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Background/aim: This study aims to compare the success rates of rigid registration (RR) and elastic registration (ER) systems in diagnosing all cancers and clinically significant prostate cancer (csPC) in software-based targeted prostate biopsies (TPBs) by performing matching analysis. Materials and methods: The data of 2061 patients from six centers where software-based TPB is performed were used. All cancer and csPC detection rates of the RR and ER systems were compared following Mahalanobis distance matching with the propensity score caliper method. Logistic regression analysis was applied to identify factors predicting clinically insignificant prostate cancer (ciPC) and csPC diagnoses. Additionally, the International Society of Urological Pathology Grade Group (ISUP GG) upgrade rates of RR and ER systems were compared between biopsy and radical prostatectomy pathologies. Results: The matched sample included 157 RR and 157 ER patients. No statistically significant difference was found between ER and RR in terms of csPC detection rate (28.0% vs. 22.3% respectively, p = 0.242). The detection rate of all cancers by ER compared to RR was found to be significantly higher (54.8% vs. 35.7% respectively p < 0.001,). No statistically significant difference was found between the ER and RR groups regarding pathological upgrade (39.7% vs. 24.2% respectively, p = 0.130). In the logistic regression analysis performed to determine the factors predicting ciPC, decreased prostate volume and ER system use were found to be independent predictive factors. Conclusion: While the detection rate of csPC was similar for the RR and ER systems, the detection rate of all cancers and ciPC was significantly higher with the ER systems. [ABSTRACT FROM AUTHOR]

Purpose: To discern whether reduced infection rates were attributed to antiseptic solutions or mechanical rectal irrigation. Patients and Methods: After receiving ethical approval, the study included patients who underwent transrectal prostate biopsy due to elevated PSA or abnormal digital rectal examination findings, and prostate cancer under active surveillance, at Tepecik Training and Research Hospital between April 2022 and June 2023. Standard antibiotic prophylaxis was administered. Patients were randomized into three equal groups according to the rectal irrigation strategy. Results: Overall complications occurred in 4%. Despite distinct cleaning agents, there was no significant difference in infection rates (p = 0.780) or fever incidence (p = 0.776). Pathological analyses revealed comparable outcomes (p = 0.764). Conclusion: The study challenges the prevailing belief that antiseptic solutions are indispensable for infection prevention, as saline demonstrated similar efficacy. Limitations include data gaps from potential external hospital visits and absent rectal microorganism swab culture. While TRUS-PB remains the gold standard, this study suggests that mechanically cleansing the rectal mucosa with saline—a cost-effective, side-effect-free alternative—may be a viable infection prevention method, particularly beneficial for patients with antiseptic allergies. The findings prompt a reconsideration of the necessity of antiseptic solutions in TRUS-PB, offering an alternative approach to mitigate infectious complications. [ABSTRACT FROM AUTHOR]

Objective: We aimed to investigate the long-term surveillance outcomes (biochemical recurrance, survival) and adequacy of active surveillance criteria to detect low-risk prostate cancer patients who were eligible for active surveillance but underwent radical prostatectomy. Materials and Methods: Data of patients who underwent radical prostatectomy for prostate cancer between January 2005 and January 2019 were retrospectively evaluated. Upstaging, upgrading, surveillance periods, and survival status of patients with clinical stage T1c and T2a, serum prostate-specific antigen below 10 ng/mL, International Society of Urological Pathology grade 1, number of tumor-positive cores in biopsy 2 and below, tumor percentage in tumor-positive cores 50 and below were inclusion criteria for active surveillance. Results: The study included 606 patients. Of these patients, 184 (30.4%) met the inclusion criteria for active surveillance. Upgrading was detected in 77 (41.8%) patients and upstaging in 29 (15.8%) patients who met the criteria for active surveillance. The prostate-specific antigen (PSA) and PSA density values of the patients who met the active surveillance criteria were significantly lower than those of the other patients (p<0.05). The mean surveillance period was 127.6±49.6 (8-227) months, and 123 patients died during this period. Among them, 18 (3%) patients died because of related causes of prostate cancer. None of the patients who met the criteria for active surveillance died because of prostate cancer (p=0.018). Conclusion: No cancer-related deaths were observed in patients who is eligible for active surveillance but underwent radical prostatectomy. This may suggest that active surveillance criteria are suitable for detecting low-risk prostate cancer patients. [ABSTRACT FROM AUTHOR]

Objective: To assess the impact of surgical delay in localized prostate cancer (PCa) on adverse pathological features and oncological outcomes. Materials and Methods: Patients who underwent surgery for localized PCa were included from the Turkish Urooncology Association PCa database. History of previous treatment or active surveillance was considered an exclusion criterion. Patients were divided into two groups according to the time period between the diagnosis and surgery; less than or equal to 90 days (group 1) or longer than 90 days (group 2). Surgical pathology results and oncological outcomes were compared between the groups. Results: In total, 2454 out of 3646 patients were assessed. Pathological findings of radical prostatectomy specimens were similar between the two groups. However, there was slightly more seminal vesicle invasion in the final surgical pathology in group 1 (12.9% vs. 9.3%, respectively p=0.042). The 5-year biochemical recurrence-free survival times were similar across all D'Amico risk categories between the two groups. The regression analysis demonstrated seminal vesicle invasion as the only factor affecting the time to prostate-specific antigen progression in high-risk patients (p<0.001 HR=2.51 confidence interval=1.58-4.45). Conclusion: In conclusion, our results in this large cohort suggest that surgical delay does not cause a deterioration in PCa surgical outcomes, even in high-risk patients. These findings may be helpful for planning limited healthcare resources especially in conditions like the coronavirus disease-2019 pandemic where the availability and optimal use of healthcare system resources are crucial. [ABSTRACT FROM AUTHOR]

