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The aim of this study was to evaluate the effect of vitamin D replacement in patients with lower urinary tract symptoms (LUTS)/erectile dysfunction (ED) who did not respond to tadalafil 5 mg treatment. Patients who applied to the Andrology Clinic with LUTS/ED between September 2017 and August 2020 and used 5 mg Tadalafil daily for treatment and did not benefit from treatment for 1 month were included in the study. Vitamin D levels of the patients were analysed and Vitamin D3 100,000 IU/week oral therapy was administered for a month to the patients with low levels of Vitamin D(<20 ng/ml).The values of the patients before and after Vitamin D replacement were compared. A total of 84 patients were included in the study. The mean age was 49.175 ± 11.63(28-70) years and the mean BMI was 25.93 ± 6.82(18.26-37.87). Testosterone levels of the examined patients were 3.45 ± 0.99 ng/ml. After 1 month of Vitamin D replacement + Tadalafil 5 mg/d treatment, the international index of erectile function-erectile function (IIEF-EF) (pre-treatment: 10.73 ± 6.12, post-treatment: 24.18 ± 4.87; p = 0.001) and International Prostate Symptom Score (pre-treatment: 9.12 ± 7.16, post-treatment: 3.11 ± 1.08; p = 0.003) scores of the patients improved significantly. Evaluation of Vitamin D levels is important to improve treatment response, especially in patients who do not respond to PDE-5 inhibitors., (© 2022 Wiley-VCH GmbH.)

Purpose: We investigated role of neutrophil-to-lymphocyte ratio (NLR) in the diagnosis and prediction of extracapsular extension (ECE) in clinically localized prostate cancer (PCa)., Materials and Methods: A total of 396 patients with clinically localized PCa who underwent open radical retropubic prostatectomy (RRP), and 260 patients with benign prostatic hyperplasia (BPH) who underwent suprapubic prostatectomy were included in the study. Preoperative NLR, prostate specific antigen (PSA), prostate specific antigen density (PSAD), free PSA, prostate volume (PV), free/total PSA (f/t PSA) in both groups, and relation of NLR with PSA, Gleason Score (GS), and pathologic stage in PCa group were investigated. Records of patients were analyzed retrospectively., Results: NLR, free PSA, f/t PSA, and PV were statistically higher in BHP, and PSAD was higher in PCa group. In PCa group, NLR was found to be higher in patients with PSA >10 ng/ml compared to those with less than ⩽10 ng/ml. NLR increases as the preoperative GS increases, and it was higher in pT3 patients than pT2 patients. NLR was statistically higher in those patients with positive lymph nodes than those without after RRP ( p  = 0.029)., Conclusion: NLR is not a sufficient biomarker in differentiating clinically localized PCa from BPH. NLR increases as preoperative GS and pathologic stage increases. Lymph node involved patients after RRP have statistically higher NLR. NLR can be an indicator of ECE and lymph-node involvement in clinically localized PCa.

Background: Renal stone disease is a common disorder in urology practice. Kidney stone has various treatment methods such as extracorporeal shock wave lithotripsy, retrograde intrarenal surgery, and percutaneous nephrolithotomy (PCNL). In this study, we aimed to determine the value of S.T.O.N.E. nephrolithometry score, which is considered as a new scoring system for predicting residual stone rate and complications in patients undergoing PCNL due to renal calculi. Materials and Methods: A total of 120 patients >18 years old who underwent PCNL were evaluated prospectively. Five parameters available from preoperative noncontrast-enhanced computed tomography were measured: stone size (S), tract length (T), obstruction (O), number of involved calices (N), and essence or stone density (E) and then S.T.O.N.E. nephrolithometry score was calculated. The prediction of the stone-free rates and complication rates of this scoring was evaluated statistically. Results: When the age, gender, body mass index, comorbidities, and American Society of Anesthesiologists scores of the patients were evaluated according to the patients' postoperative stone-free status, no statistical difference was found between the groups. Patients had a stone-free rate of 78%. Patients' mean neuropilitometry score was calculated to be 7.75 S.T.O.N.E. nephrolithometry score statistically significant ( P  = .001) for prediction of stone-free status. S.T.O.N.E. nephrolithometry score was significantly correlated with operation time, estimated blood loss, duration of fluoroscopy, duration of hospital stay, and number of punctures. Complications were seen in 13 patients. Conclusions: S.T.O.N.E. nephrolithometry score can be used as an objective criterion for predicting the complexity of the PCNL process. In addition, this scoring system is expected to provide more objective preoperative counseling and can provide standardization in academic studies.

