimed to present a case of spontaneous splenic rupture which had developed soon after the inclusion of the case suffering from end-stage renal disease in routine hemodialysis program in the absence of any trauma or other prespecified risk factors for splenic rupture. A 55-year-old male patient was admitted to our hospital to have the ureteral double J stent removed. The operation was completed without any complication. Complaining an abdominal pain more prominent in the left upper abdominal quadrant in the first postoperative day, the patient underwent a through physical examination which disclosed abdominal distension, widespread tenderness, and rebound and defense positivity. The abdominal tomography depicted 122 × 114 × 95 mm lesion compatible with a hematoma. On the basis of these findings, an emergency exploratory operation was decided to be performed. Following clearance of the retroperitoneal hematoma, splenectomy was implemented. Experiencing progressive deterioration in his clinical status despite antibiotherapy, the patient unfortunately died of sepsis with multiorgan failure on the 25(th) postoperative day. In conclusion, NSSR is such an entity that may be missed out, can pursue variable clinical courses, and requires emergency therapy upon definitive diagnosis. The possibility of spontaneous bleedings should be kept in mind in any case with the history of hyperuricemia even in the absence of overt trauma, no matter if they are included in routine hemodialysis or not.