There are interdisciplinary fields of study within the art of music. Technology has become a discipline among the study areas of music. New methods and electronic devices have been developed to record musical works and deliver them to the audience. These technological studies have brought different research approaches on the art of music. Rapid developments in computer technology have accelerated music production and digitalization of music. Electronic hardware has been replaced by software due to its high cost, and software developed by compiling acoustic instrument sounds, as well as software plug-ins that produce synthetic sounds such as synthesizers, have become an effective tool frequently used in music production. Although many Western music instrument sound libraries have been created for the music technology sector, the sound libraries developed for Turkish music instruments are insufficient in terms of quality and quantity. In this study, a sound library of the Turkish musical instrument cümbüş was developed for Native Kontakt 7, a sampler software, and for the electronic key instrument Korg Krome EX. The study consists of the steps of recording the fret sounds and placing the recorded sounds on the keyboard keys. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of the International Society of Urological Pathology (ISUP) grade group 4 (GG4) and ISUP GG5 subgroups according to prostate biopsy on biochemical recurrence (BCR). Materials and Methods: Patients who underwent radical prostatectomy (RP) after being diagnosed with GG4 and GG5 prostate cancer according to prostate biopsy and who had follow-up data were retrospectively evaluated. Patient data were obtained from the Urologic Cancer Database-Prostate of the Turkish Urooncology Association. GG4 and GG5 pathologies were evaluated using Gleason subgroups. The effect of clinicopathological parameters on BCR after RP was investigated separately in the GG4 and GG5 patient groups. Results: In GG4, 73 of 188 patients developed BCR. When GG4 patients were evaluated for BCR, only lymphovascular invasion was significant for BCR (p=0.004). In addition, seminal vesicle invasion (SVI) and high ISUP grade according to RP pathology were significant in patients with BCR (p=0.004 and p=0.005). In the follow-up of 145 patients with GG5, 80 patients developed BCR. When GG5 patients were evaluated for BCR, no predictive factor was found for developing BCR. However, surgical margin positivity, extraprostatic extension, and SVI after RP were found to be significant in patients with BCR (p=0.031, p=0.011 and p=0.007). Conclusion: According to our results, the ISUP GG system, which does not include Gleason subgroups, is an appropriate classification system for GG4 and GG5 patients for the prediction of BCR in the Turkish patient population, in parallel with the current literature. [ABSTRACT FROM AUTHOR]

Objective: Diagnoses of variant histopathology (VH) in bladder cancer (BC) are increasing, and although there is a standard treatment algorithm for BC, the guidelines lack a standardized approach for treating VH in BC. We aimed to compare the survival results of the treatment algorithm applied to patients with BC with VH in the first transurethral resection of the bladder (TUR-B) procedure. Materials and Methods: We retrospectively assessed data on patients with VH of BC in the first TUR-B between January 2000 and January 2021. After the first TUR-B, we determined TUR-B+/-BCG, radical cystectomy (RC), and trimodal therapy (TMT) as the three potential treatments for patients according to the initial plans applied by the clinics. Results: A total of 289 patients with VH of BC in the first TUR-B were included in the study. Their mean age was 66.7±10.1 years, and most (246, 85.1%) were male. We found that TMT was associated with lower survival, and BCG administration offered no advantage in terms of overall survival (OS) or cancer specific survival (CSS) among patients with non-muscle-invasive bladder cancer (NMIBC). In patients with MIBC, immediate RC provided a significant advantage over other treatment methods in terms of both OS and CSS. Conclusions: There is still no standard treatment for patients with VH of BC. Patients are less likely to survive TMT than other treatment modalities. [ABSTRACT FROM AUTHOR]

Objective: The coronavirus disease-2019 pandemic has shown us that postponing elective surgeries that include nephrectomy due to renal cell carcinomas (RCC) was undertaken by the physicians to use hospital facilities in a balanced way. However, both urologists and patients were concerned about postponements that may increase the risk of progression. To determine the optimal threshold of postponement time-period for surgery (PTP) and according to the clinical T stages in patients who underwent nephrectomy due to RCC, we used the Urologic Cancer Database-Kidney. Materials and Methods: Patients who underwent detailed clinical T stage analysis with admission and surgery dates were included in the study. PTP was calculated using the dates of definitive preoperative diagnosis and surgery date. Recurrence, overall mortality (OM), recurrence-free survival, and overall survival (OS) were evaluated. The effects of PTP on oncological outcome according to tumor diameter and clinical T stages were also evaluated. We also analyzed the optimal cut-offs of PTP based on clinical T stages. Results: Among 3.258 patients, in the evaluation of 2.946 clinically localized patients, PTP and tumor diameter were found to be important predictors of recurrence (p=0.037 and p<0.001). The optimal PTP of 30 days was found to be an important significant threshold time for the T1 stage and 20 days for T2-4 stage tumors. Patients with longer PTP according to the thresholds shown in this study had higher upstaging for clinical T1a, T2a, and T3 stages; higher recurrence rates for T1b and T2b stages; and higher OM for T2a and T3 tumors. The survival have also shown that more than 20 days of PTP affected OSs for clinical-stage T1 (p=0.019), T2 (p=0.021) and T3 (p=0.007) tumors. Conclusions: All patients with tumors, including clinical T1 tumors, had worsening oncological results as the PTP increased (>20-30 days). [ABSTRACT FROM AUTHOR]

