Sacral neur al neuromodulation tr omodulation treatment for urinar eatment for urinary voiding dysfunctions: results of treatment with the largest single-center series in a ter series in a tertiary referral center in T al center in Turkey.

BACKGROUND: Sacral neuromodulation (SNM) is a minimally invasive treatment that modulates spinal reflexes to regulate bladder, urinary sphincter, and pelvic floor and has successfully been used in the treatment of refractory voiding dysfunctions. The aim of this study was to present our experience with SNM in a tertiary referral center with the largest number of patients and review the safety and efficacy of the procedure. METHODS: A total of 42 patients with refractory lower urinary tract symptoms were included into the study. After an initial test period, patients who showed more than 50% improvement in their symptoms underwent the second stage of SNM. Twelve patients had overactive bladder (OAB), bladder pain syndrome/interstitial cystitis (BPS/IC) and 17 had urinary retention. The clinical success was examined during follow-up by voiding diary, urodynamics, and global response assessment. RESULTS: Between February 2015 and December 2020, a total of 29 patients underwent stages I&II SNM procedures. The mean ages of patients in OAB/BPS group and retention group were 40 (37-57 years) and 35 (27-44 years), respectively. Mean follow-up time was at least 1 year. Overall, 58.5% success rate was observed in OAB, BPS/IC, and urinary retention groups. Global response assessment score in both groups increased significantly (p = 0.001). No statistically significant difference was found between success or failure rates when sex and age were variable parameters (p > 0.05). DISCUSSION: SNM appears to be an effective and safe treatment option in restoring voiding dysfunctions in patients with refractory idiopathic and neurogenic voiding dysfunctions. Our initial series revealed favorable results; however, further studies with larger series and longer follow-up are needed.

Comparison of transperineal and transrectal targeted prostate biopsy using Mahalanobis distance matching within propensity score caliper method: A multicenter study of Turkish Urooncology Association.

OBJECTIVE: To compare the clinically significant prostate cancer (csPC)-detecting results of transperineal and transrectal targeted biopsy (TPTB and TRTB, respectively) by performing matching analysis. PATIENTS AND METHODS: This study has used the PC and prostate biopsy database from the Turkish Urooncology Association. A total of 1143 patients with Prostate Imaging-Reporting and Data System (PI-RADS) with ≥3 lesions on multiparametric magnetic resonance imaging (mpMRI) and who had received a software-guided transperineal/transrectal MRI/transrectal ultrasound (TRUS) fusion prostate biopsy with concomitant standard systematic 12-core biopsy were included in this study. csPC detection rates of the TP and TR approaches were compared following Mahalanobis distance matching within propensity score caliper method. The following four variables were selected as covariates for the matching procedure: age, digital rectal examination findings, PSA density, and the index lesion PI-RADS score. RESULTS: The matched sample included 508 TR and 276 TP patients. In both the TP and the TR groups, targeted biopsy was superior to systematic biopsy in detecting csPC (27.5% vs. 24.6%, p < 0.001 and 19.5% vs. 16.3%, p < 0.0001, respectively). Both TPTB and TP systematic biopsy was found to be superior to TRTB and TR systematic biopsy in terms of csPC detection (27.5% vs. 19.5%, p = 0.012 and 24.6% vs. 16.3%, p = 0.006). In patients with an anterior index lesion, an apical index lesion, and a larger prostate, the superiority of TPTB to TRTB was found to be more prominent in terms of csPC detection (37.8% vs. 18.3%, p = 0.044; 34.6% vs. 14.7%, p = 0.002; and 25% vs. 5.1%, p = 0.033, respectively). CONCLUSION: Targeted biopsy was found to be superior to systematic biopsy in detecting csPC in both the TP and the TR approaches. The TP approach is preferred because of its clear superiority in detecting csPC in targeted biopsy, especially in patients with anterior and apical lesions and with larger prostates.

Sacral neuromodulation treatment for urinary voiding dysfunctions: Results of treatment with the largest single-center series in a tertiary referral center in Turkey.

