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© 2022 by SLS, Society of Laparoscopic & Robotic Surgeons.Background and Objectives: The multiple endoclip retraction technique (MERT) was developed based on our experience with suturing renal parenchyma in laparoscopic partial nephrectomy. In this study we prospectively evaluated the one-year results of cases treated by transperitoneal laparoscopic Burch with the MERT. Methods: The patients were evaluated with stress test, one-hour pad test, and were requested to complete the International Continence Society Incontinence Questionnaire short form (ICIQ-SF) in the postoperative period. The follow-up periods were postoperative 3, 6, and 12 months. Results: The primary outcome of this study was surgical success, defined as being cured of stress urinary incontinence (SUI) (no symptoms), experiencing improved symptoms of SUI in ICIQ-SF and negative stress test, and less than 2g urine leakage in a one-hour pad test. No statistically significant difference was found in terms of age, number of children, and body mass index (BMI) in patients according to the results of the 12 month postoperative stress test. We found statistically significant improvements at all control months in terms of stress test and pad weight. ICIQ-SF results showed a significant decrease at three months in patients who recovered after the operation. This rate has not changed in following control months. However, there was no statistical change in ICIQ-SF values in patients who did not recover after the operation. Conclusion: MERT seems to be one of the safe and effective modifications in the management of SUI with good one year outcomes when performed by suitably trained experienced surgeons.

Objective: To investigate the effect of four different techniques used in the treatment of ureteral stones on patients' daily physical functioning (PF) and quality of life (QoL). Materials and Meth...

Objective:Falls are a significant cause of morbidity and mortality, particularly in hospitalized patients. In this study, we aimed to evaluate the risk of falls in the patients hospitalized in a urology clinic.Materials and Methods:The study included patients that were hospitalized in a urology clinic between November and December 2018. All the patients were administered both Itaki Fall Risk scale (IFS) and Morse Fall scale (MFS). Demographic and clinical characteristics, history of falls within the past six months, type of surgery, primary diagnosis (urooncological vs non-urooncological), and the department/unit from which the patients were referred [outpatient clinic vs emergency service/intensive care unit (ICU)] were recorded.Results:The risk of falls was significantly higher in the patients with urooncological diseases compared to the patients with non-urooncological diseases (p

Background Although open radical prostatectomy has been used in the treatment of localized prostate cancer for a long time, minimally invasive surgical approaches such as laparoscopic radical prostatectomy and robot-assisted radical prostatectomy have recently gained importance in order to improve postoperative results and shorten hospital stay. Although the enhanced recovery after surgery (ERAS) protocol was first defined for gastrointestinal surgeries in 2001, it has now been used in gynecological, orthopedic, thoracic and urological surgeries. In our study, we aimed to compare the results of the ERAS protocol with the conventional approach in patients who underwent laparoscopic radical prostatectomy. Methods There is a retrospective analysis of 70 patients who underwent laparoscopic radical prostatectomy at Kayseri City Hospital between May 2018 and January 2021. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) for Windows, version 25.0 (IBM SPSS, Armonk, NY, USA). Seventy patients were included in the study. While 48 patients who underwent perioperative care with the traditional approach were included in the conventional group, 22 patients were included in the ERAS group. Age, comorbidities, preoperative PSA level, digital rectal examination findings, preoperative imaging, extra prostatic spread and lymph node involvement, location of tumors, time between biopsy and surgery, lymphadenectomy status, and histopathological findings of transrectal ultrasound biopsy and prostatectomy specimens were recorded for each patient. Initiation of enteral feeding, time to first defecation, duration of antibiotic use, ileus development rate and length of hospital stay (LOS) were compared for both groups. Results The mean age of 48 patients in the conventional group was 63.37 ± 7.01 years, while the mean age of 22 patients in the ERAS group was 66.36 ± 5.31 years (p = 0.080). Although the first defecation time was shorter in the ERAS group (4.75 ± 3.21 vs. 3.73 ± 2.12 days, p = 0.179), there was no statistically significant difference. Ileus developed in 10 (20.8%) patients in the conventional group and 2 (9.1%) in the ERAS group. Use of antibiotics in the postoperative period in the conventional group (5.83 ± 3.62 vs. 3.18 ± 2.42 days, p = 0.003) and LOS (7.92 ± 3.26 vs. 5.91 ± 2, 15 days, p = 0.011) were statistically significantly longer. Conclusion In summary, ERAS protocol is associated with short LOS, time to initiation of enteral feeding and duration of antibiotics use. There was no statistically significant difference in the rate of ileus and time to first defecation between the two groups. Randomized prospective studies on heterogeneous and larger patient groups are needed to confirm our findings.

