How reliable are imaging techniques in aging males with bladder cancer?

INTRODUCTION: The aim of this study was to evaluate consistency between clinical lymph node positivity and pathological lymph node positivity in patients undergoing open radical cystectomy and pelvic lymph node dissection due to bladder cancer. MATERIAL AND METHOD: A total of 135 patients who had open radical cystectomy, extended lymph node dissection, and clear preoperative contrast-enhanced abdominopelvic computed tomography (CT) or magnetic resonance imaging (MRI) images were included in the study. Positive clinical lymph nodes and positive pathological lymph nodeswere recorded. The largest positive clinical and pathological lymph nodeswere recorded. In terms of clinical lymph node involvement, compatibility between radiological findings and pathological results was evaluated. RESULTS: In the CT group, the sensitivity was 25.81%, specificity was 95.45%, positive predictive value (PPV) was 66.67%, negative predictive value (NPV) was 78.50%, and accuracy was 77.31%. In the MRI group, the sensitivity was 50.00%, specificity was 100%, PPV was 100%, NPV was 76.92%, and accuracy was 81.25%. For consistency between pathological lymph nodes and clinical lymph nodes according to the imaging type, there was no statistically significant difference in the sensitivity, specificity, NPV, and accuracy rates between the imaging techniques (p > 0.05). However, the PPV was significantly higher in the MRI group than the CT group (100% vs.66.67%, respectively; p = 0.014). CONCLUSION: Positive lymph nodes play a critical role in the prognosis of patients with bladder cancer and the sensitivity of contrast-enhanced abdominopelvic CT and MRI used routinely in clinical practice is low in lymph node detection. MRI seems more reliable than CT in lymph node detection.

Effect of artificial urinary sphincter implantation on erectile function and sexual satisfaction.

Artificial urinary sphincter (AUS) implantation is the gold standard treatment in total stress urinary incontinence (SIU). Our aim is to evaluate the effect of AUS implantation on erectile function and sexual satisfaction (SS). Fourteen patients aged 58-73 years (mean: 66.92 ± 4.51 years) who underwent AUS implantation by a perineal approach between May 2015 and April 2018 were included in our study. Patients with neurogenic disease or very low or no erectile function and those who underwent non-nerve-sparing radical prostatectomy were excluded. Erectile function and intercourse satisfaction were evaluated pre-operatively and post-operatively at 6-month follow-up using international index of erectile function (IIEF) questionnaires. After AUS implantation; eight patients were totally dry, four achieved social continence (less than one pad/day), and two still had SUI (two or more pads/day). Mean pre- and post-operative IIEF values of the patients were 16.14 ± 3.18 and 17.42 ± 4.43 respectively. Mean pre- and post-operative SS values were 8.57 ± 1.78 and 8.71 ± 2.19 respectively. There was no statistically significant difference between pre- and post-operative IIEF-5 and intercourse satisfaction scores (p > 0.05). Although we did not see a significant effect of AUS implantation in our study, in SIU patients, coital incontinence or unpleasant odour during intercourse can lead to sexual avoidance and reduced SS, and AUS implantation may improve SS.

The effect of urethroplasty surgery on erectile and orgasmic functions: a prospective study.

OBJECTIVES: To examine the effects of urethroplasty surgery on sexual functions by taking into account age, location of stenosis, length of stenosis and surgical technique parameters. MATERIALS AND METHODS: The prospective study was conducted between January 2015 and August 2017 with 60 cases. Patients were categorized according to age groups (19-65 / 65-75 years), surgery technique and stricture localization and length. Before the urethroplasty operation and postoperative 6th month follow-up, the international index of erectile function (IIEF) form (15 questions), was filled, the relevant domains of sexual function; erectile function (Q1,2,3,4,5,15), orgasmic function (Q9,10) and overall satisfaction (Q13,14) were assessed. RESULTS: The mean age of the cases is 54 ± 13. However, preoperative IIEF, sexual satisfaction and orgasmic function averages of patients with a stenosis segment length of 1-3 cm was found to be significantly higher than that of patients with a stenosis segment length of 4-7 cm. Between stenosis segment length groups, there was no statistical difference in terms of preoperative and postoperative sexual functions. And also, there was no statistically significant change in patients' preoperative and postoperative sexual function scores in terms of localization of stricture and surgery techniques. However, there were statistically significant change in the postoperative IIEF and sexual satisfaction averages according to preoperative averages. CONCLUSION: Our study suggests that urethroplasty surgery itself does not significantly affect erectile function, orgasmic function, and general sexual satisfaction regardless of the type of surgery, localization and length of stenosis. Besides, there was a significant decrease in erectile function in senior adults.