Testicular torsion is an emergency urological disease, and the treatment is immediate surgery. Despite emergency surgery, testicular damage may occur due to reperfusion. Therefore, a medical treatment to prevent this damage may be a rational idea. We aimed to evaluate the protective effect of oltipraz in testicular ischaemia/reperfusion damage. Twenty-eight Wistar-Albino rats were randomly divided into four groups. In ischaemia/reperfusion group, testicular torsion was executed, and orchiectomy was done 4 hr after detorsion with no treatment. Second group performed torsion; intraperitoneal 50 mg/kg oltipraz was applied 30 min before detorsion, and orchiectomy was performed 4 hr after detorsion. Third group applied torsion; intraperitoneal 150 mg/kg oltipraz was applied 30 min before detorsion, and orchiectomy was performed 4 hr after detorsion. Last one was the sham group. We evaluated tissue malondialdehyde (MDA), transforming growth factor-β1 (TGF-β1), superoxide dismutase (SOD), reduced glutathione (GSH) and Johnsen testicular biopsy score. There was a significant decrease in TGF-β1, GSH and MDA values in oltipraz treatment groups compared with ischaemia/reperfusion group. Oltipraz treatment has significant protective effect in testicular ischaemia/reperfusion damage. However, more clinical studies are needed to demonstrate appropriate dose and its effects., (© 2021 Wiley-VCH GmbH.)

Objective: The aim of this study is determine and compare improvement of hydronephrosis, renal function, and operative outcome between laparoscopıc and open pyeloplasty in adults., Material and Methods: Sixty-five adult patients with primary ureteropelvic junction obstruction (UPJO) underwent pyeloplasty between January 2014 and September 2020. Thirty-four patients had laparoscopıc pyeloplasty (LP), 31 patients had open pyeloplasty (OP). In this retrospective study demographics, differential renal function (DRF), hydronephrosis, anteroposterior diameter of pelvis renalis (APD) and operative outcomes: operation time, blood loss, complications, hospital stay, etiology, analgesic requirement, complications, and success rates were compared between two groups., Results: Improvement of APD is higher in OP group ( p : 0.001). Improvement of DRF ( p : 0.713) and hydronephrosis ( p  = 1.000), success ( p : 0.407) and complication rate ( p : 0.661) are comparable between two groups. Median hospital stay, postoperative analgesia requirement and blood loss was less in LP group, mean operative time was shorter in OP group ( p : 0.001)., Conclusion: Pain complaints are greatly reduced after pyeloplasty in adult patients but the drainage of kidney, DRF and hydronephrosis does not improve as much as desired. Improvement of APD is better and median operative time is less in OP, intraoperative blood loss, hospital stay, and analgesic requirement is less in LP group in our study.

This study was performed to evaluate the effect of liraglutide on experimental testicular ischaemia reperfusion in rats in terms of biochemistry, histopathology and immunohistochemistry. A total of 28 male Wistar-Albino rats were divided randomly into 4 groups: control (7), sham (7), ischaemia-reperfusion (7) and ischaemia-reperfusion + liraglutide (7). Biochemically, Nitric Oxide, Malondialdehyde, Superoxide dismutase, Glutathione peroxidase and Catalase levels were measured in the testis. Apoptosis protease activating factor-1 and inducible nitric oxide synthase activity were evaluated immunohistochemically as well. Statistical analyses were made via the Kruskal-Wallis and Mann-Whitney U tests. In the reperfusion group, CAT and SOD values were increased (p > .05), NO and MDA values were decreased (p < .05) after administration of liraglutide. In addition, GPx values were significantly increased in ischaemia reperfusion + liraglutide administered group compared to reperfusion group (p < .05). Apaf-1 and iNOS activity were significantly decreased with the addition of liraglutide treatment to the ischaemia-reperfusion group (p < .05). First of all, we would like to say that liraglutide treatment is moderately preventive against I/R injury in testicular torsion. The anti-inflammatory, antioxidant and antiapoptotic properties of liraglutide are create a moderately protective effect as we show in this study., (© 2021 Wiley-VCH GmbH.)