Background/aim: Sacral neuromodulation (SNM) is a minimally invasive treatment that modulates spinal reflexes to regulate bladder, urinary sphincter, and pelvic floor and has successfully been used in the treatment of refractory voiding dysfunctions. The aim of this study was to present our experience with SNM in a tertiary referral center with the largest number of patients and review the safety and efficacy of the procedure. Materials and methods: A total of 42 patients with refractory lower urinary tract symptoms were included into the study. After an initial test period, patients who showed more than 50% improvement in their symptoms underwent the second stage of SNM. Twelve patients had overactive bladder (OAB), bladder pain syndrome/interstitial cystitis (BPS/IC) and 17 had urinary retention. The clinical success was examined during follow-up by voiding diary, urodynamics, and global response assessment. Results: Between February 2015 and December 2020, a total of 29 patients underwent stages I&II SNM procedures. The mean ages of patients in OAB/BPS group and retention group were 40 (37-57 years) and 35 (27-44 years), respectively. Mean follow-up time was at least 1 year. Overall, 58.5% success rate was observed in OAB, BPS/IC, and urinary retention groups. Global response assessment score in both groups increased significantly (p = 0.001). No statistically significant difference was found between success or failure rates when sex and age were variable parameters (p > 0.05). Conclusion: SNM appears to be an effective and safe treatment option in restoring voiding dysfunctions in patients with refractory idiopathic and neurogenic voiding dysfunctions. Our initial series revealed favorable results; however, further studies with larger series and longer follow-up are needed.

Comparison of TRUS and combined MRI-targeted plus systematic prostate biopsy for the concordance between biopsy and radical prostatectomy pathology.

AIM: To evaluate the accuracy in histologic grading of MRI/US image fusion biopsy by comparing conventional 12-core TRUS-Bx at radical prostatectomy specimens (RP). METHODS: Consecutive patients diagnosed prostate cancer (127 with combination of both targeted biopsy (TBx) plus systematic biopsies (SBx) and separate patient cohort of 330 conventional TRUS-Bx without mpMRI) with a PSA level of <20 ng/mL prior to RP were included. The primary end point was the grade group concordance between biopsy and RP pathology according to biopsy technique. RESULTS: Clinically significant prostate cancer detection was 51.2% for TRUS-Bx, 49.5% for SBx, 67% for TBx and 75.7% for TBx + SBx. Upgrading and downgrading of at least one Gleason Grade Group (GGG) was recorded in 43.3%/ 6.7% patients of the TRUS-Bx and in 20.5%/ 22% of the TBX + SBx group, respectively (all P < .001). Concordance level was detected to be significantly higher for ISUP 1 in combined TBx + SBx method compared to conventional TRUS-Bx (61.3% vs 37.9%, P = .014). In ISUP 1 exclusively, significant upgrading was seen in TRUS-Bx (62.1%) when compared to TBx (41.4%) and TBx + SBx (38.7%). CONCLUSIONS: MRI-targeted biopsies detected more significant PCa than TRUS-Bx but, superiority in significant cancer detection appears as a result of inadvertant selective sampling of small higher grade areas. Within an otherwise low grade cancer and does not reflect accurate GGG final surgical pathology. TBx + SBx has the greatest concordance in ISUP Grade 1 with less upgrading which is utmost important for active surveillance.

Effects of androgen deprivation therapy on cognitive functions in patients with metastatic prostate cancer: A multicentric, prospective study of the Society of Urological Surgery Andrology group.

AIMS OF THE STUDY: The aim of this study was to investigate the impact of testosterone deficiency on cognitive functions in metastatic prostate cancer patients receiving androgen deprivation therapy (ADT). METHODS: In this multicentric prospective study, 65 metastatic prostate cancer patients were evaluated. Demographic and clinical data were recorded. Cognitive functions were assessed using the Symbol Digit Modalities Test, the California Verbal Learning Test Second Edition, the Brief Visuospatial Memory Test-Revised, and the Trail Making Test. Depressive symptoms were assessed using the Beck Depression Inventory. Cognitive functions and depressive symptoms were recorded before the androgen deprivation therapy and at the 3- and 6-month follow-ups. RESULTS: At the basal cognitive assessment, the mean Symbol Digit Modalities Test, the California Verbal Learning Test Second Edition, the Brief Visuospatial Memory Test-Revised scores were 25.84 ± 17.54, 32.68 ± 10.60, and 17.63 ± 11.23, respectively, and the mean time for the Trail Making Test was 221.56 ± 92.44 seconds, and were similar at the 3-month, and 6-month controls (P > .05). The mean pretreatment, third and sixth month testosterone levels were 381.40 ± 157.53 ng/dL, 21.61 ± 9.09 ng/dL and 12.25 ± 6.45 ng/dL (P < .05), and the total PSA levels were 46.46 ± 37.83 ng/mL, 1.41 ± 3.31 ng/mL and 0.08 ± 0.14 ng/mL (P < .05), respectively. CONCLUSION: The ADT in patients with metastatic prostate cancer does not affect patients' cognitive functions and depressive symptoms. However, further prospective randomised studies with higher cohorts and longer follow-up periods are needed.

