Influence of toileting behavior on the natural course of anterior vaginal wall prolapse.

BACKGROUND: Many risk factors for pelvic organ prolapse (POP) have been proposed, and the cause is most likely multifactorial. This study aimed to investigate the effect of toileting behaviors on the natural course of anterior vaginal wall prolapse (AVWP). METHODS: Data on 75 women who underwent surgery for symptomatic AVWP were collected. Patients with grade ≥ II AVWP were included in this study and were divided into two groups according to their voiding and defecation position. The volunteers who voided and defecated in a sitting position comprised Group 1, and those who voided and defecated in a squatting position comprised Group 2. The Colorectal-Anal Impact Questionnaire (CRAIQ), Pelvic Floor Impact Questionnaire (PFIQ), Pelvic Organ Prolapse Impact Questionnaire (POPIQ), Urinary Impact Questionnaire (UIQ) and visual analog scale (VAS) pain scores were used to evaluate the patients' symptoms. RESULTS: Forty-four patients were included in Group 1 (sitting position), and 31 patients were included in Group 2 (squatting position). The groups were similar in terms of BMI, parity, menopause duration, topical estrogen use, comorbidities, the presence of constipation and urinary incontinence, and the pad count for incontinence. The time from initial symptoms to surgery was shorter in Group 2 than in Group 1 12 (3-73) and 24 (2-182) months (p = 0.001), respectively. The PFIQ, POPIQ and POP-related VAS scores were significantly higher in patients who voided and defecated in a squatting position. CONCLUSION: In patients with symptomatic POP, increased IAP while performing the squat position during defecation and voiding may increase the severity of patients' symptoms related to prolapse more than that of sitting position. Therefore, questioning the toileting position of patients with AVWP may help inform management decisions, with changing to a sitting position encouraged.

The Simple Nephrectomy Is Not Always Simple: Predictors of Surgical Difficulties.

BACKGROUND: Inflammation is one of the major risk factors for SN complications because the dense and fibrotic tissue leads to significant challenges to dissection. OBJECTIVES: We aimed to evaluate the predictive factors preoperatively, especially inflammation markers and radiologic findings, which can pose challenges to surgery in simple nephrectomy. METHODS: We retrospectively evaluated the data of 156 patients who underwent simple open nephrectomy. There were 87 patients in group 1 (peroperative nonadherent perinephric fat) and 69 patients in group 2 (peroperative adherent perinephric fat). The preoperative computed tomography findings (renal volume, perinephric stranding, posterior perinephric fat thickness, lateral perinephric fat thickness, Hounsfield unit [HU] of perinephric fat, HU of subcutaneous fat, HU of renal parenchyma, HU of renal pelvis), side of the kidney affected, prior surgery at the same kidney, complication rates, and operative time were analyzed. Preoperative inflammation markers, neutrophil-lymphocyte ratio, systemic immune-inflammation index, monocyte-HDL ratio, and platelet-lymphocyte ratio levels were recorded. RESULTS: Preoperative NLR and SII were statistically higher, and HDL was statistically lower in group 2; there was no difference in PLR and monocyte-HDL ratio between the 2 groups. According to the preoperative imaging, the perinephric stranding, HU of perinephric fat, and HU of renal parenchyma were higher in group 2, 54 (78.3), -36.93 (-91.46, -21.69), and 38.60 (32.11, 41.94), respectively. DM, history of nonsterile urine culture, HU of perinephric fat >61.78, and SII >689.36 were the factors that could be identified as independent significant predictors of presence of adherent perinephric fat. CONCLUSION: The radiological findings and inflammation markers can be used as the predictive factor for peroperative adherent perinephric tissue and surgical difficulties.

Are the preoperative neutrophil/lymphocyte ratio and platelet/lymphocyte ratio predictive for lamina propria invasion in aging patients?

