Success of extracorporeal shock wave lithotripsy based on CT texture analysis.

OBJECTIVE: The aims of the study were to evaluate whether computerised tomography texture analysis (CTTA) based on non-contrast computed tomography (NCCT) has predictive value for the success of extracorporeal-shockwave lithotripsy (ESWL) in upper urinary tract stones (UUTS). METHODS: This study included 156 of 356 patients undergoing ESWL for UUTS sized 0.5-2 cm from 2015 to 2019. Patients with congenital kidney anomalies, radiolucent stones, multiple stones, treated for upper urinary tract stones previously and lower pole stones were excluded from study. The number of ESWL sessions of the patients was as follows: 78 (50%) patients had 1 session, 30 (19.2%) patients had 2 sessions and 48 (30.8%) patients had >2 sessions. First- and second-order CTTA properties of patients' UUTS were evaluated using texture analysis software (LIFEx Software). Other clinical features such as Hounsfield Unit (HU), initial stone size, body-mass index (BMI) and skin to stone distance (SSD) was recorded. The patients were divided into two groups according to ESWL success. Cases with residual stones larger than 4 mm were considered failed cases. RESULTS: BMI, the standard deviation of HU, SSD, skewness, kurtosis, entropy and all second-order statistics were found to be statistically different between the two groups except for correlation (P < .05). Multivariate analysis showed longer SSD and four new parameters of CTTA (kurtosis, entropy, dissimilarity and energy by the distribution of pixel grey levels in the UUTS) to be significant predictors for unsuccessful ESWL outcomes. SSD and second-order CTTA properties (dissimilarity and energy) had an area under ROC curve of 0.802, 0.850 and 0.824 at a 95% confidence interval. ESWL success rate in all patients was 76.9%. CONCLUSION: CTTA can help select patients who will undergo ESWL for upper urinary tract stones. Thus, we can reduce treatment costs and ESWL complications by preventing unnecessary ESWL applications.

The efficacy and reliability of VI-RADS in determining candidates for repeated transurethral resection in patients with high-risk non-muscle invasive bladder cancer.

OBJECTIVE: Our study aims to evaluate the efficiency and reliability of Vesical Imaging Reporting Data System (VI-RADS) in prospectively identifying the patients to undergo RE-TURBT in the management of patients with high-risk non-muscle invasive Bladder Cancer(HR-NMIBC).The secondary objective was to evaluate the performance of the VI-RADS scoring system in differentiating between muscle-invasive bladder cancer (MIBC) and non-muscle invasive bladder cancer(NMIBC) prospectively. METHODS: The study included 330 patients who underwent transurethral resection of bladder tumour(TURBT) for Bladder Cancer (BC) in our clinic. All patients underwent multiparametric-magnetic resonance imaging (Mp-MRI) before the operation and VI-RADS scoring was administered. The cut-off value of VI-RADS was accepted as three and above. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for the differentiation between NMIBC and MIBC distinction in all patients. Receiver operating characteristic (ROC) analysis was performed to evaluate the performance of the VI-RADS scoring system. In the second phase of the study, patients with MIBC and low-risk NMIBC (LR-NMBIC) were excluded and 158 patients with HR-NMIBC were included, and their sensitivity, specificity, PPV and NPV values were measured. ROC analysis was performed. RESULTS: In all patients, sensitivity, specificity, PPV and NPV values of the VI-RADS scoring in the differentiation of MIBC and NMIBC were 91.3, 91.8, 81.7 and 96.3 respectively. The AUC value was 0.934 (95%CI: 0.903-0.964). Sensitivity, specificity, PPV and NPV values were found to be 87, 91.8, 74.1, 95.2 in the evaluation specifically made for patients with HR-NMIBC. The AUC value was 0.900 (95% CI:0.843-0.957). Inter-reader agreement was excellent (Ƙ = 0.90, 95% CI:0.71-0.95). CONCLUSIONS: The VI-RADS scoring system is an effective and reliable method in determining the patients who will undergo RE-TURBT and in differentiating MIBC and NMIBC.

Protective effect of liraglutide on experimental testicular ischaemia reperfusion in rats.