Objective: To investigate the effect of ureterorenoscopic stone removal timing on kidney function in unilateral ureteral stones. Materials and Methods: Hundred and eighty-seven patients included in the study were divided into two groups: 98 patients who underwent surgery ≤14 days after the stone diagnosis constituted the Early Surgery Group and 39 patients who were operated >14 days after the stone diagnosis comprised the Late Surgery Group. Preoperative serum levels of creatinine, blood urea nitrogen (BUN), and glomerular filtration rates (GFR) were recorded for the patients in both groups. In the postoperative first month, serum creatinine, BUN, and GFR were again recorded and compared with the preoperative values. Results: The mean preoperative serum creatinine, GFR, and BUN levels in the Early Surgery Group were 1.25 ± 0.65μmol/L, 80.04 ± 33.6ml/min/1.73m2, and 50 ± 16.6mmol/L, respectively. A decrease was observed in serum creatinine (0.82 ± 0.22μmol/L, p< 0.001) and BUN (14.08 ± 7.25mmol/L, p< 0.001) levels one month after surgery, whereas GFR increased (105.33 ± 21.6ml/min/1.73m2, p< 0.001). In the Late Surgery Group, postoperative levels of serum creatinine (0.94 ± 0.33 vs. 0.95 ± 0.30μmol/L, p= 0.102), and BUN (17.38 ± 9 vs. 17.92 ± 8.8mmol/L, p= 0.283), increased minimally, also a minimal decrease was observed in GFR (95.15 ± 27.3 vs. 93.77 ± 24.3ml/min/1.73m2, p= 0.338) without any statistically significant difference. Conclusion: We believe that surgical treatment should be planned within two weeks at the latest, as prolonged obstruction may result in kidney damage.

Aim: In this study, we aimed to demonstrate the effect of mirabegron on ureteral access sheath (UAS) placement during flexible ureterorenoscopy (f-URS).

Objective We aimed to determine the most suitable technique for prostate volume (PV) measurement to decide for the most appropriate surgical approach - endoscopic or open - by establishing the relationship between imaging techniques and the resected tissue weight (RTW). Materials and Methods Sixty men aged 49-95 years with lower urinary tract symptoms, who were scheduled for transurethral resection, were enrolled. The relationship of RTW with PV determined by preoperative abdominal ultrasonography as well as transrectal ultrasonography (TRUS) performed at the table just before surgery, and prostatic urethral length (PUL) measured at the time of cystoscopy was analyzed. Two groups were established with respect to PV, (less than or equal to 75 cc and greater than 75 cc, respectively), and according to PUL (less than or equal to 2.5 cm and longer than 2.5 cm, respectively). Statistical analyses were performed between the groups to identify the best correlation between resected tissue weight and pre-surgical volume determination methods. Results The strongest correlation between RTW and prostatic volume measurements was established for the TRUS measurements (r=0.79; p