How did the COVID-19 pandemic affect audience's attitudes in webinars?

INTRODUCTION: Following the COVID-19 pandemic, the face-to-face meetings are delayed to a future date, which is still not clear. However, seminars, meetings and conferences are necessary for updating our knowledge and skills. Web-based seminars (webinars) are the solutions to this issue. This study aimed to show the participant behaviour when webinars present at the COVID-19 pandemic era. METHODS: From December 2017 to July 2020, 58 webinars were broadcasted via the Uropedia, electronic library of SUST. Data of all webinars were collected with the YouTube analytics and application of the Uropedia. Data of streaming webinars included participant behaviours such as content views, engagement time, total unique attendees, average engagement time and the number of audience to leads. Data were split into two groups; group-1 is webinars before COVID-19 (before March 2020) and group-2 is the webinars during COVID-19. RESULTS: Total broadcast time and total page view number were found to be 112.6 hours (6761 minutes) and 15 919, respectively. The median participant age was 40.1 y. Median content view and median engagement time were found to be 261.0 and 12.2 minutes, respectively. Comparison of two groups revealed a significant increment in the content views (group-1; 134.0 range = 86.0-87.0 and group-2; 414.0 range = 296.0-602.0, P < .001) and the number of the unique attendees (group 1; 18.0 range = 10.0-26.0 and group-2; 57.0 range = 27.0-100.0, P < .001) following COVID-19. However, the median engagement time of the audience did not seem to change with the COVID-19 pandemic (group-1; 11.5 range = 10.0-13.3 minutes and group-2; 13.2 range = 9.4-18.1 minutes, P = .12). CONCLUSION: The webinars are effective ways to share information and have many advantages, including low cost, reaching a high number of audiences. Audience number and page visits seemed to increase following the COVID-19 pandemic. However, this era did not seem to affect the critical attitude of the audience, which is engagement time.

The relationship between premature ejaculation and the timing of pre-adult circumcision.

We aimed to investigate the relationship between premature ejaculation and the age when men had been circumcised before adulthood. A total of 2,768 sexually active male patients aged between 18 and 65 years were included in this study. A multicentre study was conducted prospectively with the participation of 20 centres. A survey consisting of 12 questions prepared by the researchers, as well as the validated Turkish versions of the five-item Premature Ejaculation Diagnostic Tool, was administered to all participants. The study included 1,603 participants who met the inclusion criteria. There was no significant difference in the Premature Ejaculation Diagnostic Tool and self-reported ejaculation time between the participants who had been circumcised at different ages during childhood. Remembering circumcision experience with fear or anxiety did not increase the risk of sexual dysfunction compared to the participants who described their experience with happiness or with no particular emotion. There was no significant difference in Premature Ejaculation Diagnostic Tool scores or the self-reported ejaculation time of the participants circumcised at different ages. The age of childhood circumcision, having a fearful or anxious circumcision experience, does not affect the risk of premature ejaculation in adult life.

Changing Aspects of Male Sexual Functions Accompanying Treatment of Benign Prostatic Hyperplasia With Silodosin 8 mg Per Day.