Objective: In this study, we investigated the correlation between prostate imaging reporting and data scoring system (PIRADS) grades of patients’ prostate lesions detected by multiparametric prostate magnetic resonance imaging (MpMRI) and prostate specific antigen (PSA) values obtained before prostate biopsy and its role in predicting clinically significant cancer in prostatectomy specimens. Materials and Methods: Patients who underwent biopsy and were diagnosed with prostate cancer (PCa) because of positive or negative MpMRI were evaluated. Histopathological factors were recorded, and the relationship between the PIRADS grading system and PSA values was analyzed in patients who underwent radical prostatectomy and preoperative MpMRI. PSA cut-off values predicting clinically significant PCa (CSPCa) in MpMRI were calculated. Results: A total of 1,319 patients were included in the study. MR-fusion biopsy was performed in 58% of the patients, and malignant histopathology was detected in 49% of the patients. While 87% of the patients had CSPCa, 13% had clinically insignificant PCa. The sensitivity and specificity of the PSA 4 ng/mL cut-off value were 88.6% and 15.1% in all patient groups, respectively. In predicting CSPCa, sensitivity was 88.9% and specificity was 18.8% for PSA 4 ng/mL cut-off value in MpMRI-negative patients. If PSA >4 ng/mL in MpMRI-negative patients, there is a >45% PCa detection rate in biopsy, but biopsy is more appropriate for PSA >10 ng/mL for CSPCa. In MpMRI-positive patients, if PSA is >2.5 ng/mL, biopsy provides a >50% PCa and >30% CSPCa diagnosis. If there are PIRADS 5 lesions and PSA is >2.5 ng/mL, biopsy has a >70% PCa and >60% CSPCa detection rate. Conclusions: It may be appropriate to consider higher PSA cut-off values (PSA >10 ng/mL) to make a biopsy decision in patients with negative MpMRI, whereas it may be possible to detect CSPCa at lower PSA values in patients with positive MpMRI findings and high PIRADS grade. Keywords: Multiparametric magnetic resonance imaging, prostate specific antigen, prostate cancer, prostate biopsy [ABSTRACT FROM AUTHOR]

Objective: This study aimed to present the data of patients with prostate cancer (PCa) whose detailed information was stored in the Urologic Cancer Database- Prostate, Urooncology Association, Turkey with the title of "Turkey Prostate Cancer Map 2021." Materials and Methods: Patient data between 1995 and 2020 were retrospectively scanned. The age of the patients, their distribution according to age groups, symptoms during diagnosis, examination findings [digital rectal examination (DRE)], prostate-specific antigen (PSA) values, biopsy methods in the diagnosis, metastatic disease rates, treatment methods, and progression rates at follow-up were examined. These results were compared with the results of the previous report, namely "Prostate Cancer Incidence (Incidence) in Turkey," by the Urooncology Association in Turkey in 2009. Results: This study analyzed the data of 5040 patients from 19 different centers. The mean patient age was 63.6 (37-97) years. The age distribution examination revealed that most patients (49.8%) were aged 60-69 years. Of the patients, 51.8% were symptomatic at the time of diagnosis. The presence of symptoms was determined in 88.6% in 2009 data. The DRE of patients revealed that 25% of patients had malignancy findings. The PSA distribution examination revealed a >10 ng/mL PSA value in 37.5% of patients. With the increasing use of magnetic imaging resonance (MRI) in PCa diagnosis over the years, increased MR-fusion biopsy rates have been observed. Considering the biopsy data, 91% of patients were diagnosed with a classical transrectal ultrasound-guided biopsy, whereas 9% were diagnosed with MR-Fusion biopsy. Fusion biopsies revealed that 23% of patients with Prostate Imaging-Reporting and Data System (PI-RADS) 4 lesion and 57% with PI-RADS 5 lesion were diagnosed with cancer. Of the patients, 8.9% of patients had metastases during the initial diagnosis. This rate was 17% in 2009 data. The treatment methods examination after the diagnosis revealed that 73.9% of patients had undergone radical prostatectomy. This rate was 51.8% in 2009. Robotic and laparoscopic approaches, which are among the surgical modalities, have increased over the years. However, the most frequently applied modality in our country was open radical prostatectomy with 62.6%. Considering the follow-up data after treatment, 8.9% of patients had progression, of which 62.6% was biochemical, 30.2% was radiological, and 6.9% was a clinical progression. Conclusion: Technological advancements for PCa diagnosis (MRI and MR-guided biopsies) are becoming a routine part of daily practice compared to the results of the "Prostate Cancer Incidence in Turkey" project in 2009. The comparative study results revealed that the rate of symptomatic and metastatic disease decreases at the time of diagnosis, and laparoscopic and robotic surgery methods are used at increasing rates for localized disease. [ABSTRACT FROM AUTHOR]