This study was performed to evaluate the effect of liraglutide on experimental testicular ischaemia reperfusion in rats in terms of biochemistry, histopathology and immunohistochemistry. A total of 28 male Wistar-Albino rats were divided randomly into 4 groups: control (7), sham (7), ischaemia-reperfusion (7) and ischaemia-reperfusion + liraglutide (7). Biochemically, Nitric Oxide, Malondialdehyde, Superoxide dismutase, Glutathione peroxidase and Catalase levels were measured in the testis. Apoptosis protease activating factor-1 and inducible nitric oxide synthase activity were evaluated immunohistochemically as well. Statistical analyses were made via the Kruskal-Wallis and Mann-Whitney U tests. In the reperfusion group, CAT and SOD values were increased (p > .05), NO and MDA values were decreased (p < .05) after administration of liraglutide. In addition, GPx values were significantly increased in ischaemia reperfusion + liraglutide administered group compared to reperfusion group (p < .05). Apaf-1 and iNOS activity were significantly decreased with the addition of liraglutide treatment to the ischaemia-reperfusion group (p < .05). First of all, we would like to say that liraglutide treatment is moderately preventive against I/R injury in testicular torsion. The anti-inflammatory, antioxidant and antiapoptotic properties of liraglutide are create a moderately protective effect as we show in this study.

Metabolic syndrome is associated worsened erectile function in patients undergoing TURP due to benign prostatic hyperplasia.

INTRODUCTION: Transurethral resection of the prostate (TURP) is the gold standard method for surgical treatment of benign prostatic hyperplasia (BPH). So, the complications of TURP is important, in which erectile dysfunction is the most important. The aim of the present study is to evaluate erectile dysfunction in patients undergoing TURP treatment for BPH and investigate the correlation between metabolic syndrome and erectile dysfunction. MATERIALS AND METHODS: This study included 120 patients who underwent surgery for BPH at Beylikdüzü State Hospital and Okmeydani Training and Research Hospital. IIEF-5 form was administered to the patients before the surgery and six months after the surgery. The Student's t-test, Wilcoxon, and chi-square test were used in the statistical analysis. RESULTS: The patients were investigated by IIEF-5 scoring into three groups (severe, moderate, and non-ED (erectyl disfunction)-mild). The statistical analysis of IIEF-5 form administered to 120 patients who underwent surgery did not show any significant difference before surgery and six months after surgery (p > 0.05). Metabolic syndrome and erectile dysfunction correlation were examined, and a significant correlation was obtained between metabolic syndrome and severe erectile dysfunction (p < 0.05). CONCLUSIONS: IIEF-5 results administered before and after surgery showed no significant difference. The study showed that patients with metabolic syndrome have a higher probability of having erectile dysfunction after TURP compared to patients without metabolic syndrome. Moreover, post-surgery, patients with metabolic syndrome seemed to be affected negatively regarding erectile dysfunction compared to patients with no metabolic syndrome.

Comprehensive examination of haematological parameters of patients operated due to testicular torsion.

We aimed to investigate the pre-operative predictive role of haematological parameters in patients with testicular torsion. The medical records of patients operated between January 2016 and November 2018 were retrospectively analysed. The demographic characteristics and complete blood count of the patients were recorded. We divided the patients who operated with testicular torsion into two groups: detorsion (Group 1) and orchiectomy (Group 2). A control group (Group 3) was created from healthy volunteers. All haematological parameters and other demographic data were compared between three groups. A total of 144 participants were included; Group 1, Group 2 and Group 3; 61, 27 and 56 respectively. The duration of symptoms and monocyte counts were found statistically significantly higher in patients undergoing orchiectomy than detorsion (p < .01). We found a significant difference in terms of neutrophil, lymphocyte, monocyte counts and neutrophil-lymphocyte ratio between patients with testicular torsion and controls. We also found that the monocytes count and symptom duration differed significantly between the detorsion group and the orchiectomy group. It is obvious that there is contradictory information according to the studies in the literature. We can say that the duration of symptoms and the number of monocytes are predictors of testicular viability.

Effect of metabolic syndrome on sexual function in pre- and postmenopausal women.

Female sexual dysfunction is a prevalent and multidimensional disorder related to many biological, psychological, and social determinants. The authors assessed the effect of one of the many factors affect sexual function-metabolic syndrome-on female sexual function. They equally divided 400 women participants among 4 groups: (a) premenopausal with metabolic syndrome, (b) premenopausal without metabolic syndrome, (c) postmenopausal with metabolic syndrome, and (d) postmenopausal without metabolic syndrome. The authors used the Female Sexual Function Index to assess women's sexual function. Female sexual dysfunction was found more often in both pre- and postmenopausal women with metabolic syndrome (p =.001). Overall Female Sexual Function Index score and satisfaction, pain, and desire domain scores independently of the menopause status showed statistically significant differences across women with metabolic syndrome in comparison with participants with no metabolic syndrome (p <.05). The authors also evaluated the associations among 5 components of metabolic syndrome and Female Sexual Function Index scores. Higher fasting glucose levels were significantly associated with the Female Sexual Function Index score (p <.05). This study shows that sexual dysfunction is more prevalent in pre- and postmenopausal women with the metabolic syndrome.