BACKGROUND: Alpha-adrenergic antagonist treatment for benign prostatic hyperplasia (BPH) and drug-related sexual side effects are frequent in aging men. AIM: To investigate functional changes in erectile and ejaculatory aspects of male sexuality under Silodosin 8 mg per day treatment for BPH. METHODS: Sexually active patients diagnosed with BPH and who initiated Silodosin treatment were the subjects of the study. The International Prostate Symptom Score, premature ejaculation patient profile (PEP-male) questionnaire, Sexual Health Inventory for Men (SHIM) questionnaire, and estimated intravaginal ejaculation latency time (IELT) values of the participants were used to evaluate sexual functions. Data evaluation was performed in 8 urology clinics retrospectively. OUTCOMES: Participant ratings for SHIM, PEP, and estimated IELT were the primary outcome measures in the study. RESULTS: Among 187 recruited patients, data of 98 patients, who completed the trial period in the study, were eligible. The median age of the eligible participants who completed the trial period for 3 months was 59.5 years (range 45-82). 16 patients of 187 (8%) reported a desire for drug withdrawal for anejaculation during the recruitment period. 46 (46.9%) and 49 (50%) patients reported anejaculation in the first and third month of the treatment, respectively. De novo erectile dysfunction was noticed in 15 patients (15.3%). There was a significant increase in the estimated IELT of subjects in both the first (P = .01) and third (P = .002) month. SHIM-1 (P = .008), SHIM-total (P = .009), and PEP scores (P = .008) were also improved in the third month of the treatment. Neither baseline patient characteristics nor changes in the International Prostate Symptom Score after treatment predicted final outcomes with multivariable analysis. The subgroup analysis of participants who reported "anejaculation" also revealed better outcomes compared with participants ejaculating naturally in the third month as per SHIM ratings. CLINICAL IMPLICATIONS: Despite several male patients having dry orgasms due to Silodosin-induced anejaculation, the majority experienced improved erectile function. STRENGTHS & LIMITATIONS: The present study demonstrated pioneering results while investigating both erectile and ejaculatory dimensions of the male sexual function during Silodosin treatment for BPH. However, lack of partner evaluation, low follow-up rates, and lack of knowledge about reasons why subjects are lost to follow-up after drug initiation have limited our interpretation. CONCLUSION: Most patients using Silodosin 8 mg per day for BPH treatment experienced improvement in their erectile function, estimated IELT, and premature ejaculation profile in the third month of the treatment. Underlying mechanisms and reasons for individual differences necessitate further investigation. Cihan A, Kazaz IO, Yildirim Ö, et al. Changing Aspects of Male Sexual Functions Accompanying Treatment of Benign Prostatic Hyperplasia With Silodosin 8 mg Per Day. J Sex Med 2020;17:1094-1100.

The new Avicenna Roboflex: How does the irrigation system work? Results from an in vitro experiment.

INTRODUCTION: Since 2012 Elmed has been working on a robot specifically designed for flexible ureteroscopy. After the first version of Avicenna Roboflex, a second version was developed in 2015, with significant changes especially in the irrigation system. We consider mandatory for the endourologist that works with the Avicenna Roboflex be aware of the functioning of the irrigation system. MATERIALS AND METHODS: We connected a container to the pump's irrigation system and measured the quantity of saline per second delivered by each speed setting, with/without the flush in five different modalities: pump on its own, pump with ureteroscope, with two laser fibers, with 1.9 Fr basket, and with a Terumo guidewire. RESULTS: The highest mean flow-rates were observed in the 200- micrometer laser fiber, after the pump on its own. Median flowrates for all speed settings were significantly higher for the pump on its own than for the URS in both flushed and nonflushed modes (p = 0.045, p = 0.039 respectively). There was no statistically significant difference in median flow-rates between the guide wire and basket in all of the speed settings (p = 0.932 and p = 0.977). For both laser fibers there was no statistically significant difference between the median flow rate on both nonflush and flush modes. (p = 0.590 & p = 0.590). There was a linear correlation between the speed setting and the increase measured with the flush-option for pump only measurements (r = 0.602, p = 0.038). There was no statistically significant difference between laser fibers and the pump on its own on the increase of flow rate with flush mode. (p = 0.443 for the 272- micrometer fiber and p = 0.219 for the 200-micrometer fiber). CONCLUSION: The irrigation system of the new Avicenna Roboflex is optimized compared to the previous version. However other more complex studies concerning the live flow/pressure relationship are needed before firm conclusions can be made.

Is 40 cm H2 O detrusor leak point pressure cut-off reliable for upper urinary tract protection in children with myelodysplasia?

