Nation-wide analysis of the impact of Covid-19 pandemic on daily urology practice in Turkey.

OBJECTIVE: To present a nation-wide analysis of the workload of urology departments in Turkey week-by-week during Covid-19 pandemic. METHODOLOGY: The centres participating in the study were divided into three groups as tertiary referral centres, state hospitals and private practice hospitals. The number of outpatients, inpatients, daily interventions and urological surgeries were recorded prospectively between 9-March-2020 and 31-May-2020. All these variables were recorded for the same time interval of 2019 as well. The weekly change of the workload of urology during pandemic period was evaluated, also the workload of urology and the distributions of certain urological surgeries were compared between the pandemic period and the same time interval of the year 2019. RESULTS: A total of 51 centres participated in the study. The number of outpatients, inpatients, urological surgeries and daily interventions were found to be dramatically decreased by the 3rd week of pandemics in state hospitals and tertiary referral centres; however, the daily urological practice were similar in private practice hospitals throughout the pandemic period. When the workload of urology in pandemic period and the same time interval of the year 2019 were compared, a huge decrease was observed in all variables during pandemic period. However, temporary measures like ureteral stenting, nephrostomy placement and percutaneous cystostomy have been found to increase during Covid-19 pandemic compared with normal life. CONCLUSIONS: Covid-19 pandemic significantly affected the routine daily urological practice likewise other subspecialties and priority was given to emergent and non-deferrable surgeries by urologists in concordance with published clinical guidelines.

Efficacy and tolerability of mirabegron in female patients with overactive bladder symptoms after surgical treatment for stress urinary incontinence.

PURPOSE: To evaluate the efficacy and tolerability of mirabegron in females with overactive bladder (OAB) symptoms after surgical treatment for stress urinary incontinence (SUI). MATERIALS AND METHODS: The study was conducted with a prospective, randomized and double-blinded design. 62 patients over the age of 40 who met the inclusion-exclusion criterias of the study were enrolled and randomly divided into two groups as Group A (mirabegron 50mg) and B (solifenacin 5mg). Patients were compared based on efficacy of treatment [Patient Perception of Bladder Condition (PPBC) scale and micturition diaries], safety of treatment (heart rate, systolic and diastolic blood pressure, adverse events), number of micturitions per day, patient's satisfaction status after treatment [Visual Analog Scale(VAS)] and quality of life. RESULTS: The mean age of the population was 48.2±3.8 years and the duration of OAB symptoms was 5.9±2.9 months. Baseline values for the mean number of micturitions, volume voided in each micturition, nocturia episodes, urgency and urgency incontinence episodes were 15.3±0.34, 128±3.88mL, 3.96±1.67, 5.72±1.35 and 4.22±0.69, respectively. After treatment, values for these parameters were 11.7±0.29, 164.7±2.9mL, 2.25±0.6, 3.38±0.71, 2.31±0.49 respectively. Quality of life score, symptom bother score, VAS for treatment satisfaction score, PPBC score after treatment were 66.1±0.85, 43.7±0.77, 4.78±0.14, 4.78±0.14, respectively. There were no significant differences between two groups on any parameter. However, mirabegron showed better tolerability than solifenacin, particularly after 6 months. CONCLUSION: Mirabegron is safe, effective and tolerable in the long-term treatment of females with OAB symptoms after surgery for stress urinary incontinence.

Holmium: Yttrium-aluminum-garnet laser lithotripsy: Is there a difference in ablation rates between short and long pulse duration?

Introduction: The high-power holmium: yttrium-aluminum-garnet lasers provide a wide variety of settings for stone disintegration. The aim of this in vitro study is to evaluate the effect of short and long pulse duration on ablation rates on urinary stones. Materials and Methods: Two types of artificial stones were created by BegoStone™ with different compositions (15:3 and 15:6, stone/water ratio). Stones with a 15:3 and 15:6 powder-to-water ratio were defined as hard and soft stones, respectively. Lithotripsy was performed with different laser settings using a custom-made in vitro model consisting of a 60 cm long and 19 mm diameter tube. The ablation rate is defined as the final total mass subtracted from the initial total mass and divided to the time of treatment. Stone ablation rates were measured according to different laser settings with total power of 10W (0,5J-20 Hz, 1J-10 Hz, 2J-5 Hz) and 60W (1J-60 Hz, 1,5J-40 Hz, 2J-30 Hz). Results: Higher pulse rates and higher total power settings were related to higher ablation rates. Short pulse duration was more effective on soft stones, whereas long pulse duration was more effective on hard stones. For the same power settings, the highest energy-lowest frequency combination resulted in higher ablation rate in comparison to the lowest energy-higher frequency combination. Finally, short and long pulse average ablation rates do not differ so much. Conclusion: Regardless of the stone type and pulse duration, utilization of higher power settings with higher energies increased the ablation rates. Higher ablation rates were demonstrated for hard stones using long pulse duration, and for soft stones with short pulse duration.