Purpose: Prediction of extracapsular extension (ECE) before radical prostatectomy in clinically localized prostate cancer (PCa) is very important for clinical practice. ECE affects our decision on treatment strategy. The aim of this study is to identify the predictors of ECE, determine cut-off values, and compare them with the accuracy of Partin Table parameters to improve tumor staging in clinical practice., Materials and Methods: 374 patients with clinically localized PCa who underwent open radical retropubic prostatectomy (RRP) were included in this study. Gleason Score (GS), age, digital rectal examination (DRE), prostate specific antigen (PSA), prostate specific antigen density (PSAD), free PSA, Free/Total PSA, prostate volume (PV), number of cores involved, tumor length, and tumor percentage in maximum involved core in biopsy were investigated., Results: PSAD, tumor percentage, and tumor length are predictive factors of ECE. The cut-off values of PSA, PSAD, maximum tumor length, and maximum tumor percentages in predicting ECE are: > 8.90 ng/mL, > 0.26 ng/mL2, >5mm, and >50%, respectively. The cut-off values for Partin extraprostatic extension (EPE) and organ confined (OC) disease are >29% and ≤ 64%, respectively., Conclusion: Partin tables could better predict extracapsular extension in clinically localized PCa if they include PSAD, tumor percentage, and tumor length. The cut-off values of these predictive factors can be beneficial in treatment strategies and in the decisions of lymphadenectomy and nerve-sparing surgery at radical prostatectomy.

Purpose: We aimed to present our laparoscopic cystectomy experience and demonstrate that it is a feasible technique with safe oncologic principles., Methods: Total 19 patients who underwent laparoscopic radical cystectomy and pelvic lymph node dissection (PLND) in our urology clinic (Okmeydani Training and Research Hospital) were retrospectively evaluated. Demographic data, operation technique and complications, tumour pathology and follow-up details of patients were recorded., Results: Patients ranged from 40 to 73 years, with the average age of 60.8 and female/male rate was 2/17. The mean total operation time was 375 min (range 260-500). Mean hospitalisation time of patients was 10.3 days. The mean follow-up time was 11.2 months., Conclusion: Minimally invasive approaches in urology are becoming the first line treatment by the time. Due to the high costs and limited availability, robotic surgery is still not exactly widespread in the world. Our series showed that conventional laparoscopic cystectomy is an appropriate approach until robotic surgery becomes widespread.

During the COVID-19 outbreak, which is effective worldwide, the psychological conditions of healthcare professionals deteriorate. The aim of this study was to examine health professionals' changes in their sexual lives due to the COVID-19 outbreak in Istanbul, Turkey. This online survey was conducted between 2 and 26 May 2020 with 232 healthcare professionals working in a pandemic hospital. After obtaining informed consent, a questionnaire was sent online from the hospital database and health institutions social media accounts (Twitter®, Facebook®, Instagram®, WhatsApp® etc.) and e-mail addresses. The first section of the four-part questionnaire included demographic data, the second and third sections of pre-and post-COVID-19 attitudes, and the last section to assess sexual functions (International Index of Erecile Function for male and Female Sexual Function Index for female), anxiety and depression. Dependent sample t-test, Mc Nemar test, and multivariate analysis were used.The study was completed with 185 participants in total. Healthcare workers' sexual desire (3.49 ± 1.12 vs. 3.22 ± 1.17; p = 0.003), weekly sexual intercourse/masturbation number (2.53 ± 1.12 vs. 1.32 ± 1.27; p < 0.001), foreplay time (16.38 ± 12.35 vs. 12.02 ± 12.14; p < 0.001), sexual intercourse time (24.65 ± 19.58 vs. 19.38 ± 18.85; p < 0.001) decreased compared to the Pre-COVID-19 outbreak. In addition, participants prefer less foreplay (p < 0.001), less oral sex (p < 0.001) and anal sex (p = 0.007) during COVID-19 and more non-face to face sexual intercourse positions (p < 0.001). When factors affecting sexual dysfunction were analyzed as univariate and multivariate, sexual dysfunction was shown to be significantly more common in males (OR = 0.053) and alcohol users (OR = 2.925). During the COVID-19 outbreak, healthcare workers' sexual desires decreased, the number of sexual intercourses decreased, their foreplay times decreased, and their sexual intercourse positions changed to less face to face.