PURPOSE: The purpose of this study, is to find out the most accurate cut-off level for the detrusor leak point pressure (DLPP) in terms of upper urinary tract (UUT) protection in a cohort of children with myelodysplasia. MATERIALS AND METHODS: One hundred and ninety-three children with myelodysplasia were included in the study based on the availability of urological evaluation at age of 3 years. Children were assigned to one of two groups-those who had UUT damage at age 3 (group 1, n: 70) and those without UUT changes (group 2, n: 123), and compared. RESULTS: Urological follow-up data revealed higher incidences of febrile urinary tract infections and secondary tethering of the spinal cord in group 1. No statistically significant difference was determined between group 1 and group 2 in terms of DLPP values (median 42.5 vs. 39.5 cm H2 O, respectively, P = 0.087). Analysis of different cut-off values showed that DLPP above 20 cm H2 O had a higher sensitivity for UUT damage (91.4%). A normal UUT was found in 56.5% and 62.2% of children with DLPP between 20 and 40 cm H2 O, and with DLPP over 40 cm H2 O, respectively. CONCLUSIONS: Present study showed that more than half of the children with myelodysplasia had normal UUT function even with a DLPP of 40 cm H2 O and over. Thus, DLPP, is not the sole decision making parameter to rely for more invasive therapies in children with myelodysplasia. On the other hand, a DLPP cut-off value of 20 cm H2 O showed a higher sensitivity to predict UUT damage instead of 40 cm H2 O. Neurourol. Urodynam. 36:759-763, 2017. © 2016 Wiley Periodicals, Inc.

Diagnostic value of the pediatric lower urinary tract symptom score in children with overactive bladder.

PURPOSE: The aims were (1) to assess the pediatric lower urinary tract symptom score (SS) prior to treatment as a means of determining severity of overactive bladder (OAB) and (2) to investigate relationships between SS results and those of standard diagnostic modalities. MATERIALS AND METHODS: Symptom scores were recorded pre- and 6 months SS for 294 children with OAB unrelated to neurological disorder. Uroflowmetry-electromyography data, total bladder capacity, and a 2-day bladder diary were also recorded, and upper urinary tract deterioration was investigated as indicated. Overactive bladder was treated with standard approaches. No response to treatment was defined as 0-49% reduction in OAB-related symptoms based on SS results. Non-responders underwent additional evaluations as indicated. RESULTS: Two hundred forty-one patients (97%; mean age 9.8 ± 2.8 years; mean follow-up 11 months; range 6-18 months) completed the study. One hundred thirteen (47%) required ultrasonography (USG), and those with abnormal USG had a significantly higher pre- and 6 months SS (p = 0.016). All non-responders (n = 38; 16%) underwent urodynamics evaluation, 34 underwent spinal magnetic resonance imaging (MRI), 34 underwent voiding cystourethrography (VCUG), and 34 underwent dimercaptosuccinic acid scanning (DMSA). Non-responders with terminal detrusor hyperactivity had significantly lower SS after therapy (p = 0.09). Non-responders with abnormal MRI had higher pre- and 6 months SS than those with normal MRI. Thirteen (38%) of the non-responders who required VCUG had vesicoureteral reflux (VUR), and this subgroup had higher pre-treatment SS (p = 0.030). Seven (21%) of the non-responders who required DMSA had scarring, and all 7 had VUR. The subgroup with scarring had higher pre-treatment SS (p = 0.030). CONCLUSION: Pediatric OAB patients with high 6 months SS have a higher incidence of additional upper urinary tract pathology. Those with low pre-treatment SS require fewer laboratory tests and other assessments. The SS tool can reduce the number of urodynamics evaluations, and other tests required to diagnose renal damage in children with OAB.

A novel nomogram to predict clinically significant prostate cancer in MR assisted lesion biopsies: Turkish urooncology association nomogram.

OBJECTIVE: This study aimed to develop a novel nomogram to predict clinically significant prostate cancer in patients undergoing multi-parametric prostate MRI-assisted lesion biopsies, addressing the challenges in deciding on biopsy for patients with PI-RADS 3 lesions and follow-up strategies for patients with negative PI-RADS 4 or 5 lesions. MATERIALS AND METHODS: A retrospective case-control study was conducted using the Turkish Urooncology Association Databases (UROCaD). The final dataset included 2428 lesion biopsy data. Univariate analysis, logistic regression, and validation were performed, with 1942 and 486 lesion biopsy data in the training and validation datasets, respectively. RESULTS: Age, initial total PSA value, PSA density, prostate volume, lesion length, DRE findings, and PI-RADS score were significantly different between benign or non-significant cancer and clinically significant prostate cancer groups. The developed nomogram incorporated PSA density, age, PI-RADS score, lesion length, and DRE findings. The mean area under the curve for the 6-fold cross-validation was 0.836, while the area under the curve values for the training and validation datasets were 0.827 and 0.861, respectively. The nomogram demonstrated a sensitivity of 75.6% and a specificity of 74.8% at a cut-off score of 24.9, with positive and negative predictive values of 42.2% and 92.6%, respectively. CONCLUSION: The TUA nomogram, based on PSA density, age, PI-RADS score, lesion length, and DRE findings, provides a reliable and accurate prediction tool for detecting clinically significant prostate cancer in patients undergoing multi-parametric prostate MRI-assisted lesion (fusion) biopsies, potentially improving patient management and reducing unnecessary biopsies.