Safety and efficacy of PNL vs RIRS in the management of stones located in horseshoe kidneys: A critical comparative evaluation.

AIM: To assess the efficacy and safety of two different techniques (Percutaneous nephrolithotomy (PNL) vs Retrograde intrarenal surgery (RIRS)) in the management of stones in patients with horseshoe kidneys (HSK). PATIENTS AND METHODS: Departmental files of 88 cases with radiopaque kidney stones in horseshoe kidneys undergoing two different approaches (PNL vs RIRS) were evaluated with respect to the success and complication rates of in a retrospective manner. In addition to the factors related with the procedures (success and complication rates, additional procedures), patient and stone characteristics were all well evaluated. Findings obtained in both groups were evaluated in a comparative manner with respect to the statistical significance. RESULTS: Stone free rates were comparable in both groups after 1-week period (81.6% PNL vs 80% RIRS). As well as 3 months evaluation (84.2% PNL and 82.0% RIRS). The percentage of the cases with residual fragments (> 4 mm) were similar in both groups and while all PNL procedures were completed in one session, mean number of RIRS sessions was higher (1.22 ± 0.05). Mean duration of the procedure was slightly higher in RIRS group and based on Clavien scoring system, despite a higher risk of Hb drop noted in patients treated with PNL, all complication rates were found to be similar in both groups. CONCLUSION: Our results demonstrate that of the available minimally invasive treatment alternatives, both PNL and RIRS could be safe and effective alternatives for renal stone removal in patients with HSK.

Changing the Stage, Grade and Histological Subtypes of Renal Cell Carcinomas during 10 Years Period.

Renal cell carcinomas (RCCs) account 80-85% of all primary renal neoplasms and originate from the renal cortex. The patients who underwent radical or partial nephrectomy for renal tumour in our unit between January 2005 and 2015 were evaluated retrospectively. The patients were divided into two groups; group 1 includes patients who were treated between January 2005 and December 2009, group 2 those from January 2010 to 2015. There were 103 patients in group 1. The patients were between 21 and 89 years with mean age of 61.46 year. Renal cell carcinomas account 83.4% of the patients, benign renal tumours were 8.7% and transitional cell carcinomas were 7.7% of the patients in group 1. A total of 32.5% RCCs were classified as pT1a, 24.4% as pT1b, 15.1% as pT2a, 11.6% as pT2b, 15.1% as pT3a and 1.1% as pT4. There were 202 patients in group 2 and the patients were between 27 and 81 years with mean age of 58.5 year. Renal cell carcinomas comprised the main bulk of the tumours with 182 nephrectomy specimens. According to the pathological classification of RCCs, 51 specimens were found as pT1a, 54 were pT1b, 13 were pT2a, 14 were pT2b, 48 were pT3a and 2 were pT4. Although, the incidence of small renal masses has been increasing with widespread use of imaging techniques and recent advancements, the proportion of high grade and advanced stage renal tumours increased during the study period.

Adult urethral stricture: practice of Turkish urologists.