Background: Epstein criteria based on sextant biopsy are assumed to be valid for 12-core biopsies. However, very scarce information is present in the current literature to support this view. Objectives: To investigate the validity of Epstein criteria for clinically insignificant prostate cancer (PCa) in a cohort of the currently utilized 12-core prostate biopsy (TRUS-Bx) scheme in patients with low-risk and intermediate-risk PCa. Method: Pathological findings were separately evaluated in the areas matching the sextant biopsy (6-core paramedian) scheme and in all 12-core schemes. Patients were divided into 2 groups according to the final pathology report of RP as true clinically significant PCa (sPCa) and insignificant PCa (insPCa) groups. Predictive factors (including Epstein criteria) and cutoff values for the presence of insPCa were separately evaluated for 6- and 12-core TRUS-Bx schemes. Then, different predictive models based on Epstein criteria with or without additional biopsy findings were created. Results: A total of 442 patients were evaluated. PSA density, biopsy GS, percentage of tumor and number of positive cores, PNI, and HG-PIN were independent predictive factors for insPCa in both TRUS-Bx schemes. For the 12-core scheme, the best cutoff values of tumor percentage and number of positive cores were found to be ≤50% (OR: 3.662) and 1.5 cores (OR: 2.194), respectively. The best predictive model was found to be that which added 3 additional factors (PNI and HG-PIN absence and number of positive cores) to Epstein criteria (OR: 6.041). Conclusions: Using a cutoff value of "1" for the number of positive biopsy cores and absence of biopsy PNI and HG-PIN findings can be more useful for improving the prediction model of the Epstein criteria in the 12-core biopsy scheme. [ABSTRACT FROM AUTHOR]

Background and Aims: Ankaferd Blood Stopper (ABS) was used for in vitro studies of osteosarcoma and colon carcinoma cancer cell lines to reveal the apoptotic and antineoplastic effects. The aim of this study is to evaluate the antineoplastic effect of ABS on bladder cancer cell cultures. Methods: We prospectively collected minimum 0.5 cm parts of fresh frozen tumour samples from patients with bladder tumour from 2015 to 2017. Primary bladder cancer cultures were produced from the frozen tumour samples. Two different doses of ABS were used on cancer cell cultures. Viability tests of each cell cultures were performed. Flow cytometry was used for the determination of apoptosis and necroptosis. We also checked the effect of ABS on different stages, grade and variant histology of bladder cancer cells. The results of all cancer cell cultures were compared with their own controls. Results: This study included 24 patients. Mean age of patients was 66.2 ± 11.7 years (34‐83 years), where 19 of them (79.5%) were males and five (20.5%) were females. When we compared the data, we found decreased cancer cell viability ratio in each ABS group compared with their own controls. Necroptosis was observed in the great majority of ABS groups, and necroptosis and apoptosis were observed in some cell cultures. Conclusions: In this study, we demonstrated the cytotoxic effect of ABS on bladder cancer cells. The results of this study suggests planning of animal model of bladder cancer for ABS with intravesical application as an antineoplastic agent. In the future, ABS may be a candidate intravesical treatment agent for bladder cancer. [ABSTRACT FROM AUTHOR]

Objective: We aimed to investigate the effects of lymphovascular invasion (LVI) on survival rate, as well as the relationship of this parameter with lymph node (LN) involvement and other prognostic factors, in patients undergoing radical cystectomy (RC) for bladder cancer. Materials and Methods: Patients who underwent RC in our clinic for muscle invasive bladder cancer (MIBC) or high-risk non-muscle invasive bladder cancer (NMIBC) between 2006 and 2019 were retrospectively reviewed. Patients were divided into four groups: LVI (-) and LN (-) patients were in group 1, LVI (+) and LN (-) patients were in group 2, LVI (-) and LN (+) patients were in group 3, and LVI (+) and LN (+) patients were in group 4. All data were compared among the groups. Results: A total of 177 patients with a mean age of 64.4 years and mean follow-up time of 30.2 months were evaluated in this study. The mean overall survival (OS) and cancer-specific survival (CSS) of the patients were 56.6±4.2 and 68.9±4.5 months, respectively. When factors affecting survival rates were analyzed, LN positivity was not a significant factor influencing the OS (p=0.570) and CSS (p=0.533) of the patients. However, LVI [p=0.002, hazard ratio (HR)=0.402] and surgical margin (SM) positivity (p=0.001, HR=0.321) were significant factors influencing OS. SM positivity (p=0.003, HR=0.314), LVI (p=0.011, HR=0.416), and adjuvant chemotherapy (ACT) (p=0.009, HR=0.460) were also found to be independent factors affecting CSS. ACT was higher in group 3 than in other groups, and overall and cancer-specific mortality rates were lower in group 1 than in other groups. OS and CSS in group 2 (15.3±2.9 and 21.2±4.6 months, respectively) and group 4 (21.5±7.2 and 24.5±8.1 months, respectively) were lower than those in other groups (p<0.001). Conclusion: SM positivity and LVI are independent factors affecting OS and CSS. ACT, especially in group 3, could increase CSS. OS and CSS were lower in patients with LVI than in those without. [ABSTRACT FROM AUTHOR]