OBJECTIVE: To evaluate if the preoperative neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) are predictive in discriminating between Ta and T1 tumors in aging male patients. METHODS: We retrospectively evaluated 240 male patient data who were ≥ 65 years old, diagnosed primary non-muscle invasive bladder cancer (NMIBC) with transurethral resection between 2008 and 2020. The patients were divided into the two groups according to the pathological stage, which has a stage of Ta defined group 1 and stage of T1 defined group 2. Before the transurethral resection, serum levels of NLR and PLR were obtained from each patient and compared between the groups. RESULTS: About 115 patients enrolled in group 1 (pTa patients) and 106 patients enrolled in group 2 (pT1 patients). The median age was 73 years (range 65-89) in group 1 and 75 years (range 65-98) in group 2. In complete blood cell (CBC) parameters, neutrophil count, NLR and PLR were higher and lymphocyte count was lower in group 2. There was no statistical difference in leukocyte and platelet counts between groups. CONCLUSION: The present study revealed that higher preoperative NLR and PLR were associated with lamina propria invasion in aging male patients with BC and the results have predictive value.

Serving as a bedside surgeon before performing robotic radical prostatectomy improves surgical outcomes.

INTRODUCTION: To evaluate the influence of previous experience as bedside assistants on patient selection, perioperative and pathological results in robot assisted laparoscopic radical prostatectomy. MATERIALS AND METHODS: The first 50 cases of two robotic surgeons were reviewed retrospectively. Group 1 consisted of the first 50 cases of the surgeon with previous experience as a robotic bedside assistant between September 2016-July 2018, while group 2 included the first 50 cases of the surgeon with no bedside assistant experience between February 2009-December 2009. Groups were examined in terms of demographics, prostate volume, presence of median lobe, prostate specific antigen (PSA), preoperative Gleason score, positive core number, clinical stage, console surgery time, estimated blood loss, postoperative Gleason score, pathological stage, positive surgical margin rate, postoperative complications, length of hospital stay and biochemical recurrence rate. RESULTS: Previous abdominal surgery and the presence of median lobe hypertrophy rates were higher in Group 1 than in Group 2 (20% vs. 4%, p=0.014; 24% vs. 6%, p=0.012; respectively). In addition, patients in Group 1 were in a higher clinical stage than those in Group 2 (cT2: 70% vs. 28%, p=0.001). Median console surgery time and median length of hospital stay was significantly shorter in Group 1 than in Group 2 (170 min vs. 240 min, p=0.001; 3 vs. 4, p=0.022; respectively). Clavien grade 3 complication rate was higher in Group 2 but was statistically insignificant. CONCLUSION: Our findings might reflect that previous bedside assistant experience led to an increase in self-confidence and the ability to manage troubleshooting and made it more likely for surgeons to start with more difficult cases with more challenging patients. It is recommended that novice surgeons serve as bedside assistants before moving on to consoles.

Does the experience of the bedside assistant effect the results of robotic surgeons in the learning curve of robot assisted radical prostatectomy?

INTRODUCTION: The success of the robot assisted radical prostatectomy (RARP) procedures depend on a successful team, however the literature focuses on the performance of a console surgeon. The aim of this study was to evaluate surgical outcomes of the surgeons during the learning curve in relation to the bedside assistant's experience level during RARP. MATERIALS AND METHODS: We retrospectively reviewed two non - laparoscopic, beginner robotic surgeon's cases, and we divided the patients into two groups. The first surgeon completed the operations on 20 patients with a beginner bedside assistant in February - May 2009 (Group-1). The second surgeon completed operations on 16 patients with an experienced (at least 150 cases) bedside assistant in February 2015 - December 2015 (Group-2). The collected data included age, prostate volume, prostate specific antigen (PSA), estimated blood loss, complications and percent of positive surgical margins. In addition, the elapsed time for trocar insertion, robot docking, console surgery, specimen extraction and total anesthesia time were measured separately. RESULTS: There were no significant differences between the groups in terms of age, co-morbidity, prostate volume, PSA value, preoperative Gleason score, number of positive cores, postoperative Gleason score, pathological grade, protection rate of neurovascular bundles, surgical margin positivity, postoperative complications, length of hospital stay, or estimated blood loss. The robot docking, trocar placement, console surgery, anesthesia and specimen extraction times were significantly shorter in group 2 than they were in group 1 (17.75 ± 3.53 min vs. 30.20 ± 7.54 min, p ≤ 0.001; 9.63 ± 2.71 min vs. 14.40 ± 4.52 min , p = 0.001; 189.06 ± 27.70 min vs. 244.95 ± 80.58 min, p = 0.01; 230.94 ± 30.83 min vs. 306.75 ± 87.96 min, p = 0.002; 10.19 ± 2.54 min vs. 17.55 ± 8.79 min, p = 0.002; respectively). CONCLUSION: Although the bedside assistant's experience in RARP does not appear to influence the robotic surgeon's oncological outcomes during the learning curve, it may reduce the potential complications by shortening the total operation time.