OBJECTIVES: To evaluate national practice patterns in the treatment of male anterior urethral strictures among Turkish urologists. MATERIALS AND METHODS: A survey form including 12 questions prepared to determine active Turkish urologists' approach to diagnosis and treatment of the adult urethral stricture (US) were filled out. Based on the survey results, the institutions which 218 urologists work and their years of expertise, methods they used for diagnosis and treatment, whether or not they perform open urethroplasty and timing of open urethroplasty were investigated. RESULTS: Optic internal urethrotomy and dilatation are the most commonly used minimal invasive procedures in treatment of US with the ratios of 93.5% and 63.3% respectively. On the other hand it was seen that urethroplasty was a less commonly used procedure, compared to minimal invasive techniques, with the ratio of 36.7%. Survey results showed us that the number of US cases observed and open urethroplasty procedures performed increases with increasing years of professional experience. CONCLUSIONS: As a method demanding special surgical experience and known as a time-consuming and challenging procedure, open urethroplasty will be able to take a greater part in current urological practice with the help of theoretical education and practical courses given by specific centers and experienced authors.

Does resectoscope size play a role in formation of urethral stricture following transurethral prostate resection?

BACKGROUND AND AIMS: To investigate the possible effect of resectoscope size on urethral stricture rate after monopolar TURP. MATERIALS AND METHODS: A retrospective study of 71 men undergoing TURP was conducted at two centers' from November 2009 to May 2013. The patients were divided into one of two groups according to the resectoscope diameter used for TURP. Resectoscope diameter was 24 F in group 1 (n=35) or 26 F in group 2 (n=36). Urethral catheter type, catheter removal time and energy type were kept constant for all patients. Urethral stricture formation in different localizations after TURP was compared between groups. RESULTS: There was no significant difference between the two groups in terms of age, pre-operative prostate gland volume (PV), prostate-specific antigen (PSA), maximal urinary flow rates (Qmax), International Prostate Symptom Score (IPSS) and post-voiding residual urine volume (PVR). The resection time and weight of resected prostate tissue were similar for both groups (p>0.05). A statistically significant higher incidence of bulbar stricture was detected in group 2 compared to group 1 (p=0.018). CONCLUSIONS: The use of small-diameter resectoscope shafts may cause a reduction in the incidence of uretral strictures in relation to urethral friction and mucosal damage.

A new problem in inflammatory bladder diseases: use of mobile phones!

PURPOSE: Technological developments provide a lot of conveniences to our lives. This issue is one of the risks that arise along with these conveniences. In our study we tried to understand the impact of electromagnetic waves from mobile phones on bladder tissue. MATERIALS AND METHODS: Twenty-one adult male albino rats were divided into three equal groups. Group 1 was exposed to electromagnetic wave for 8 hours per day for 20 days and then their bladders were taken off immediately. Group 2 was firstly exposed to electromagnetic wave for 8 hours per day for 20 days then secondly another for 20 days without exposition to electromagnetic wave and then their bladders were taken off. Group 3 was the control group and they were not exposed to electromagnetic wave. RESULTS: Under microscopic examination of bladder tissue, in the first group severe inflammatory cell infiltration was seen in lamina propria and muscle layer in contrast to intact urothelium. In the second group mild inflammatory cell infiltration was seen in lamina propria and muscle layer. The mean scores for the three groups were 5.5 ± 2.5, 0.8 ± 1.3 and 1.2 ± 1.5 respectively. Mean score of group 1 was statistically higher than others (p = 0.001). CONCLUSION: Intensive use of mobile phones has negative impact on bladder tissue as well as the other organs. Keeping a minimum level of mobile phone use makes it easy to be kept under control of diseases in which inflammation is an etiologic factor.

Evaluation of depression and self-esteem in children with monosymptomatic nocturnal enuresis: A controlled trial.

OBJECTIVES: Nocturnal enuresis (NE) is very common and is one of the most common causes for patients to be admitted to urology, pediatrics, child psychiatry and child surgery departments. We aimed to investigate the effect on depression and self-esteem of this disorder that can cause problems on person's social development and human relations. MATERIAL AND METHODS: 90 patients who were admitted to our clinic with complaints of nocturnal enuresis were enrolled. Investigations to rule out organic causes were performed in this group of patients. Out of them 38 children and adolescents (age range 8-18 years) with primary monosymptomatic nocturnal enuresis (PMNE) agreed to participate in the study In the same period 46 healthy children and adolescents with a similar age range without bed wetting complaint were included in the study as a control group. The age of the family, educational and socioeconomic level were questioned and Piers-Harris Children's Self-Concept Scale (PHCSCS) and Children's Depression Inventory (CDI) forms were filled out. RESULTS: Mean age of the cases (18 females or 47.4% and 20 males or 52.6%) was 10.76 ± 3.82 years whereas mean age of controls (26 females or 56.5% and 20 males or 43.5%) was 10.89 ± 3.11 years. Depression scale was significantly higher (p = 0.001) in the case group than in the control group (10.42 ± 4.31 vs 7.09 ± 4.35). In both groups there was no statistically significant difference by age and sex in terms of depression scale (p > 0.05). CONCLUSION: NE is widely seen as in the community and is a source of stresses either for children and for their families. When patients were admitted to physicians for treatment, a multidisciplinary approach should be offered and the necessary psychological support should be provided jointly by child psychiatrists and psychologists.