Sünnet işleminin süresini kısaltacak ve estetik açıdan daha tatmin edici bir yöntem olmaya aday SMART klemp yöntemini değişik parametrelerle değerlendirmek.GEREÇ VE YÖNTEM: 2010-2013 yılları arasında, yaşları 1-10 arasında değişen toplam 178 çocuk, tek bir üroloji uzmanı tarafından (KÇ) smartklemp kullanılarak sünnet edildi. Ek bir hemostatik yöntem kullanılmadı. Sütür atılmadı. Anestezi sonrası sünnet süresi kaydedildi. Sünnet sonrası 5. Gün tüm çocuklar çağrılarak smartklemp çıkartıldı ve 10. Gün tekrar çağrılarak oluşan komplikasyonlar kaydedildi. Ebeveynlere sünnet sonrası hissettikleri endişe ve estetik açıdan tatmin edici olup olmadığı sorularak kaydedildi.BULGULARAnestezi sonrası sünnet süresi ortalama 6 dk olarak olarak belirlendi. Onbir ( %6,1) çocukta yetersiz sünnet saptanırken tatmin edici düzeyleri kötü olarak değerlendirilen 5 çocuğa klasik dorsal slit yöntemiyle revizyon uygulandı. Yetmiş iki çocukta (%40,5) smartklemp çıkartıldığında, sünnet sonrası kalan mukozal alanda, parafimozisde görülene benzer ödem görüldü ve sünnet sonrası 10. günde çoğu kaybolurken 14 (%7,8) sünnet olgusunda saptanan ödem şiddetli düzeyde idi ve en uzunu 17. günde kayboldu. Sünnet sonrası kontrolde hiçbir olguda kanama ve enfeksiyon saptanmadı. Sünnetlerin tamamında, mukozal alanın, klasik dorsal slit yöntemine kıyasla daha fazla kaldığı dikkat çekti. Ebeveynlerin sünnet sonrası duydukları kaygı düzeylerinin oranları %10,6 hiç, % 31,4 az, %43,8 orta, % 14,04 yüksek düzeyde idi. Estetik sonucun tatmin düzeyleri ise %8,42 kötü, % 5,05 orta, %44,38 iyi ve % 42,13 çok iyi olarak belirlendi.SONUÇ: Sünnet işleminden genel memnuniyet düzeyi iyi olmakla birlikte, tek bir teknik altında standardize etmek için daha fazla çalışmalara ihtiyaç vardır., AIM: To evaluate the Smart Clemp method which is a candidate for more satisfaction cosmetics results and shorthening the circumcision duration. METHODS: A total of 178 children with the ages ranging between 1–10 were circumcised by single urologist between 2010–2013. Accessory hemostatic method was not used. No sutures were preferred. The duration of the circumcision was recorded after anesthesia. All the patients were called on postoperative 5th day for removing the Smart Clemp and on 10th day they were called again for recording the complications. The anxiety and satisfacion degree for cosmetics results were asked and recorded. RESULTS: Average operation time was 6 minutes. Inadequate circumcision was observed in 11 children and 5 of them whose satisfaction degrees were bad were revised by using dorsal sleet method. Paraphymosis like oedamatous formation was observed in 72 children after removal of the Smart Clemp and albeit most of them disappeared on postoperative 10th day, 14 cases suffered from serious oedama and the longest duration was 17 days for disappearing. No infection or bleeding was recorded at the postoperative control. Mucosa was observed much more, when compared with dorsal sleet method. The anxiety of the parents was non in 10.6%, few in 31.4%, moderate in 43.8% and high in 14.04%. The parental satisfaction rates of cosmetics were bad in 8.42%, moderate in 5.05%, good in 44.38%, and very good in 42.13%. CONCLUSION: Average parental satisfaction degree was beter than classical circumcision; but more studies are required for standartization