Is the presence of varicocele associated with static and dynamic components of benign prostatic hyperplasia/lower urinary tract symptoms in elderly men?

OBJECTIVES: To evaluate the relationship between varicocele and benign prostatic hyperplasia/lower urinary tract symptoms in patients over the age of 40 years. METHODS: A total of 1040 patients with benign prostatic hyperplasia/lower urinary tract symptoms were evaluated for prostate volume, testicular volume, testicular consistency, total testosterone, total prostate-specific antigen and body mass index. A questionnaire including International Prostate Symptom Score and a uroflow test were also carried out. The presence and grade of varicocele was determined in each patient by physical examination. RESULTS: Varicocele was found bilaterally in 22.3% and unilaterally in 25.7% of the patients. There was no difference in terms of age and body mass index distribution between subgroups. When grouping patients for varicocele laterality, total testosterone (P = 0.04), prostate volume (P = 0.009) and total prostate-specific antigen (P = 0.02) level were significantly different. Similarly, these parameters were significant between patients with grade 1, 2 and 3 varicocele. Total testosterone level (P = 0.02) and prostate volume (P = 0.035) were found to be significantly different when patients were grouped according to testicular size. A positive correlation was found between testosterone level and prostate volume (P = 0.004; r(2) = 0.084). CONCLUSIONS: Bilateral and/or higher-grade varicocele is associated with lower prostate volume and testosterone levels, as well as lower prostate-specific antigen levels. However, it is not associated with dynamic components of benign prostatic hyperplasia/lower urinary tract symptoms in patients over the age of 40 years.

Effect of preoperative single-dose methylprednisolone administration on early postoperative pain following retrograde intrarenal surgery.

PURPOSE: To evaluate the effect of preoperative single-dose methylprednisolone use on postoperative early pain after retrograde intrarenal surgery (RIRS). METHODS: Patients who had 10-20 mm solitary kidney stones and underwent RIRS procedures were included in this prospective cohort study between February 2022 and May 2023. Patients who were administered methylprednisolone at a dose of 1 mg/kg preoperatively were included in group 1 (n: 31), and the other first 90 patients who met the inclusion criteria and did not receive methylprednisolone before surgery were included in group 2 (n: 90). Demographic data, features of stone, postoperative pain at 1, 6, 12, 18, and 24 hour, the need for analgesics, changes in serum glucose levels, and the prevalence of postoperative fever were compared. RESULTS: Age, sex, stone laterality, localization, size, Hounsfield Unit, modified Satava scores, stone-free status, duration of the RIRS procedure, and duration of the ureteral access sheath were found to be similar between groups. Visual Analog Scale (VAS) scores at postoperative 1, 6, 12, 18, and 24 h were found to be statistically significantly lower in group 1 (p = .001, p = .001, p = .001, p = .001, and p = .001, respectively). Similarly, postoperative analgesic requirements were found to be significantly lower in group 1 (p = .048) with a similar postoperative fever rate and changes in serum glucose levels between groups. CONCLUSION: Giving a single dose of methylprednisolone at a dose of 1 mg/kg preoperatively for the RIRS procedure is safe and effective at preventing early pain and the need for analgesics after the RIRS procedure.

Uncovering the Penile Clock: Expression of Molecular Clock Proteins in Human Penile Cavernous Tissue.