The importance of Internet usage for urologic patients.

OBJECTIVES: To evaluate Internet usage frequency, rate of searched diseases and impact of Internet derived data on future patient physician relationship in patients applying to an Urology Department. METHODS: A well prepared questionnaire has been given to 1000 referring cases, out of which 589 accepted to participate on a volunteer basis to a face to face interview. Patients were divided into subgroups with respect to age, gender and as well as their educational and economical status. Regarding Internet, questions inquired the use of Internet, the point of view about it, opinions about healthcare system and most commonly urological diseases searched in Internet. RESULTS: Of 589 patients participating, 38.2% reported access to the Internet; in relation to subgroup analysis of data, there was a statistically significant relationship between the use of Internet and age (p < 0.001), gender (p = 0.048), educational status (p < 0.001) and economical status of (p = 0.002) the cases evaluated. Disease specific information was most frequently sought: 18.2% searched for urolithiasis, 14.2% for non-cancer related kidney diseases, and 14.2% for urologic cancers. CONCLUSIONS: Younger patients with higher educational status tended to use Internet and the majority of these cases share all these information with their physicians during their visit. These findings indicate that all physicians should consider this fact seriously and make their future plans in the light of internet based activities which provides numerous advantages.

The effects of electromagnetic waves emitted by the cell phones on the testicular tissue.

OBJECTIVES: Various risks have emerged in parallel to the rapidly increasing use of cell phones. Herein we studied the effects of cell phone emitted electromagnetic waves (EMW) on rat testes. MATERIAL AND METHODS: Twenty one adult male Albino rats were grouped into 3 groups each consisting of 7 rats. The first group was exposed to EMW on talk mode for 8 hours per day for 20 days and then their testes were extracted. The testes of the second group were extracted after 20 days of whole day EMW exposure. The third group was the control group. For the statistical analysis Mann- Whitney U analysis was performed. RESULTS: At light microscopic examination of the testicular tissue, the existence of a high number of immature cells in the lumen of the seminiferous tubule in addition to the normal seminiferous tubules, besides irregular tubules with a reduction in the spermatogenic cell lines and tubules without lumen were observed in groups 1 and 2. Histopathological alterations were scored as 0 = none, 1 = low, 2 = medium, 3 = serious. The average scores of the three groups were found to be 4.25 ± 1.5 for the group 1, 4.33 ± 3.9 for the group 2 and 0.37 ± 1.1 for the group 3 respectively. As a result of the statistical evaluation, group 1 and group 2 had significantly higher scores than the control group (p = 0.001). CONCLUSION: Infertility is one of the current problems of today due to a rapid increase in its incidence and cost. The negative effects of the EMWs on the testis should be taken into account and the necessary measures should be taken for prevention.

Short-term revision rate of Rigicon Testi10TM testicular prosthesis in adolescents and adults: a retrospective chart review.