Aside from the ordinary plasma lipid level measurements, the ratios based on individual plasma lipid levels such as atherogenic index of plasma (AIP), Castelli's risk index 1/2 (CRI-1/2), and atherogenic coefficient (AC) are the novel parameters to evaluate the patients with a high risk of CVD. In this study, we aim to evaluate the relationship between AIP, AC, and CRI-1/2 with increased risk of ED. Between April 2018 and February 2019, 253 patients, who were diagnosed as a vasculogenic ED in our clinic, were enrolled in the study. While the first group ( n  = 134) consisted of patients with moderate and mild ED (IIEF-EF: 17-30), the second group ( n  = 119) consisted of patients with severe ED. In addition to the mean values of lipid parameters; CRI-1 (total cholesterol/HDL), CRI-2 (LDL/HDL) AIP (log10(triglycerides/HDL), and AC (non-HDL/HDL) were calculated. The mean age was 44.02 ± 10.41 (24-70), and the mean BMI was 27.80 ± 4.12 (18.52 ± 41.97). However, CRI-1 and AIP values were found to be higher in the severe ED group compared to the mild ED group (CRI-1: 4.50 ± 1.47, 4.88 ± 1.30; p  = .039; AIP: 0.489 ± 0.315, 0.617 ± 0.283; p  = .007). Our results demonstrated that CR-1 and AIP have a positive correlation with the severity of ED. Moreover, we can suggest that patients with higher CR-1 and AIP values are likely to have more severe ED in the future.

We aimed to investigate the pre-operative predictive role of haematological parameters in patients with testicular torsion. The medical records of patients operated between January 2016 and November 2018 were retrospectively analysed. The demographic characteristics and complete blood count of the patients were recorded. We divided the patients who operated with testicular torsion into two groups: detorsion (Group 1) and orchiectomy (Group 2). A control group (Group 3) was created from healthy volunteers. All haematological parameters and other demographic data were compared between three groups. A total of 144 participants were included; Group 1, Group 2 and Group 3; 61, 27 and 56 respectively. The duration of symptoms and monocyte counts were found statistically significantly higher in patients undergoing orchiectomy than detorsion (p < .01). We found a significant difference in terms of neutrophil, lymphocyte, monocyte counts and neutrophil-lymphocyte ratio between patients with testicular torsion and controls. We also found that the monocytes count and symptom duration differed significantly between the detorsion group and the orchiectomy group. It is obvious that there is contradictory information according to the studies in the literature. We can say that the duration of symptoms and the number of monocytes are predictors of testicular viability., (© 2020 Blackwell Verlag GmbH.)

Objectives: We researched to detect the optimal method for evaluating stone volume, by comparing the ellipsoid formula and 3D reconstructed volume to gold standard of water displacement volume using 3D printed models., Methods: We retrospectively analyzed out patient database and evaluated 27 patients who had percutaneous nephrolithotripsy. From the DICOM data of patient's preoperative CT images, stone structures were obtained using an image identification system. All DICOM files were saved in the stereolithography file format and a 3D printed model was created. True stone volume was found by water displacement method using this model and this volume compared with ellipsoid formula and 3D-reconstructed volume., Results: Stone volume on water displacement ranged from 0.38-29.8cm3 with a median of 17.5cm3, stone volume on ellipsoid formula ranged from 0.46-34.7cm3 with a median of 19.6cm3 and stone volume on CT based 3D-reconstructed ranged from 0.48-31.8cm3 with a median of 18.9cm3. There was a significant difference between ellipsoid formula and water displacement ( p <   0.0001 ); however, there was no difference between 3D-reconstructed volume and water displacement ( p = 0.051 )., Conclusion: Stone volume calculation using CT based 3D-reconstructed algorithm improves the accuracy of stone volume estimation and this measurement is superior to ellipsoid formula.