Objective Transrectal ultrasound-guided prostate biopsy (TRUS-Bx) is a standard diagnostic modality for detecting prostate cancer (PCa). Pain during biopsy is the most important problem that still needs a solution. The purpose of this study was to compare 3 pain control techniques and to investigate the relationship between the level of pain and histopathological findings. Materials and Methods 139 patients underwent prostate biopsy utilizing 3 analgesic techniques; 1- using lidocain gel (group 1), 2- pethidine+diazepam (group 2) and 3- periprostatic nerve block (group 3). Pain level, the tolerability and repetition of the procedure were questioned. The pathological findings were recorded. Results There was a statistically significant difference between group 1 and the others with regard to tolerability and repeating the procedure. The pain score during biopsy in group 1 was greater than in the other groups and those in group 2 was higher than in group 3. The mean pain score during probe insertion in group 2 was lower than in groups 1 and 3. The mean pain score taken during the biopsy was higher than that during probe insertion in group 2. However, the mean pain score during probeinsertion in group 3 was not different from that in group 1. There was no significant difference in pathological results between group 1 and groups 2 and 3. Pain scores in patients with chronic prostatitis were statistically higher than those in patients with benign prostatic hyperplasia (BPH) and Pca in groups 2 and 3 (p

Objectives To investigate the effect of furosemide given before shock wave lithotripsy (SWL) in patients with renal stones. Methods Two-hundred patients with renal stones measuring 6–20 mm in diameter were prospectively included in this study. The treatment group (n=100 patients) received 40 mg furosemide 30 min before SWL plus 1000 mL 0.9% sodium chloride, infused during the procedure. Standard SWL alone was used for the control group (n=100 patients). The effectiveness of SWL was compared between the two groups. Results No statistically significant difference was found between the groups in age, stone size, Hounsfield units, urinary pH, stone density, average number of sessions, average number of pulses or mean energy used. The stone-free rate was 69% in the control group and 71% in the treatment group (p=0.758). Conclusions Although it is an easy and safe application, no positive effects of furosemide and hydration were found.

Aims: To investigate whether air in the kidney or bladder is only associated with gas - forming infection, or whether it can be observed after endoscopic interventions including ureteral and cystoscopic. If this is the case, what are the parameters that affect the amount of air in the urinary tract? Study Design: A prospective case series study. Place and Duration of Study: Sample: Department of Urology, Kafkas University Faculty of Medicine, between 2013 and 20 14. Methodology: One hundred and forty patients who underwent any kind of ureteral intervention including flexible ureteroscopic lithotripsy (FURS - L), semi - rigid ureteroscopic lithotripsy (URS - L), double J stenting alone (JJS), URS - L + JJS, and FURS - L + JJ S due to urinary system stones were enrolled. Computed tomography without contrast substance was performed 6 hours after ureteral intervention in order to determine whether there was any air in the urinary tract. Two groups were

Yard. Doc. Dr. Mert Ali Karadag, Kafk as Universitesi Tip Fakultesi, Uroloji Anabilim Dali, Kars, Turkiye, Tel. 532 558 43 24 Email. karadagmert@yahoo.com Gelis Tarihi: 13.03.2014 • Kabul Tarihi: 03.02.2015 ABSTRACT The destiny of prostate cancer patients has been dramatically changed since the introduction of prostate specifi c antigen (PSA) into clinical use in late 1980s. Currently more men are diagnosed with localized, small, less aggressive and non-lethal prostatic carcinoma. Besides radical prostatectomy, cryosurgical ablation of the prostate, brachytherapy and high-intensity focused ultrasound have been accepted as alternative treatment options in clinically localized prostatic carcinoma. In this review, we aimed to evaluate the success and complication rates of alternative focal treatment options as the primary outcome. The secondary outcome of this review was to defi ne the candidate patients eligible for these procedures. We searched the Medline using specifi ed expressions including “focal treatment alternatives of prostatic carcinoma”, “high-intensity focused ultrasound and cryosurgery of prostatic carcinoma” and “radiofrequency ablation of prostatic carcinoma”. A total of 1173 papers related to the focal treatment options were analyzed and only 45 of them related to the subject were included. There wasn’t a controlled trial dealing with the topic. American Urologic Association guidelines have accepted cryosurgical ablation of the prostate as a therapeutic option; however the high-intensity focused ultrasound is still considered as an experimental treatment option, although it has been developed as a minimally invasive procedure with reduced morbidity and potentially with the same therapeutic effi cacy in comparison with the surgical or non surgical options. For patients meeting the variable criteria for regular follow up visits without intervention but experiencing anxiety with the feeling of losing active treatment options, focal therapies may be ideal alternatives. However, focal therapy options should be spared for patients with low to moderate risks. The radiologic and clinical stages should be below T2b and T2a, respectively. In addition, all candidates should be informed that the alternatives are considered as experimental and they may need an alternative treatment option in time. Focal therapy alternatives may be more realistic treatment options in the near future; however, well designed multicenter prospective randomized trials are required to provide evidence based data.