Evaluating the Performance of ChatGPT in Urology: A Comparative Study of Knowledge Interpretation and Patient Guidance.

Background/Aim: To evaluate the performance of Chat Generative Pre-trained Transformer (ChatGPT), a large language model trained by Open artificial intelligence. Materials and Methods: This study has three main steps to evaluate the effectiveness of ChatGPT in the urologic field. The first step involved 35 questions from our institution's experts, who have at least 10 years of experience in their fields. The responses of ChatGPT versions were qualitatively compared with the responses of urology residents to the same questions. The second step assesses the reliability of ChatGPT versions in answering current debate topics. The third step was to assess the reliability of ChatGPT versions in providing medical recommendations and directives to patients' commonly asked questions during the outpatient and inpatient clinic. Results: In the first step, version 4 provided correct answers to 25 questions out of 35 while version 3.5 provided only 19 (71.4% vs 54%). It was observed that residents in their last year of education in our clinic also provided a mean of 25 correct answers, and 4th year residents provided a mean of 19.3 correct responses. The second step involved evaluating the response of both versions to debate situations in urology, and it was found that both versions provided variable and inappropriate results. In the last step, both versions had a similar success rate in providing recommendations and guidance to patients based on expert ratings. Conclusion: The difference between the two versions of the 35 questions in the first step of the study was thought to be due to the improvement of ChatGPT's literature and data synthesis abilities. It may be a logical approach to use ChatGPT versions to inform the nonhealth care providers' questions with quick and safe answers but should not be used to as a diagnostic tool or make a choice among different treatment modalities.

Practices and utility of imaging among urological communities for urolithiasis, observations, and inferences from a targeted survey.

To evaluate the general practice among urologists about the use of various radiological imaging and measurement tools, and to compare the different preferences in radiological evaluations between Turkish and European urologists. Our study was designed as a survey study. The survey comprised 22 questions which evaluated the epidemiological information, caseload of participants, general preferences of participants on CT image slice thickness, basic radiologic workup routines prior to surgery, use of special tools and measurements on CT. Data collection was conducted with both an online poll and printed copies. A total of 222 urologists from 23 different countries responded to the survey. The most performed endourologic surgery was semi-rigid URS which was performed more than 25 times/year by 90.1% (n = 200) of the participants. Although PCNL was performed more commonly by Turkish urologists (39.7%) compared to their European (17.3%) colleagues (p < 0.001), it was still the least often performed endourological surgery among all participants (31.5%). The stone size evaluation was the most performed measurement performed by the participants. Although the group of surgeons used size measurement tools, there were differences between the two groups. Turkish urologists used size measurement before PCNL (85.7%) as opposed to European urologists who used it mostly before URS (91.4%). Non-contrast CT images for urolithiasis are mainly evaluated by urologists themselves and a considerable number of urologists do not use additional measurement tools in evaluating CT images. Although there are similarities in the knowledge of various radiological tools, there are distinct regional differences.

Adjuvant Treatment Approaches after Radical Prostatectomy with Lymph Node Involvement.