Testicular prosthesis implantation is a valuable solution for the physical, cosmetic, and psychological challenges associated with testicular loss which may affect males of any age. We evaluated the safety and reliability of the new Rigicon Testi10TM testicular prosthesis in adults and adolescents by performing an IRB-approved retrospective study of data drawn from Patient Information Forms (PIFs). A total of 427 patients (382 adults and 45 adolescents) had at least one testicular prosthesis implanted. Only one adult patient required revision surgery due to rupture of the Rigicon Testi10 TM saline-filled prosthesis. A 40-year-old patient was found to have a leaking prosthesis approximately one week postoperatively, which was suspected to be due to inadvertently punctured by the surgeon during the sterile saline filling process. There were no post-implantation revisions required for adolescent patients. According to our results, Kaplan-Meier calculation of survival from removal or revision was 99.8% for all patients at 54 months (99.7% for adults and 100% for adolescents). The complication rates among patients in this study are lower than those reported in previous published studies. Our study underscores the generally safe nature of testicular prosthesis implantation, as well as the very rare incidence of revision surgery for this new device.

Methods and rates of punishment implemented by families to enuretic children in Turkey.

PURPOSE: Nocturnal enuresis is a serious health problem affecting a significant portion of the population. In this study, we investigated the frequency of punishment methods in nocturnal enuresis (NE) in Turkey and its relationship with other parameters. MATERIALS AND METHODS: A total of 501 children (301 boys and 200 girls) who were admitted to our outpatient clinic due to nocturnal enuresis were included in the study. Mean age was 9.39 years (range 5-18). Prepared questionnaire form inquiring educational status of the family, frequency and implementation and duration of punishment methods was applied to patients and families. RESULTS: At least one punishment method was applied to 291 (58.1%) of children with NE. Punishment methods of parents were detected as condemnation (257 patients, 51.3%), depriving desires of the child (120 patients, 23.9%), humiliating the child in the presence of other children (113 patients, 22.6%), reprimanding- threatening with punishment (203 patients, 40.5%). This application was found to continue for longer than 1 year in 52% of punished children. Families graduated of high school and above were found to use punishment methods significantly more than others. CONCLUSION: According to the results of our study, a quite high proportion of enuretic children were detected to be exposed to punishment methods. Even, some parents consider that these methods are a part of nocturnal enuresis treatment. We, the doctors, should endeavor more for raising awareness of the community in order to diminish this worrisome behavior.

Rigicon disposable Furlow insertion tool has the potential to decrease infection rates after inflatable penile prosthesis implantation.

Furlow insertion tool is frequently used during the insertion of the inflatable penile prosthesis cylinders inside the corporal bodies. Although these devices are completely disassembled and separately sterilized after each operation, the residual blood clots and tissues after inadequate cleaning may become the primary sources of penile prosthesis infection. In order to minimize the risk of infection, Rigicon, Inc. (NY, USA) has developed the first disposable Furlow insertion tool. Head-to-head comparison studies with conventional and disposable Furlow insertion tools are necessary to confirm if there is a significant difference in post-implant infection rates.

First safety outcomes for rigicon conticlassic® artificial urinary sphincter.

The Rigicon ContiClassic® is a new sphincteric device designed to treat male stress urinary incontinence. This study evaluates the surgical outcomes and safety profile of the first 116 patients who received the implant between September 2021 and April 2022. Data were collected from patient information forms completed at the time of the implant and submitted by implanting surgeons, nursing staff in the Operating Room or company representatives present during the surgery. The study analyzed patient demographics, surgical details, and etiology of incontinence. The mean age of patients was 68.3 years +/- 9.65 yrs. Minimum age was 23 and maximum age was 83. The most common reason for implantation was urinary incontinence (58.6%) after radical prostatectomy. The results showed a revision rate of 6.90%, with three cases of fluid loss, four cases of iatrogenic mistaken sizing, and one case of patient dissatisfaction. There were no reported infections. Kaplan-Meier calculation showed survival rate of 93.2% at 12 months. This study shows the early safety outcomes for the Rigicon ContiClassic® sphincter device to be comparable to others presently on the market.

Safety outcomes of the first Rigi10™ malleable penile prostheses implanted worldwide.