PURPOSE: To evaluate the expression of core molecular clock genes/proteins in penile cavernous tissue from healthy male subjects and to determine whether their expression has circadian variation. MATERIALS AND METHODS: Corpus cavernosum biopsy samples were obtained from 10 healthy males with penile deviation or fracture who underwent surgical intervention during the day and night. The daytime group (n=5) underwent corpus cavernosum tissue sampling during zeitgeber time (ZT) 8-12, while the nighttime group (n=5) underwent sampling during ZT 20-24. The expression and localization of BMAL1, CLOCK, PER1, PER2, PER3, CRY1, and CRY2 proteins were analyzed using immunohistochemistry and quantified using H-score analysis. RT-qPCR analysis was performed to assess the expression of core molecular clock genes in the corpus cavernosum tissue of 5 additional daytime patients. RESULTS: The expression of core molecular clock proteins was detected in vascular endothelial cells (VECs) and smooth muscle cells (SMCs) in corpus cavernosum during daytime and nighttime. BMAL1 exhibited the most significant nuclear expression during daytime in both cell types, whereas its expression decreased significantly at night. In VECs, a significant decrease in the nuclear expression of CRY1 was observed at night. In SMCs, a significant decrease in the cytoplasmic expression of PER3 was observed at night. The expression patterns of the core molecular clock genes were ascertained through a RT-qPCR analysis. CONCLUSIONS: Our research provides compelling evidence that core molecular clock genes are distinctly expressed in penile tissue in humans. Furthermore, we observed the expression of molecular clock proteins within the VECs and SMCs of the corpus cavernosum, with BMAL1 being the most prominently expressed. The discovery of core molecular clock genes in penile tissue, as well as proteins within the SMCs and VECs of the corpus cavernosum, introduces the potential significance of the molecular clock mechanism in the physiology of penile erection.

Efficacy of Aspiration-Assisted Ureteral Access Sheath (ClearPETRA) in Retrograde Intrarenal Surgery.

Backgrounds: In the renal intrarenal stone surgery (RIRS) procedure, ureteral access sheath (UAS) is still used in the majority of surgeries to both protect the flexible ureteroscope (FURS) and reduce intrarenal pressure. ClearPETRA is a new UAS that has an integrated aspiration port. We aimed to evaluate the clinical outcomes and effectiveness of Aspiration-Assisted UAS (ClearPETRA) in the RIRS procedure. Methods: One thousand six hundred twenty patients who underwent RIRS between January 2021 and January 2024 were evaluated retrospectively and 512 patients were included in the study. According to stone size, patients with stones less than 2 cm and those with stones between 2 and 3 cm were analyzed separately. Patient's demographic data, stone size, body mass index, Extracoporeal Shockwave Lithotripsy (ESWL) history, stone side, stone density (Hounsfield Unit), operation time, stone-free rate (SFR), and the number of patients with sepsis were recorded. SFR was evaluated with kidney urinary bladder 3 months after surgery for opaque calculi. Nonopaque calculi patients were evaluated with noncontrast computed tomography 3 months after surgery. In the postoperative evaluation, patients with stones less than 4 mm were evaluated as SFR. P value of <0.01 was considered statistically significant. Results: Patient's demographic data, stone characteristics, and history of ESWL were similar in the ClearPETRA and UAS groups (P > .05). A total of 328 patients who underwent RIRS for stones less than 2 cm were included (80 ClearPETRA, 248 UAS). Length of hospital stay, operation time, SFR, secondary intervention, or postoperative sepsis (P ≥ .01) were similar in both groups. The incidence of postoperative fever was statistically significantly lower in the ClearPETRA group (P = .006). A total of 184 patients who underwent RIRS for stones between 2 and 3 cm were included (42 ClearPETRA, 142 UAS). In the ClearPETRA group, operation time was statistically significantly shorter (P = .002), SFR was statistically significantly higher (P = .003), and the number of fever and sepsis were statistically significantly less (P = .003 and 0.002, respectively). Conclusion: We found that ClearPETRA reduces the likelihood of postoperative fever after RIRS surgeries. Moreover, we can say that the use of ClearPETRA in RIRS, especially for stones larger than 2 cm, reduces the operation time, increases the SFR, and also reduces sepsis rates.

Is there an association between a high monocyte/high-density lipoprotein cholesterol ratio and recurrence of urethral stricture after internal urethrotomy?