Female ventral-onlay buccal mucosal graft urethroplasty supported with martius labial fat pad flap: early results.

PURPOSE: There is a growing interest in reconstructive urology and female urethroplasty. We aimed to report our experience in ventral-onlay buccal mucosa graft (BMG) urethroplasty supported with Martius flap (MF) in treating female urethral stricture disease. METHODS: We retrospectively evaluated data of 18 female patients (ages 35-78) who were diagnosed with urethral stricture disease and underwent ventral-onlay BMG urethroplasty supported with MF by single surgeon in a tertiary referral centre between February 2019 and October 2022. Detailed history, international prostate symptom score (IPSS), pelvic examination, urine flow rate (rate and pattern), post void residual (PVR), storage and voiding phase urodynamic study, and voiding cystourethrography were recorded. At the last visit; the number of urethral dilatations before urethroplasty, time from urethral dilation to urethroplasty, hospital stay, urethral catheterization time, postoperative IPSS, PVR and uroflowmetry values were recorded. RESULTS: The presenting symptoms were obstructive voiding symptoms in 16 patients. While the mean number of urethral dilatation was 2.11 ± 1.93 (1-7), the mean time from dilatation to urethroplasty was 5.83 ± 5.00 (1-19 months) months. Maximum flow rate increased from 8.36 ± 3.26 ml/sec in preoperative uroflowmetry to 21.45 ± 5.27 ml/sec at the last follow-up (p < 0.001). Post-void residual urine (PVR) decreased from preoperative mean 116.66 ± 105.88 cc to 26.94 ± 22.69 cc postoperatively (p < 0.004). None of the patients developed stricture recurrence, incontinence or vaginal fistula until the last follow-up. The mean follow-up period was 17.28 ± 11.65 (1-35) months. CONCLUSIONS: A ventral-onlay BMG urethroplasty supported with MF represents an effective and reproducible treatment option for FUS in the present study.

Sarcopenia is an independent predictor of survival in patients undergoing radical cystectomy for bladder cancer: a single-centre, retrospective study.

Introduction: This study aimed to determine whether sarcopenia is a predictor of overall survival (OS) and cancer-specific survival (CSS) in patients with bladder cancer (BC) undergoing radical cystectomy (RC). Material and methods: Patients who underwent radical cystectomy for BC between September 2016 and June 2022 were retrospectively reviewed. Patients underwent digital computed tomography (CT) scans of the abdomen and pelvis. The skeletal muscle index (SMI) was used to assess sarcopenia using CT images. OS and CSS were estimated using Kaplan-Meier curves. Predictors of CSS and OS were analysed using univariate and multivariate Cox regression models. Results: Of the 84 reviewed patients, 45 (53.6%) had sarcopenia. The median follow-up period for survivors was 70 months. Patients with sarcopenia were older and had a lower BMI, but other preoperative clinical and laboratory parameters were similar to those of patients without sarcopenia. During follow-up, 57 (67.9%) patients died, 39 (46.4%) due to BC. In addition, patients with sarcopenia had worse 5-year OS (24.4% vs 41.0%, p = 0.036) and CSS (35.6% vs 61.5%, p = 0.012) than non-sarcopenic patients. The findings indicate that sarcopenia is an independent predictor of increased CSS (HR, 2.841; p = 0.003) and overall mortality (HR, 2.465; p = 0.004) in multivariate analysis. Conclusions: The results of this study support the view that sarcopenia is an important risk factor for predicting CSS and OS in BC patients undergoing RC.