OBJECTIVE: The aim of this study was to evaluate the adjuvant treatment preferences and effects on disease progression in patients with pathologically positive lymph node prostate cancer. METHODS: Patients who underwent radical prostatectomy from the prostate cancer database of the Turkish Urooncology Association with lymph node involvement were included in the study. Database includes prostate cancer patients from many experience Urooncology centers of Turkey. Adjuvant treatment approaches and the factors that effect the PSA recurrrence was analysed. RESULTS: Postoperative median 2 (1-3) lymph nodes were found to be positive, and the median lymph node density was reported as 0.13 (0.07-0.25). Seventy-four percent of patients received adjuvant treatment postoperatively. Seventy four of the patients (46.54%) received hormonal therapy in combination with radiotherapy; 47 of them (29.55%) received only hormonal treatment and 20(12.57%) only received radiotherapy. The number of lymph nodes removed was less in the group requiring adjuvant treatment, and this group had a higher rate of surgical margin positivity and seminal vesicle invasion. In addition, adjuvant treatment group had a statistically significant higher lymph node density. There was no significant difference in Kaplan-Meier method comparing 5-year PSA recurrence-free survival in patients with and without adjuvant therapy. When the patient clustered as non-adjuvant, only hormonal therapy and hormonal therapy with radiotherapy, a significant survival advantage was found in the hormonal therapy with radiotherapy group compared to the other two groups (p=0.043). CONCLUSION: No significant difference was found between two groups in terms of time until PSA recurrence during our follow-up. In subgroup analysis survival advantage was found in the hormonal therapy with radiotherapy group compared to non-adjuvant and only hormonal therapy groups.

The association of free testosterone levels with coronavirus disease 2019.

BACKGROUND: Angiotensin-converting enzyme 2 and transmembrane protease serine 2 are critical factors of virus transmission. Expression of angiotensin-converting enzyme 2 is highest in testes, and testicular function and testosterone levels were affected by coronavirus disease 2019. Low testosterone levels are related to infections, especially respiratory tract infections, and could worsen clinical conditions by exacerbating cytokine storms and increasing pro-inflammatory cytokines. OBJECTIVES: We aimed to evaluate the acute and chronic effects of coronavirus disease 2019 on gonadal functions. Our second aim was to detect the relationship between free testosterone levels and disease prognosis and determine the impact of low-free testosterone on admission to the intensive care unit. METHODS: Eighty-one patients with reverse-transcription polymerase chain reaction-confirmed coronavirus disease 2019 were enrolled. Twenty-nine patients were assessed again for 6 months post-coronavirus disease 2019 follow-up, and seven of them had a semen analysis. Serum follicle-stimulating hormone, luteinizing hormone, sex hormone-binding globulin, and total testosterone levels were measured. RESULTS: In this observational study, 71.6% (n = 58) of patients had low free testosterone levels at baseline, in which 69% were considered secondary hypogonadism. A longer length of hospitalization and increased inflammatory markers (d-dimer, high-sensitive C-reactive protein, and procalcitonin) were detected in the low-free testosterone group. Follicle-stimulating hormone, total, free, and bioavailable testosterone levels were lower in patients who required admission to the intensive care unit. Free testosterone levels were inversely correlated with the length of hospitalization and prognostic disease factors. Oligozoospermia and impaired progressive motility were present in 42.8% (3/7) of the patients. In 6 months post-coronavirus disease 2019 follow-up, out of 29 patients, 48.2% still had low testosterone levels. CONCLUSION: A high rate of hypogonadism (71.6%) was found, especially secondary hypogonadism, and about half of the patients had hypogonadism in the sixth months' follow-up. Low free testosterone levels were correlated with inflammatory parameters, and it is related to the intensive care unit admission. Studies with long-term follow-up data in larger groups are needed to determine persistent hypogonadism and impaired spermatogenesis.

Homozygosity for a novel INHA mutation in two male siblings with hypospadias, primary hypogonadism, and high-normal testicular volume.

Background: The human INHA gene encodes the inhibin subunit alpha protein, which is common to both inhibin A and B. The functional importance of inhibins in male sex development, sexual function, and reproduction remain largely unknown. Objective: We report for the first time two male siblings with homozygous INHAmutations. Methods: The medical files were examined for clinical, biochemical, and imaging data. Genetic analysis was performed using next-generation and Sanger sequencing methods. Results: Two brothers complained of gynecomastia, testicular pain, and had a history of hypospadias. Biochemistry revealed low serum testosterone, high gonadotropin and anti-Mullerian hormone, and very low/undetectable inhibin concentrations, where available. Both patients had azoospermia in the spermiogram. We have identified a homozygous 2 bp deletion (c.208_209delAG, R70Gfs*3) variant, which leads to a truncated INHA protein in both patients, and confirmed heterozygosity in the parents. The external genital development, pubertal onset and progression, reproductive functions, serum gonadotropins, and sex hormones of mother and father, who were heterozygous carriers of the identified mutation, were normal. Conclusion: Homozygosity for INHA mutations causes decreased prenatal and postnatal testosterone production and infertility in males, while the heterozygous female and male carriers of INHA mutations do not have any abnormality in sex development and reproduction.