INTRODUCTION: Internal urethrotomy (IU) has been the most commonly used procedure for the treatment of urethral strictures (US) since it was described by Scahse in 1974. Although simple to perform and associated with a short recovery time, the main disadvantage is the high recurrence rate of stenosis. At present, there are no markers available for the prediction of recurrence after IU. The aim of this study was to evaluate the correlation between MHR and recurrence rates. METHODS: The data of a total of 250 male patients who underwent IU for the first time for bulbar urethral stricture less than 2cm in our hospital between January 2011 and January 2019 were retrospectively analysed. The MHR was calculated as the ratio of monocytes to HDL-C. RESULTS: In all, 78 patients experienced a recurrence while the remaining 177 did not. The stricture recurrence rate was recorded as 31.2% at the 3-year follow-up. There was a statistically significant difference in stricture length and MHR (P=0.015 and 0.001 respectively). MHR was high in the recurrent group. As a result of the Chi-square test, the positive predictive values (PPV) and negative predictive values (NPV) were 65.3% and 89.7%, respectively. ROC analysis was used to determine the optimal cut-off value. The cut-off value was found to be 1.72. CONCLUSION: In our opinion, a high MHR may indicate the presence of immune inflammation and it can be used as a prognostic factor for stricture recurrence after IU.

Fluoroscopy-free RIRS on the second session after ureteral stent placement.

AIM: Fluoroscopy is used in some stages of the conventional Retrograde Intrarenal Surgery (RIRS) procedure and is beneficial. On the other hand, radiation exposure is its most obvious disadvantage. As a subgroup, we aimed to show that fluoroscopy-free technique is safe and effective in patients who underwent RIRS after passive dilatation. MATERIALS AND METHODS: Between October 2018 and April 2020, 54 cases of second session RIRS of renal stones performed by a single surgeon were retrospectively evaluated. Patients' demographic characteristics (age, gender), stone features (laterality, size, number, volume, and location), mean operative time, and, perioperative and postoperative complications, as well as the stone-free rate (SFR), were all retrospectively evaluated. The results were classified as stone free, clinical insignificant residual fragments (CIRF), and presence of residual stones. Complications were graded using the Clavien-Dindo classification system. We used a modified surgical technique. RESULTS: All of complications were minor. There were no major complications (Clavien grade III-IV). The stone-free rate was 70.3% (38/54) on the first day after surgery and 83.3% (45/54) 1 month afterward, respectively. If we accept the absence of residual stone as success, we can say that it is about 91% successful in the first month. CONCLUSION: This technique has a high stone-free success rate and a low complication rate without the use of radiation. For surgeons experienced in endourology, we can say that the fluoroscopy-free technique is safe and effective in secondary-session RIRS cases which passive dilatation was performed by inserting a ureteral catheter before.

Effect of physical activity level and occupation on resolution of pain after varicocelectomy: A prospective clinical study.

INTRODUCTION AND OBJECTIVES: Persistent scrotal pain after varicocelectomy is stressful for both surgeon and patient. The number of researches focusing on which patient will benefit more from the operation is increasing in the literature. In this prospective study, we aimed to investigate whether the patient's physical activity levels and occupations affect the success of varicocelectomy in terms of pain relief. MATERIALS AND METHODS: The data of 176 patients who underwent subinguinal microscopic varicocelectomy were analyzed according to BMI, age, varicocele grade, laterality, duration of pain, testicular volume difference, quality of pain, level of physical activity, and profession. The International Physical Activity Questionnaire was used to evaluate the level of physical activity. Patients were grouped as inactive, moderately active, and active according to this scale. Visual analog scale (VAS) scores of the patients were recorded before and after the procedure. RESULTS: 135 patients (76.7%) reported complete resolution of their pain. Partial resolution of pain was observed in 34 patients (19.3%). Seven patients (4%) complained of the same pain level. Univariate analysis showed that patient occupations and physical activity levels significantly affected the pain level (p=0.041, p=0.032, respectively). In the multivariate analysis, only physical activity levels of the patients were statistically significant in predicting the resolution of pain (p=0.024). CONCLUSIONS: Patients with low physical activity levels who underwent microscopic varicocelectomy surgery are less likely to have postoperative pain.

Transurethral resection of the prostate (TURP) versus transperineal laser ablation (TPLA) due to benign prostatic hyperplasia (BPH): prospective and comparative study.