Ventral onlay buccal mucosa graft urethroplasty for female urethral stricture improves female sexual functions.

Female urethroplasty provides excellent results with high success rates in the treatment of female urethral stricture (FUS), but sexual functions after urethroplasty is another concern and have not been adequately investigated. We aimed to evaluate changes in the sexual functions of patients undergoing ventral onlay buccal mucosa graft urethroplasty (VOBMGU). We retrospectively evaluated 18 patients who underwent VOBMGU supported with a Martius labial fat pad flap (MLFPF) in our tertiary referral centre, between 2019 and 2021. After excluding patients who were sexually inactive and those with missing postoperative data, 13 patients were included. Surgical outcomes were assessed with uroflowmetry, the American Urological Association symptom score (AUA-SS), and Urogenital Distress Inventory (UDI)-6. Short Form-36 (SF-36) was used to evaluate the quality of life (QoL). Sexual function was assessed using the Female Sexual Function Index (FSFI) both preoperatively and at 6 months following surgery. The median age was 50 (IQR:44-62) years. There was no surgical failure, and none of the patients developed incontinence or stricture recurrence during a median follow-up of 30 (IQR:12-30) months. The median maximum flow rate increased from 9.2 (IQR:5-11.5) to 19 (IQR:17.35-27.10) ml/s (p = 0.001), the median post-void residual (PVR) volume decreased from 80 (IQR:0-205) to 20 (IQR:10-45) ml (p = 0.021), the median AUA-SS decreased from 19 (IQR:14-22) to 6 (IQR:4-8) (p = 0.001), and the median UDI-6 score decreased from 12 (IQR:6.5-16) to 4 (IQR:2-9) (p = 0.008) postoperatively. Bodily pain and general health perception domains and the physical component summary score were significantly improved in the SF-36 (p = 0.015, 0.022, and 0.009, respectively). The median total FSFI score increased from 17.40 (IQR:1.95-23.65) to 22.60 (IQR:5-24.95) postoperatively (p = 0.004). Improvements were observed in all domains (p < 0.05) except the arousal (p = 0.058) and pain (p = 0.104) domains of the FSFI. We concluded that VOBMGU has good early functional results and improves female sexual function.

Laparoscopic simple nephrectomy patient with situs inversus totalis and left renal hypoplasia: A case report.

Situs inversus totalis (SIT) is a relatively rare anatomical condition characterized by the transposition of thoracic and abdominal organs from the normal side to the opposite position. Most reports of laparoscopic procedures in patients with SIT cite technical difficulties and longer operative times due to disorientation because of the reversed abdominal organs and necessary modification of the surgeon's movements and techniques. We present a case of a patient with SIT in whom a transperitoneal laparoscopic simple nephrectomy was performed.

Trace elements levels in the serum, urine, and semen of patients with infertility.

BACKGROUND/AIM: Studies suggest that trace elements may have an adverse impact on male reproduction, even at low levels. We tried to investigate the relationships between these metals and semen quality in various body fluids among men with infertility. MATERIALS AND METHODS: A total of 255 samples of blood, semen, and urine were collected from 85 men suffering from infertility. Inductively coupled plasma-optical emission spectrometry was used for the determination of 22 trace elements. We compared the results of the semen parameters with the results of the element determinations. RESULTS: Because of the high proportion of samples with values lower than the limit of detection for a number of the elements, only 8 of a total 22 trace elements were determined in the samples. When the concentrations of sperm were classified according to the World Health Organization's guidelines for normospermia, oligospermia, and azoospermia, statistically significant differences were found among Zn, Ca, Al, Cu, Mg, Se, and Sr concentrations in various serum, sperm, and urine samples (P < 0.05). CONCLUSION: In the present study, we found significant correlations between concentrations of Zn, Ca, Al, Cu, Mg, Se, and Sr and semen parameters in various body fluids.