Objective: To present the postoperative and oncological outcomes of patients diagnosed with unclassified renal cell carcinoma (uRCC). Materials and Methods: Radiological and pathological data of patients who underwent radical nephrectomy for renal tumour diagnosed with uRCC according to histopathologic evaluation were investigated between 2006 and 2013. Follow-up data, such as metastasis-free and overall survivals, were also evaluated. Patients' characteristics and data were compared between localised tumour (T1-T2) and locally invasive tumour (T3-T4) groups and metastasis positive and negative groups during follow-up, separately. Results: A total of 17 patients participated in the study, wherein 7 had adrenalectomy in addition to radical nephrectomy and 3 had lymph node dissection. The mean tumour diameter was 91.9±44 mm (30-200 mm), and seven patients were pathologically T3a, two were T3b and one patient had T4 tumour, whereas eight had Fuhrman grade 4 and five had Fuhrman grade 3 tumours. Pathologically, seven patients had tumours with sarcomatoid features, whereas four had microvascular invasion and seven had renal sinus invasion. T-stage correlated with renal sinus invasion and was identified as an important factor in metastasis progression. The overall survival time was observed to be low in locally invasive and metastasis positive groups. Nevertheless, differences were not statistically significant. In the investigation of factors affecting metastasis development, microvascular invasion and renal sinus invasion were significant. Conclusion: The study revealed more aggressive nature (advanced stage, bigger tumour, more aggressive histopathological features and more metastasis and shorter survival on follow-up) of uRCC tumours, even without obtaining statistically significant differences. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to investigate the relevance of the Epstein criteria for the 12-core transrectal prostate biopsy (TRUS-Bx) scheme with the evaluation of clinicopathologic data recorded in the Urologic Cancer Database - Prostate (UroCaD-P), Urooncology Association, Turkey (UOAT). Materials and Methods: Patients with detailed pathological 12-core TRUS-Bx data for each biopsy core and who underwent RP due to PCa were included in this study. A total of 1167 patients from seven different centres were analysed. TRUS-Bx pathological findings were separately evaluated in the areas matching the sextant biopsy (6-core paramedian-lateral) scheme and in all 12-core biopsy areas (12-core biopsy scheme). Overall detection rates of PCa and ratios of clinically significant (sPCa) and insignificant PCa (insPCa) after RP were defined and compared between the biopsy schemes. Biopsy findings, according to the Epstein criteria, were also compared between the two schemes. A model for each biopsy scheme was created, including the Epstein criteria and additional biopsy findings using logistic regression analysis to predict clinically sPCa after RP. Results: There was a high correlation for the prediction of clinically insPCa between the two biopsy schemes in the same population. However, 7.3% of PCa could not be diagnosed in the 6-core TRUS-Bx scheme. Also, 69.4% of these had clinically sPCa according to the Epstein criteria in 12-core TRUS-Bx scheme and 51.8% of these were clinically sPCa after RP. The presence of perineural invasion (PNI) in 12-core biopsy was also significant regarding predicting sPCa (p<0.001). Conclusion: The Epstein criteria in 12-core prostate biopsy provide a better prediction of clinically sPCa than the 6-core biopsy scheme. Biopsy PNI findings appeared to improve the effectiveness of 12-core prostate biopsy, in addition to the Epstein criteria. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Introduction: Almost half of the cystic renal lesions are still overdiagnosed and overtreated. New clinical and radiological parameters are needed to distinguish the malignant Bosniak 3 lesions from the benign ones. We aimed to evaluate the clinical and radiological parameters that may be related to malignancy risk for Bosniak category 3 renal cysts. Materials and Methods: Patients who underwent surgical resection of a histopathologically confirmed Bosniak 3 renal cyst between March 2007 and September 2019 were evaluated. Two experienced uro-radiologists have reevaluated the last preoperative computed tomography and/or MRI images of the patients and reclassified the lesions according to the Bosniak classification. They also reported cystic features such as nodularity, septation, focal thickening, enhancement, and calcification. Clinical, pathological, and oncological outcomes were recorded. Then patients were divided into 2 groups as Group 1 (benign pathology) and Group 2 (malignant pathology) according to final histopathological report. Results: A total of 79 patients were included in this study. Mean follow-up time was 47 ± 34 months. There were 30 patients in Group 1 and 49 patients in Group 2. Hypertension (p = 0.001) and smoking history (p = 0.008) were more common in malignant group. Among the radiological findings, lower tumor diameter (p = 0.024), presence of cyst wall enhancement (p = 0.025), presence of nodularity (p = 0.002), and presence of focal thickening (p = 0.031) were found to be statistically significant for malignancy. Most of the tumors were at pathological T1 stage and Fuhrmann Grade 1–2. Only nodularity was found to be independent predictive factor for malignancy in multivariate analysis. Conclusion: Clinical factors including hypertension and smoking, radiological factors including lower lesion size, cyst wall enhancement, nodularity, and focal thickening were predictors for malignancy of Bosniak 3 cysts. [ABSTRACT FROM AUTHOR]