AIM: We aimed to compare the first-year results of Transurethral resection of the prostate (TURP), the gold standard method, and Transperineal laser ablation (TPLA) techniques. MATERIAL AND METHODS: This study was designed as a prospective, randomized, controlled, and single-center and was conducted between November 2021 and February 2023. TURP candidates were included in the study. Demographic data and perioperative data were recorded. Preoperative and first-year International Prostate Symptom Score (IPSS), International Erectile Function Index (IIEF-5), Male Sexual Health Questionnaire-Ejaculatory Dysfunction (MSHQ-EjD), QoL, peak urinary flow rate (Qmax), prostate volume (PV) and postvoid residual (PVR) data were recorded. RESULTS: Fifty patients were included in the study and were assigned to equal numbers of groups. TPLA group had a higher ASA score (p = 0.03). There was improvement in IPSS, Qmax, and PVR parameters compared to baseline values in both groups at 1 year (p < 0.01). The improvement in Qmax was better in the TURP group (p < 0.01). IIEF-5 score was similar between groups (p = 0.83 and p = 0.12, respectively). The MSHQ scores in the first year did not change according to their baseline values in the TPLA group (p = 0.54 and p = 0.34, respectively). CONCLUSION: According to the first-year results of TPLA, the symptomatic improvement effect without sacrificing ejaculatory functions is comparable to TURP. We think that this method will can be an alternative, especially for patients who want to avoid ejaculatory dysfunction, who have a high risk of anesthesia, and whose anticoagulant/antiplatelet therapy cannot be discontinued.

The effect of an information video on preoperative anxiety level before percutaneous nephrolithotomy procedure: A prospective, randomized trial.

INTRODUCTION: We aimed to show the effect of patient information videos on preoperative anxiety before performing the percutaneous nephrolithotomy (PCNL ) for kidney stones. METHODS: This study was designed as a randomized, controlled trial with patients scheduled for PCNL operation for kidney stones. Demographic information, such as age, gender, and American Society of Anesthesiologists (ASA) score, were collected. State-Trait Anxiety Inventory (ST AI) was used to measure anxiety levels. Before informing the patients, anxiety levels were evaluated using the ST AI-state (pre-information ST AI-S) and ST AI-trait (ST AI-T). Patients were randomly divided into two groups: both groups received written and verbal information, while the "video" group was also shown a video of a PCNL procedure. The post-information anxiety levels of both groups were evaluated using ST AI-S (post-information). RESULTS: A total of 109 patients were included in the study and 50 patients were included in each group after nine patients were excluded. The participants in the two groups were similar in terms of gender distribution, mean age, and pre-information ST AI-S scores. Post-information ST AI-S scores were statistically significantly lower in the video group (p=0.02). There was no significant difference between post-information and pre-information ST AI-S scores in the no-video group (p=0.86), whereas a significant decrease was found in post-information ST AI-S scores in the video group (p<0.01). CONCLUSIONS: In addition to written and verbal information before PCNL operations, informative videos are an inexpensive, effective method to reduce preoperative anxiety levels. Video-based briefing may be routinely used in addition to preoperative verbal and written information.

The severity of renal colic pain: Can it be predicted?

INTRODUCTION: We aimed to determine whether there was a relationship between the perception of renal colic pain and different psychosocial and physiological factors. METHODS: Between May 2021 and July 2022, we prospectively analyzed 320 patients over the age of 18 who were diagnosed with renal colic occurring unilaterally and secondary to a single kidney stone of any size. Body mass index (BMI), education level, hospital anxiety and depression scale (HADS), somatosensory amplification scale (SAS), and the visual analog scale (VAS) features of stone (diameter, Hounsfield value, and localization) and degree of hydronephrosis were analyzed. Correlation analysis of VAS score and these parameters were completed with Spearman's test. The regression analysis was used to determine the predictive factors of severe pain. RESULTS: There was no significant difference found between sex and VAS scores of colic pain (p=0.122). We found a significant correlation between VAS score and localization of kidney stone, degree of hydronephrosis, and anxiety level of patients. High grade of hydronephrosis and high anxiety level were found to be associated with high VAS scores (p<0.001 and p=0.035, respectively). It was shown that SAS and level of depression did not correlate with pain. Only a high degree of hydronephrosis was found to be a predictive factor for severe pain (p<0.01). CONCLUSIONS: The patient's high anxiety level and a high degree of hydronephrosis were positively correlated with renal colic pain caused by kidney stones. With this study, the severity of pain in patients with a high degree of hydronephrosis and high anxiety can be predicted and may be a criteria to select suitable treatment to reach faster response.

Value of neutrophil-to-lymphocyte ratio in predicting surgical intervention for hydronephrosis during pregnancy.