Introduction: Benign prostatic hyperplasia (BPH) is one of the most common diseases in the world and also one of the most common causes of urinary complaints that occur with increasing age. Thus, BPH should be addressed with surgical procedures. To contribute to the relevant literature, the present study aims to investigate the effects of surgical therapies for BPH on the patients quality of life., Materials and Methods: This study included 120 patients who underwent surgery for BPH at a Training and Research Hospital. The short-form health survey (SF-36) was administered to the patients before the surgery and at three months after the surgery. Eight parameters of the SF-36 and mental (MCS) and physical (PCS) component summary scores were calculated. The Student's t-test, Wilcoxon, and chi-square test were used in the statistical analysis., Results: When the eight parameters within the SF-36 health questionnaire were examined separately, the findings showed that patients quality of life increased significantly with respect to physical functioning, social functioning, and role limitations because of emotional problems , vitality, bodily pain, general health perceptions, and mental health domains three months after surgery (p < .001). The PCS and MCS significantly increased after surgery (p < .001)., Conclusion: The SF-36 questionnaire results showed that a significant improvement in the patients quality of life was observed in patients who underwent surgery for BPH. Our findings suggest that SF-36 could be considered a reliable evaluation test to be used in the patients with BPH after surgery.

Objective: To investigate the prevalence of Burnout syndrome (BS) with its emotional exhausting (EE), depersonalization (DP), and personal accomplishment (PA) dimensions among Turkish urologists., Material and Methods: A total of 2,259 certified Turkish urologists were invited by e-mail to participate in this cross-sectional survey-based study. An online survey was conducted to evaluate three dimensions of BS ie: -EE, DP and PA-and their association with socio-demographic variables of Turkish urologists using the Maslach Burnout Inventory (MBI)., Results: Of the 2259 urologists contacted, 362 (with a mean age of 44±9.9 years) completed the survey. The mean EE, DP and PA scores were 16.8±8.7, 6.6±4.6 and 8.2±5.6, respectively. Cronbach's α reliability co-efficiencies were 0.920 for EE, 0.819 for DP and 0.803 for PA. Antidepressant drug usage was quite prevalent among participants (21.9%), and the most common comorbidity was hypertension (13%). The academic title, age, smoking status, monthly income and relationships between colleagues and employers were associated with BS (p<0.05)., Conclusion: The prevalence of BS among Turkish urologists is quite prevalent in terms of EE and DP subscales and may negatively affect the psychosocial status and well-being of the urologists. In this study, a high prevalence of BS has been reported among Turkish urologists. In conclusion the BS could become an important occupational and health problem, if it is not properly managed.

We analyzed our stone-free rates of PNL with regard to stone burden and its ratio to the renal collecting system volume. Data of 164 patients who underwent PNL were analyzed retrospectively. Volume segmentation of renal collecting system and stones were done using 3D segmentation software with the images obtained from CT data. Analyzed stone volume (ASV) and renal collecting system volume (RCSV) were measured and the ASV-to-RCSV ratio was calculated after the creation of a 3D surface volume rendering of renal stones and the collecting system. Univariate and multivariate statistical analyses were performed to determine factors affecting stone-free rates; also we assessed the predictive accuracy of the ASV-to-RCSV ratio using the receiving operating curve (ROC) and AUC. The stone-free rate of PNL monotherapy was 53% (164 procedures).The ASV-to-RCSV ratio and calyx number with stones were the most influential predictors of stone-free status (OR 4.15, 95% CI 2.24-7.24, <0.001, OR 2.62, 95% CI 1.38-4.97, p < 0.001, respectively). Other factors associated with the stone-free rate were maximum stone size (p < 0.029), stone surface area (p < 0.010), and stone burden volume (p < 0.001). Predictive accuracy of the ASV-to-RCSV ratio was AUC 0.76. Stone burden volume distribution in the renal collecting system, which is calculated using the 3D volume segmentation method, is a significant determinant of the stone-free rate before PCNL surgery. It could be used as a single guide variable by the clinician before renal stone surgery to predict extra requirements for stone clearance.