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Objective: This study aimed to prospectively investigate the predictive value of ureteral jet dynamics measured by Doppler ultrasonography (D-US) to differentiate postrenal obstruction from other reasons after double-J stent (DJS) removal in patients who underwent renal transplantation (RTx) due to chronic renal failure. Materials and Methods: Patients who underwent RTx between 2017 and 2018 were prospectively evaluated. After RTx, D-US was performed on all patients following DJS removal. Renal Artery Resistive index (RA-Ri), renal pelvis anterior-posterior diameter (RP-APD), pelvicalyceal system dilation (PCSD), and ureteral jet flow dynamics [maximum (JETmax) and average velocity (JETave)] were measured by D-US. Patients' demographics, estimated glomerular filtration rate (eGFR), acute rejection, and hemodialysis (HD) time were investigated. Patients were divided into two groups as patients without PCSD (group 1) and patients with PCSD during follow-up (group 2). In addition, group 2 was also divided into two subgroups as patients with postrenal obstruction (group 2a) and without postrenal obstruction (group 2b). All values were compared between the groups. Results: A total of 28 patients were evaluated in the study. HD time and RP-APD were significantly higher in group 2 than in group 1 (p<0.05). Ureteral jet dynamics between the groups were comparable. In group 2, RA-Ri and RP-APD were comparable, but JETave and JETmax were significantly lower in group 2a. Conclusion: In patients who underwent RTx with PCSD (especially dilation with suspected acute rejection and low eGFR) after DJS removal, investigation of ureteral jet flow dynamics can provide important information that can help determine and differentiate postrenal obstruction. [ABSTRACT FROM AUTHOR]

Objective: In this study, we aimed to investigate the oncologic outcomes of patients who were diagnosed with primary (muscle invasive cancer at the time of diagnosis) and secondary (cancer that showed progression from non-muscle invasive bladder cancer) muscle invasive bladder carcinoma (MIBC) before radical cystectomy (RC). Materials and Methods: Patients who underwent RC at our clinic for MIBC between July 2008 and June 2017 were included in the study. They were divided into two groups based on their diagnosis as primary and secondary MIBC. Their clinical, pathological, and oncologic data (upstaging, adjuvant chemotherapy, overall mortality, overall survival, cancer-specific mortality, and cancer-specific survival) were evaluated retrospectively. Results: A total of 80 patients underwent RC due to bladder cancer with a mean age of 64.4±7.8 years (range: 42-83 years) and a mean follow-up time of 32.9±32.1 months (range: 1-113 months). The overall and cancer-specific survivals of the patients were 64.7±6.6 and 74±6.8 months, respectively. Sixty-five and 15 patients were evaluated in the primary and secondary MIBC groups, respectively. Lymph node metastasis was higher in primary MIBC group (p=0.031). Although, there were no statistical differences between the groups, in secondary MIBC group, the overall survival (67.3±7.2 months vs 42.5±8.4 months; p=0.835) and cancerspecific survival (77.6±7.4 months vs 46.6±8.6 months; p=0.546) were lower, while the overall mortality (44.6% vs 53.3%; p=0.372) and cancer-specific mortality (32.3% vs 46.7%; p=0.293) were higher compared to primary MIBC group. Conclusion: The pre- and postoperative pathological T stages were similar between the groups, whereas postoperative lymph node positivity was lower for secondary MIBC patients. The mortality was higher and overall and cancer-specific survivals were lower in secondary MIBC patients; however, these findings were not statistically significant. [ABSTRACT FROM AUTHOR]

Background: The prediction of positive surgical margins (SM) after radical prostatectomy (RP) is important for planning the surgical modality and adjuvant therapy in patients with prostate cancer (PCa). Objectives: To investigate factors affecting SM positivity in patients diagnosed with PCa who underwent RP using the PCa database of the Urooncology Association (Turkey). Methods: Patients who underwent RP due to clinically T1c–T3 PCa and who had detailed SM data for the RP specimen were included in the study. Pathological data of 12 core transrectal ultrasound prostate biopsies and RP were evaluated. Patients were divided into 2 groups (SM positive and SM negative) according to SM status after RP. Data were compared between the groups. Factors affecting SM positivity, the number of positive SM sites, and the location of positive SM were separately evaluated with regression models. Results: A total of 2,643 patients from 6 different centers (median age: 63 years) with a prostate-specific antigen (PSA) level of 7.3 ng/mL were investigated in the study. BMI, PSA, biopsy Gleason score (GS), and perineural invasion (PNI) were found to be independent predictive factors for SM positivity and the number of positive SM locations, respectively (p < 0.05). According to the positive SM location, PSA was found to be associated with positive SM in apex, anterior prostate, and bladder neck locations. Also, according to posterolateral SM status, PNI and nerve-sparing RP (nsRP) rates were 21.3 and 44% for patients with negative posterolateral SM, and rates were 35.4 and 50.6% for patients with positive posterolateral SM, respectively (p < 0.05). In patients who underwent nsRP, positive SM was present in 22.2% of patients who did not have PNI on prostate biopsy, whereas positive SM was present in 40.6% of patients with PNI (p < 0.001). Similarly, 10.9% of patients without PNI had positive posterolateral SM, whereas 17.3% of patients with PNI had positive posterolateral SM (p = 0.031). Conclusions: BMI, PSA, biopsy GS, and biopsy PNI positivity were found to be predictive factors affecting SM positivity. The most important factors affecting posterolateral positive SM were biopsy PNI and nsRP, indicating that the nsRP approach may cause positive SM in the posterolateral margin of the prostate (neurovascular bundle location) in patients with positive PNI on biopsy. [ABSTRACT FROM AUTHOR]