BACKGROUND: We aimed to examine the hematological parameters of pregnant patients with ureteral stones that require intervention. METHODS: Medical data of patients presenting to urology department between October 2018 and December 2020 were retrospectively analyzed. Patients with flank pain associated with hydronephrosis were included in the study and divided into two groups according to whether an intervention was performed or not (Group-1, Group-2). Ureterorenoscopy (URS) or ureteral stent placement was performed as intervention. Demographic data, complete blood count (CBC), urine analysis, and ultrasonographic findings were collected. Gestational age (week), number of pregnancies, maternal age (years), Anteroposterior pelvis diameter (mm), VAS (Visual Analog Scale) (range 1-10) and mean platelet volume (MPV) were collected from the patient file. Inflammatory markers including neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were computed. RESULTS: About 35 patients were included in Group-1 and 52 patients in Group-2. Ureterorenoscopy was performed in 21/35 (60%) patients, and ureteral stents were placed in 14/35 (40%) patients. None of the patients experienced complications. There was no statistical difference between these two groups in terms of maternal age, gestational age, number of pregnancies, pelvis diameter, PLR, and MPV. VAS and NLR were statistically higher in group-1 (p < 0.05). According to the Receiver operating characteristic curve analysis performed for the prediction of ureteral stone presence, the best cut-off point for the NLR 4.153 (sensitivity 80%, specificity 80.6%, area under curve (AUC): 0.824). CONCLUSIONS: We think that NLR can be used to determine the group that needs to be intervented due to ureteral stones in patients with symptomatic hydronephrosis during pregnancy.

Comparison of mini-PCNL and retrograde intrarenal surgery in the treatment of kidney stone over 50 years old patients.

Mini-Percutaneous Nephrolithotomy (M-PCNL) and Retrograde Intrarenal Surgery (RIRS) are commonly used methods in treatment of kidney stones. The aim of our study is to compare the efficacy and safety of M-PCNL and RIRS in kidney stone treatment over 50 years old patients. A total of 125 patients, 65 of whom had RIRS, and 60 of whom had M-PCNL, were included in the study. Age, gender, BMI (Body-Mass Index), ASA (American Society of Anesthesiology) scores of the patients; stone size, stone location, operation side, ESWL history, HU (Hounsfield Unit) values, hospital stay durations, SFR, complication rates according to Clavien modification system, postoperative hemoglobin loss, postoperative transfusion rates, and patients who needed a secondary operation were recorded. SFR values were calculated in the postoperative third and sixth months. The data between the two groups had similar characteristics in terms of age, gender, BMI, HU, stone size, operation side, stone location, ESWL history, operation time, postoperative transfusion rate, postoperative Clavien complications (p > 0.05). When the ASA categories were evaluated, the mean ASA scores, ASA I, and ASA II data had similar characteristics in both groups (p > 0.05). When the ASA 3 scores were evaluated, the number of ASA III patients in the RIRS group was statistically significantly higher (p < 0.05). When hospital stay duration and postoperative hemoglobin loss were examined, RIRS group was found to be advantageous (p < 0.05). Postoperative third month SFR and Postoperative sixth month values were statistically significantly higher in M-PCNL group (p < 0.05). M-PCNL and RIRS are methods that can be used safely and effectively over 50 years old patients in kidney stone surgery. M-PCNL has been found to be more advantageous in terms of SFR rates and as it requires less secondary intervention. RIRS is advantageous in terms of short hospital stay, postoperative hemoglobin loss, and applicability to patients who are not suitable for the prone position.

A new biomarker for lung metastasis in non-seminomatous testicular cancer: De Ritis Ratio.

PURPOSE: We aimed to show that the De Ritis Ratio (DRR) may be a new biomarker for lung metastasis in non-seminomatous Testicular Cancers (TC). MATERIAL AND METHODS: Patients who underwent radical orchiectomy due to TC between January 2010 and January 2021 were included in the study. Demographic characteristics, preoperative laboratory and radiological findings and pathological data of the patients were recorded. The DRR was calculated from preoperative peripheral blood analysis. RESULTS: A total of 124 patients with non-seminomatous TC were included. Mean patient age was 30.67±7.45 years, and the mean tumour diameter was 4.69±2.55 cm. 61 patients had T1, 51 had T2, and 12 had T3 disease. 42 of them had lung metastasis; 82 of them had no lung metastasis. The optimal DRR threshold was 1.21 for lung metastasis. [Area Under the Curve (AUC): 0.724 with a sensitivity of 81% and specificity of 74%]. DRR was determined as an independent prognostic factor for lung metastasis in univariate and multivariate analyses (p=0.002). CONCLUSIONS: A high preoperative DRR can be used to detect the presence of lung metastases in non-seminomatous TCs.