Effect of the pandemic on surgical procedures in a tertiary care hospital: A retrospective review.

Objectives: The aim of this study was to examine the impact of performing surgeries with necessary precautions and to evaluate demographic characteristics of operated patients during novel coronavirus-2019 (COVID-19) pandemic and the infection rates during hospitalization and within 14 days after surgery. Material and Methods: Between March 15th, 2020 and April 30th, 2020, a total of 639 patients who had been operated on in our center were retrospectively analyzed. According to the triage system, the surgical procedures were classified as emergency, time-sensitive, and elective procedures. Data including age, sex, indication for surgery, the American Society of Anesthesiologists (ASA) class, pre- and postoperative symptoms, the presence and/ or absence of reverse transcriptase-polymerase chain reaction (RT-PCR) test result, type of surgery, surgical site, and documented COVID-19 infections during hospitalization and within 21 days after surgery were recorded. Results: Of the patients, 60.4% were males and 39.6% were females with a mean age of 43.08 ± 22.68 years. Malignancy was the most common indication for surgery (35.5%), followed by trauma (29.1%). The abdominal area and head and neck region were the most frequent surgical sites in 27.4% and 24.9% of the patients, respectively. Of all surgical procedures, 54.9% were emergency and 43.9% were time-sensitive procedures. Of the patients, 84.2% were in ASA Class I-II while 15.8% patients were in ASA Class III, IV and V. General anesthesia was the most common anesthesia type in 83.9% of the patients. The overall rate of COVID-19 infection was 0.63% in the preoperative period. The rate of COVID-19 infection during and after surgery was 0.31%. Conclusion: With similar infection rates to the general population, surgeries of all types can be performed safely taking preventive measures in the preand postoperative period. It would be wise to perform surgical treatment without delay in patients with an increased risk for mortality and morbidity in accordance with strict infection control principles.

Does Vaginal Wall Surgical Trauma During Hybrid Transvaginal NOTES Nephrectomy Have Traumatic Effects On Sexual Functions? A Prospective Study.

BACKGROUND: Surgical trauma due to vaginal wall incision to extract the specimen during transvaginal hybrid Natural-Orifices-Transluminal-Endoscopic-Surgery (NOTES) nephrectomy can result in sexual dysfunction and have traumatic psychological impacts. We evaluated the alteration of sexual functions in the postoperative period. METHODS: Patients who underwent a transvaginal NOTES nephrectomy were prospectively enrolled. Patients and their partners were evaluated with the Golombok-Rust Inventory of Sexual Satisfaction (GRISS) questionnaire pre- and post-operatively. Surgical characteristics were recorded. RESULTS: Fifty-three patients (mean age: 52.72 ± 2.39 years; mean tumor size 4.77 ± 2.55 cm) were included. The total GRISS scores of all patients were similar in pre- and post-operative periods. Although females reported no change in the GRISS score, 60.4% of partners showed a drop in the total score. Non-communication and avoidance subdomains showed significant changes for females; males showed a significant change in avoidance, non-sensuality and dissatisfaction subdomains. Subgroup analyses showed that neither tumor stage nor nulliparous status did not affect total score changes for both genders. The trocar number and perioperative complication rates had no significant effects on total score changes. CONCLUSION: Sexual function can be affected after transvaginal NOTES nephrectomy and care should include a stringent approach to addressing sexual dysfunction. We support the transvaginal NOTES nephrectomy technique if adequate secondary measures to protect sexual function are taken.

Event Locations in Extra-Familial Child Sexual Molestation Cases: The Istanbul Example.

A great deal of attention has been devoted to sexual molestation cases, both in theory and in practice. Child molesters are versatile and are not easily identified. Various theories and tactics, the most contemporary of which is environmental criminology, have been developed to find those criminals. Locations of victims, crime scenes, and distances among them as well as other situational variables are used to predict possible future offences in environmental criminology. This study applies the theory to sexual molestation crimes in Istanbul. Dependent distance variables are found to be correlated with several situational variables in a selected sample of 127 extra-familial child sexual molestation cases.