Does ureteral access sheath have an impact on ureteral injury?

OBJECTIVE: To present a well-organized review about ureteral access sheath impact on ureteral injury. MATERIALS AND METHODS: Systemic search on literature was done. Total of 3766 studies observed by two urologists and results were unified. A Prisma diagram was used for eliminating irrelevant studies and at the end of elimination process 28 studies were found eligible for this review. RESULTS: Not only clinical studies but also comparative experimental animal studies show that there is no significant data to claim that ureteral access sheath insertion causes more ureteral injury. Pre-stented patients were found to be at lower risk for ureteral injury. Risk of progression to ureteral injury seems to be low even if ureteral injury occurs with insertion of ureteral access sheath. CONCLUSION: Summary of studies' results indicate that use of ureteral access sheath doesn't increase ureteral injury. This review may help understanding safety profile of ureteral access sheath on evidence-based level. There is not enough data to make a statement that ureteral access sheath prevents ureteral injury.

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.

Differentiation of ureteral stones and phleboliths using Hounsfield units on computerized tomography: a new method without observer bias.

To differentiate ureteral stones and phleboliths by measuring density [as Hounsfield unit (HU)] and volume (as mm3) of the opacities in the bony pelvis on unenhanced computerized tomography (U-CT). A total of 52 patients, who underwent semirigid ureteroscopy and laser lithotripsy for distal ureteral stone and had isochoronous phleboliths in U-CT, were included. Images were reviewed for density and volume of the opacities. Data were compared, and a cut-off value was defined with receiver operating characteristics curve analysis to differentiate the nature of the opacity. Using the cut-off values of 171 mm³ for volume (sensitivity 75 %, specificity 100 %) and 643 HU for density (sensitivity 75 %, specificity 93 %), differentiation between stone and phlebolith was achieved. Differentiation of pelvic opacities needs meticulous observation with certain signs on U-CT. On the other hand, our study offers a new method, with certain cut-off values, such as 643 HU and 171 mm3, which can be used to precisely predict the actual nature of opacities of interest.

Efficacy and tolerability of mirabegron in female patients with overactive bladder symptoms after surgical treatment for stress urinary incontinence

ABSTRACT Purpose To evaluate the efficacy and tolerability of mirabegron in females with overactive bladder (OAB) symptoms after surgical treatment for stress urinary incontinence (SUI). Materials and Methods The study was conducted with a prospective, randomized and double-blinded design. 62 patients over the age of 40 who met the inclusion-exclusion criterias of the study were enrolled and randomly divided into two groups as Group A (mirabegron 50mg) and B (solifenacin 5mg). Patients were compared based on efficacy of treatment [Patient Perception of Bladder Condition (PPBC) scale and micturition diaries], safety of treatment (heart rate, systolic and diastolic blood pressure, adverse events), number of micturitions per day, patient's satisfaction status after treatment [Visual Analog Scale(VAS)] and quality of life. Results The mean age of the population was 48.2±3.8 years and the duration of OAB symptoms was 5.9±2.9 months. Baseline values for the mean number of micturitions, volume voided in each micturition, nocturia episodes, urgency and urgency incontinence episodes were 15.3±0.34, 128±3.88mL, 3.96±1.67, 5.72±1.35 and 4.22±0.69, respectively. After treatment, values for these parameters were 11.7±0.29, 164.7±2.9mL, 2.25±0.6, 3.38±0.71, 2.31±0.49 respectively. Quality of life score, symptom bother score, VAS for treatment satisfaction score, PPBC score after treatment were 66.1±0.85, 43.7±0.77, 4.78±0.14, 4.78±0.14, respectively. There were no significant differences between two groups on any parameter. However, mirabegron showed better tolerability than solifenacin, particularly after 6 months. Conclusion Mirabegron is safe, effective and tolerable in the long-term treatment of females with OAB symptoms after surgery for stress urinary incontinence.