Percutaneous nephrolithotomy (PCNL) has been widely accepted and is commonly used to treat renal calculi. The optimal drainage of kidney after PCNL has not been clearly determined yet. Placement of an 18F to 24F nephrostomy tube at the end of the procedure is accepted as standard of care to date. The main advantages are adequate renal drainage, hemostatic tamponade and providing renal access for second look PCNL. However, based on the concept that the purpose of the tube is only to maintain adequate drainage of the kidney, a “tubeless” approach has been developed by placing a ureteral stent or catheter to provide drainage after PCNL instead of a nephrostomy tube. Tubeless PCNL is an effective and safe procedure for treatment of renal stones in selected cases. This procedure can even be chosen for patients with previous renal surgery, and hemorrhagic tendency. By using this method, less postoperative pain and a shorter hospital stay can be achieved, when compared with conventional PCNL. There is a controversy over ideal drainage system after PCNL in recent years. Herein, we made a systematic review for efficacy and safety of tubeless PCNL, totally tubeless PCNL, discussed different variations and compared the outcomes of this technique with standart PCNL.

Objective: To evaluate the efficacy and outcomes of PlasmaKinetic™ urethrotomy against cold knife direct vision internal urethrotomy in terms of recurrence rates. Patients and Methods: A total of 136 male patients with urethral strictures were enrolled into the study. The patients were allocated to cold knife or PlasmaKinetic urethrotomy groups sequentially by using computer-generated numbers. Group A (PlasmaKinetic) and group B (cold knife) included 70 and 66 patients, respectively. All patients were reevaluated at the 3rd, 9th and 18th month postoperatively with uroflowmetry. Results: Group A patients had a postoperative 3rd-month maximum flow rate value of 16.09 ml/s, whereas this same parameter was 15.15 ml/s in group B (p < 0.05). The urethral stricture recurrence rate up to the 9-month period was statistically significant for group A (14%) compared with group B (30%). When we compared the recurrence rates of these groups from postoperative day 1 up to the 18th month, the results were 37% for group A and 33% for group B (p > 0.05). Conclusion: PlasmaKinetic urethrotomy provides a better recurrence-free rate during the early period compared with conventional cold knife therapy. Nevertheless, the outcome of the stricture did not change and fibrotic tissue reformed between the 9th and the 18th month.

Background/objective: Acne vulgaris is one of the most common diseases of the youth. Systemic isotretinoin is the only drug which acts on all of the etiopathogenic mechanisms of acne. Isotretinoin has some well-known side effects. Besides these, there is a suspicion whether it causes infertility or not. In this study, we aimed to evaluate the effects of systemic isotretinoin on male fertility.Methods: Eighty one male patients, who were older than 18 years of age, and had severe or refractory acne vulgaris were included in the study. They were given a total dose of 120 mg/kg of systemic isotretinoin over a period of six months. Before and after the study, the spermiogram parameters of the patients were evaluated to show any possible effect on male fertility. The patients' total testosterone, follicle stimulating hormone and luteinizing hormone levels were also evaluated.Results: All of the spermiogram parameters changed positively (p