Implantation of penile prosthesis is considered when conservative measures fail or are unacceptable to patients' wishing treatment for erectile dysfunction. In the United States (US), inflatable penile prostheses are more often used than malleable penile prostheses (MPP). Outside the US, the reverse is true because third-party reimbursement is not available, and MPP is considerably cheaper. Two American manufacturers make MPP; presently, a new manufacturer, Rigicon (Ronkonkoma NY), has recently begun to sell its MPP worldwide. Patient information forms submitted to the manufacturer between March 1, 2019, and December 8, 2022, were used to conduct an initial safety study for 605 first-time patients implanted with Rigicon10® by 46 physicians in 15 countries with a mean follow-up of 21.6 months. It has the same configuration of trimmable, paired silicone rods containing a twisted stainless-steel wire for bendability. However, it is available in six widths with hydrophilic coating compared to three widths offered by competitors. Revision or explantation was needed in 6 of 605 patients (0.99%) with half of those being removed for dissatisfaction (0.50%). Two (0.33%) suffered device infection and one (0.16%) required removal for erosion. Kaplan-Meier's statistical analysis showed three-year implant survival from revision = 99.2%. It demonstrated a comparable safety record with less than 1.00% of patients requiring reoperation.

Hormonal evaluation in premature ejaculation.

INTRODUCTION: Premature ejaculation (PE) is a frequently encountered sexual dysfunction in men. It significantly impairs quality of life of the affected male and his partner. The aim of this study is to investigate the role of hormonal factors in patients with PE. PATIENTS AND METHODS: 107 male patients aged between 26 and 64 years (mean 45.1 ± 10.36) who consulted our outpatient clinics with complaints of PE and 94 healthy males (48.1 ± 11.81 years) as a control group were included in the study. RESULTS: When mean serum hormone concentrations of both groups were compared, levels of prolactin and free T4 were found to be significantly higher in the PE group relative to the control group (p < 0.05). At least one of the hormonal parameters was abnormal in 36 cases (33.6%) with PE, compared to only 22 (23.4%) of the controls. The number of hyperprolactinemic cases was found to be significantly increased in the PE group (p < 0.05). CONCLUSION: We feel that during the evaluation of this problem, which affects great numbers of men and their partners throughout the world, consideration of potential effects of hormonal factors might be beneficial.

Acute scrotum in Henoch-Schönlein purpura: fact or fiction?

Henoch-Schönlein purpura (HSP) is the most common systemic vasculitis of childhood. It is usually seen following upper respiratory tract infections. It rarely involves the genital system or causes scrotal edema. With this report, we wanted to bring a different perspective to this clinic of acute scrotum. Herein, we present two HSP patients admitted to our clinic with scrotal involvement, with a review of the literature.

Comparison of Tumor Enucleation and Standard Partial Nephrectomy According to Trifecta Outcomes: A Multicenter Study by the Turkish Academy of Urology, Uro-Oncology Working Group.

INTRODUCTION: We aimed to evaluate the impact of the resection technique (tumor enucleation (TE) or standard partial nephrectomy (SPN)) on trifecta outcomes in patients having undergone partial nephrectomy (PN). MATERIALS AND METHODS: We retrospectively analyzed the clinical and pathologic parameters in patients with localized renal cell carcinoma (pT1-2N0M0) who had undergone PN between January 2001-December 2018 at one of 15 different tertiary referral centers. Multivariable logistic regression analysis was applied to investigate independent predictors of trifecta failure, decreased postoperative renal functions (decreased estimated glomerular filtration rate (eGFR) > 10%), perioperative complications (Clavien-Dindo > 1), and positive surgical margins. RESULTS: A total of 1070 patients with a mean age 56.11 ± 11.88 years were included in our study. PN was performed with TE in 848 (79.25%) and SPN in 222 (20.75%) patients. Trifecta failure rate was 56.2% for TE and 64.4% for SPN (p = 0.028). On multivariable analysis, TE was associated with less trifecta failure (p = 0.025) and eGFR decrease >10% rates (p = 0.024). On the other hand, there was no statistically significant difference between TE and SPN according to positive surgical margins (p = 0.450) and complication > Clavien-Dindo grade 1 (p = 0.888) rates. The only independent predictive factor for complications > Clavien-Dindo 1 was the Charlson comorbidity index (CCI) (p = 0.001). CONCLUSION: TE is associated with less trifecta failure than SPN. This result is mainly due to better preservation of renal function with TE.