Coronavirus disease-19 (COVID-19) has been declared as a pandemic by the World Health Organization. The number of cases has increased over time in correlation with the increasing number of testing worldwide. In order to use the available resources for COVID-19 treatment, urological practice has been limited only to emergency procedures and certain uro-oncological surgeries. In this report, we aim to share our recommendations for the daily uro-oncology practice in light of local circumstances in Turkey. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to evaluate the influence of preoperative hydronephrosis and ureteral orifice involvement (UOI) on survival of patients undergoing radical cystectomy (RC) for bladder cancer (BC). Material and methods: A total of 162 patients with BC underwent RC between January 2006 and March 2017. Patients were divided into two groups for both presences of preoperative hydronephrosis and orifice involvement at final pathology. Additionally, tumors with orifice involvement were subgrouped histopathologically after RC as those with only UOI and those with invasive to the ureter with an additional concurrent site at final pathology. Results: Preoperative hydronephrosis was detected in 57 patients. Preoperative and postoperative creatinine on month 3 were higher in the preoperative hydronephrosis (+) group (p<0.001). In addition, postoperative T stage, surgical margin positivity, invasion of urethra, and pathological upstaging were higher in this group. Cancer-specific survival (CSS) and overall survival (OS) were better in the hydronephrosis (-) group than in the hydronephrosis (+) group (p=0.001 and p=0.001, respectively). Preoperative hydronephrosis was found to be an independent factor in pathological upstaging. Patients were divided into two groups according to the presence of UOI. Group 1 consisted of patients without UOI, and group 2 with UOI. Preoperative hydronephrosis, hydronephrosis grade, and T stage were statistically higher in tumors with UOI. Moreover, CSS and OS were lower in group 2 than in group 1. Conclusion: Preoperative hydronephrosis and UOI are predicting factors on survival of patients undergoing RC for BC. Preoperative hydronephrosis was found to be an independent factor in pathological upstaging. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of preoperative non-contrast computed tomography (NCCT) findings and peroperative laser probe selection on total laser time, energy level and ureterorenoscopy (URS) time for distal ureteral stones. Materials and Methods: We prospectively evaluated 72 patients with single distal ureteral stone measuring 5-25 mm in diameter on NCCT, who were treated with ureteroscopic lithotripsy (URSL) between June 2015 and October 2016. The patients were divided into two groups according to probe selection as 365 μm and 550 μm groups. Stone diameters, stone volume and Hounsfield units (HU) measured on NCCT, and URSL findings were noted at the end of the treatment. These findings were compared between the groups. Also the possible predictive value of NCCT findings was evaluated for URSL data. Results: There were 17 patients in the 365 μm and 55 patients in the 550 μm groups. There was no significant difference in URSL success rate and other predictive data between the groups. However, among the peroperative data, laser time, laser energy level and laser energy/time ratio were significantly lower in the 365 μm group compared to the 550 μm group (p<0.05). Correlation analysis indicated that total laser time and URS time were correlated with stone diameter, stone volume, HU values and density (HD). Laser energy level was only correlated with longitudinal stone diameter and HD. Conclusion: Stone diameter, volume and HU values are significant predictors of laser energy level, URS and laser time for distal ureteral stones. Also, use of a thinner probe decreases total laser time, laser energy level and laser energy/time ratio. In addition, thinner laser probe shortens URS time. [ABSTRACT FROM AUTHOR]

Objective: To investigate the prognostic value of neutrophil-to-lymphocyte ratio (NLR) in renal cell carcinoma (RCC). Materials and Methods: Preoperative NLR value in 125 patients who underwent surgical treatment for renal tumor between January 2012 and September 2017 and and received the pathological diagnosis of RCC, was evaluated. The patients were initially divided into two groups as patients with and without metastases at the time of diagnosis. Subsequently, the patients were divided into two groups according to the pathological stage. In the first group, patients with localized RCC (pT1 and pT2) were evaluated and in the other group, those with advanced RCC (pT3 and pT4) were evaluated, and then, these two groups were compared. Results: The mean NLR was higher in group with metastasis than in group without metastasis at the time of diagnosis (4.4±2.8 and 2.9±1.6, respectively; p=0.029). When a NLR of 3.1 was taken as the cut-off value; it was observed that the NRL value in 7 of 8 patients with metastasis at diagnosis was above 3.1. (p=0.002, OR=14.6). Overall survival was 59.8±2.7 months and 49±4.5 months in patients with a NLR of <3.1 and >3.1, respectively (p=0.045). Conclusion: We assume that preoperative NLR can be evaluated as a prognostic marker for overall survival in patients with RCC. [ABSTRACT FROM AUTHOR]