Serving as a bedside surgeon before performing robotic radical prostatectomy improves surgical outcomes

ABSTRACT Introduction: To evaluate the influence of previous experience as bedside assistants on patient selection, perioperative and pathological results in robot assisted laparoscopic radical prostatectomy. Materials and Methods: The first 50 cases of two robotic surgeons were reviewed retrospectively. Group 1 consisted of the first 50 cases of the surgeon with previous experience as a robotic bedside assistant between September 2016-July 2018, while Group 2 included the first 50 cases of the surgeon with no bedside assistant experience between February 2009-December 2009. Groups were examined in terms of demographics, prostate volume, presence of median lobe, prostate specific antigen (PSA), preoperative Gleason score, positive core number, clinical stage, console surgery time, estimated blood loss, postoperative Gleason score, pathological stage, positive surgical margin rate, postoperative complications, length of hospital stay and biochemical recurrence rate. Results: Previous abdominal surgery and the presence of median lobe hypertrophy rates were higher in Group 1 than in Group 2 (20% vs. 4%, p=0.014; 24% vs. 6%, p=0.012; respectively). In addition, patients in Group 1 were in a higher clinical stage than those in Group 2 (cT2: 70% vs. 28%, p=0.001). Median console surgery time and median length of hospital stay was significantly shorter in Group 1 than in Group 2 (170 min vs. 240 min, p=0.001; 3 vs. 4, p=0.022; respectively). Clavien grade 3 complication rate was higher in Group 2 but was statistically insignificant. Conclusion: Our findings might reflect that previous bedside assistant experience led to an increase in self-confidence and the ability to manage troubleshooting and made it more likely for surgeons to start with more difficult cases with more challenging patients. It is recommended that novice surgeons serve as bedside assistants before moving on to consoles.

Does the experience of the bedside assistant effect the results of robotic surgeons in the learning curve of robot assisted radical prostatectomy?

ABSTRACT Introduction: The success of the robot assisted radical prostatectomy (RARP) procedures depend on a successful team, however the literature focuses on the performance of a console surgeon. The aim of this study was to evaluate surgical outcomes of the surgeons during the learning curve in relation to the bedside assistant's experience level during RARP. Materials and Methods: We retrospectively reviewed two non - laparoscopic, beginner robotic surgeon's cases, and we divided the patients into two groups. The first surgeon completed the operations on 20 patients with a beginner bedside assistant in February - May 2009 (Group-1). The second surgeon completed operations on 16 patients with an experienced (at least 150 cases) bedside assistant in February 2015 - December 2015 (Group-2). The collected data included age, prostate volume, prostate specific antigen (PSA), estimated blood loss, complications and percent of positive surgical margins. In addition, the elapsed time for trocar insertion, robot docking, console surgery, specimen extraction and total anesthesia time were measured separately. Results: There were no significant differences between the groups in terms of age, comorbidity, prostate volume, PSA value, preoperative Gleason score, number of positive cores, postoperative Gleason score, pathological grade, protection rate of neurovascular bundles, surgical margin positivity, postoperative complications, length of hospital stay, or estimated blood loss. The robot docking, trocar placement, console surgery, anesthesia and specimen extraction times were significantly shorter in group 2 than they were in group 1 (17.75 ± 3.53 min vs. 30.20 ± 7.54 min, p ≤ 0.001; 9.63 ± 2.71 min vs. 14.40 ± 4.52 min, p = 0.001; 189.06 ± 27.70 min vs. 244.95 ± 80.58 min, p = 0.01; 230.94 ± 30.83 min vs. 306.75 ± 87.96 min, p = 0.002; 10.19 ± 2.54 min vs. 17.55 ± 8.79 min, p = 0.002; respectively). Conclusion: Although the bedside assistant's experience in RARP does not appear to influence the robotic surgeon's oncological outcomes during the learning curve, it may reduce the potential complications by shortening the total operation time.