Objective: We aimed to investigate the influence of preoperative factors on postoperative renal function and the association between renal function and oncologic outcomes and complications after radical cystectomy (RC). Materials and Methods: We retrospectively analyzed patients who underwent RC due to muscle-invasive bladder cancer and intravesical treatmentresistant nonmuscle-invasive bladder cancer in our center between January 2006 and March 2017. The patients' age, gender, comorbidities, preoperative estimated glomerular filtration rate (eGFR), presence of hydronephrosis, hydronephrosis grade and laterality, urinary diversion type, preoperative and postoperative pathology findings, eGFR at postoperative 3rd month, oncologic outcomes, and complication rates were evaluated. The patients were divided into 2 groups based on postoperative eGFR: group 1 (<60 mL/min eGFR) and group 2 (=60 mL/min eGFR), and data were compared between the groups. Results: The study included 125 patients with urothelial carcinoma of the bladder who underwent RC and had complete records (59 patients in group 1 and 66 patients in group 2). Of the preoperative factors, only presence of hydronephrosis was significantly higher in group 1 (p=0.012). There were no statistically significant differences between the groups in terms of urinary diversion type, pathology findings, oncologic outcomes, or complications. Conclusion: Preoperative eGFR and hydronephrosis were significantly associated with postoperative 3rd month eGFR. Postoperative eGFR <60 mL/min was not associated with diversion type, pathologic and oncologic outcomes, or complications. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to evaluate sexual functions and quality life of patients who are followed- up for non-muscle invasive bladder cancer (NMIBC). Material and methods: Between March 2015-June 2016, 50 patients underwent cystoscopy for NMIBC. At the end of the 1st year follow-up patients were assessed for sexual functions using 5-item version of the International Sexual Function Index (IIEF-5) for male and the Female Sexual Function Index(FSFI) for female; for quality of life (QoL) by the European Organisation for Research and Treatment of Cancer-Non-Muscle Invasiv Bladder Cancer Quality of Life Questionnaire (EORTC QLQ-NMIBC24) and for emotional status by Beck depression inventory. Results: There were 44 male and 6 female patients with the mean age of 57.6±11.5 years. Twenty patients received intravesical treatment after transurethral resection of bladder tumour. The mean Beck (10.7±9.5) IIEF-5 (15.6±5.9), FSFI (19.2±10.9), and the EORTC-QLQ NMBIC 24 (38.2±7.7) scores of the patients were determined as indicated. Among the patients, 42 (84%) of them were not feeling bad about their bladder tumors and 37 (74%) were not worrying about their daily lives. Moreover, 12 (24%) patients were not interested with sexuality, while 27 (54%) of them did not feel comfortable about sexual sincerity. Interestingly, 27 patients receiving intravesical treatment were concerned that the treatment they received for prevention of recurrence and progression of bladder tumor infect their partners during sexual intercourse. Conclusion: NMIBC affects patients' sexual functions and QoL negatively. Therefore during the follow-up of these patients, it is important to inform these patients accurately about their treatments to be applied and predicted complications in the follow up period. [ABSTRACT FROM AUTHOR]

Since intravesical Bacillus Calmette-Guerin (BCG) began to be used for bladder cancer, our understanding of the importance of immune mechanisms in bladder cancer has steadily grown. With developments in immunotherapy in recent years, the use of new immunotherapeutic agents for bladder cancer, especially chemotherapy-resistant invasive and metastatic cancers, has opened the way for research in this area. Of these new therapeutic agents, this article reviews studies published on PubMed or listed on the ClinicalTrials.gov website as of December 2017 regarding the effects and mechanisms of action of checkpoint inhibitors [cytotoxic t-lymphocyte associated protein-4, programmed cell death 1 receptor (PD-1) and PD-1 ligand inhibitors] on bladder cancer. Because checkpoint inhibitors were first used for chemotherapy-resistant bladder cancer after identification of positive expression in tumor cells and especially in tumor-infiltrating mononuclear cells, significant objective response rates and survival advantages have been reported. Research continues regarding the use of these agents as first- and second-line treatment for metastatic disease in combination with chemotherapy; their efficacy in neoadjuvant, adjuvant, and bladder-preserving approaches to muscle-invasive bladder cancer (MIBC) disease, and their use in non-muscle-invasize bladder cancer (NMIBC), especially BCG-refractory disease. Depending on the results of these ongoing studies, immunotherapy may direct the treatment of bladder cancer in the future. [ABSTRACT FROM AUTHOR]

Objective: In this study we evaluated the hormone data before prostate needle biopsy (PNB) in patients who underwent retropubic radical prostatectomy (RRP) due to prostate adenocarcinoma (PCa). Correlations between the patients' RRP pathology results, recurrence-free survival (RFS), and hormone data were investigated. Materials and Methods: Patients were evaluated in two groups according to RRP pathologic T stage: T2 (group 1) and T3 (group 2). Then patients were assessed in two groups based on total testosterone (TTE) values: >300 ng/dL and <300 ng/dL. The preoperative data, hormone data, RRP pathologic data, and biochemical recurrence and RFS results were compared between these groups. Results: A total of 81 patients were evaluated. The mean follow-up time was 37.7 months. Mean recurrence free survival (RFS) among all patients was 94.2±7 months. In multivariate analysis of the preoperative data, TTE/prostate volume (p=0.015) and PNB tumor percentage (p=0.004) were significantly higher in group 2 (n=32) compared to group 1 (n=49). In the postoperative data, RRP pathology Gleason score (GS) (p=0.015) and tumor volume (p=0.02) were significantly higher in group 2. RFS was 99.2±5.8 months in group 1 and 77±12.1 months in group 2 (p=0.02). When patients were assessed according to TTE levels, of the pre- and postoperative data only RRP pathology T stage, GS, and lymph node positivity were significantly higher in the TTE <300 ng/dL group (n=30) compared to the TTE >300 ng/dL group (n=51). The biochemical recurrence rates and RFS times (87.7±13.8 months and 91.3±6.4 months, respectively) were similar between the groups (p=0.571). Conclusion: We demonstrated a correlation between locally invasive PCa and low TTE measured before PNB and low TTE density. In particular, TTE values <300 ng/dL were associated with high pathologic T stage, GS, and lymph node positivity. [ABSTRACT FROM AUTHOR]