The objective of this study was to audit the costs of retrograde intrarenal surgery (RIRS) and micropercutaneous nephrolithotomy (microperc) and compare them in terms of cost-effectiveness. We performed a retrospective analysis of 63 patients who underwent microperc and 48 patients who underwent RIRS. The cases, performed between first use and first repair, were used for this initial study. The costs associated with performing RIRS and microperc, including the costs of devices, disposables, hospitalization, and additional required treatments, were audited. The main perioperative and postoperative parameters were collected, including operation time, JJ stent requirements, used disposables, stone-free rates, and complications. Statistical analyses of the means of continuous variables were performed using Student’s t test and the Mann–Whitney U test. Categorical variables were analyzed using Chi-squared tests. The mean cost of RIRS was $917.13 ± 73.62 and the mean cost of microperc was $831.58 ± 79.51; this difference was statistically significant (p < 0.001). The mean operation time of the RIRS group was significantly shorter than the microperc group (55.62 ± 19.62 min and 98.50 ± 29.64 min, respectively, p < 0.001). The assessment of required additional treatment showed that it was significantly higher in the RIRS group than the microperc group (p = 0.02). The stone-free rate for RIRS was 66.6 and 80.9 % for microperc; this difference was not statistically significant (p = 0.12). In our series, the use of microperc is less expensive than RIRS due to additional required treatments and ancillary equipment in RIRS. RIRS is more effective than microperc in terms of operation time and more effective use of operation rooms.

We evaluated the association between the mean platelet volume (MPV) and monocyte/lymphocyte ratio (MLR) with brucella-caused epididymo-orchitis to determine if they could be used to differentiate between brucella and non-brucella epididymo-orchitis. The charts of 88 patients with non-brucella and 14 patients with brucella epididymo-orchitis were retrospectively reviewed. Brucellosis was diagnosed by isolating Brucella spp from a blood culture or from a serum agglutination titer ≥ 1:160 along with accompanying clinical findings. The patients with brucella epididymo-orchitis were significantly more likely to have a lower MPV and a higher MLR than those with non-brucella epididymo-orchitis. Using a MPV cut-off level of less than 9.25 fl to differentiate brucella from non-brucella epididymo-orchitis gives a sensitivity of 78.6%, a specifity of 78.4%, a positive predictive value of 36.7% and a negative predictive value of 95.8%. Using a MLR cut-off level of greater than 0.265 to differentiate brucella from non-brucella epididymo-orchitis gives a sensitivity of 71.4%, a specifity of 65.9%, a positive predictive value of 25% and a negative predictive value of 93.5.%. MPV and MLR values may assist in differentiating between brucella and non-brucella epididymo-orchitis.

Objective: Androgen deprivation therapy (ADT) is commonly used as a first-line treatment for locally advanced and metastatic prostatic cancer (Pca). There is no consensus about which alternative treatment should be used after the failure of initial ADT. We aimed to investigate the effect of changes in treatment on PSA and testosterone levels. Material and methods: A total of 120 patients with an established diagnosis of either locally advanced or metastatic Pca in two different centers. Depending on the type of medical and/or surgical management protocol planned at initial presentation, all cases were divided into three main groups as follows. Group 1 (n: 80) included the patients who underwent medical management during whole follow-up period in whom the initial management protocol was later on switched to another medical treatment with different agents, Group 2 (n: 20) included patients who were initially treated with a medical management protocol and switched to surgical castration during follow-up evaluation and lastly Group 3 (n: 20) included the patients undergoing treated surgical castration as initial treatment modality without any further medical management protocol. Results: Evaluation of our data did clearly demonstrate a statistically significant difference between the initial and final PSA as well as testosterone levels in Group 1 cases. Mean PSA and testosterone levels increased significantly in these cases despite a change in hormonal therapy by using another agent for androgen deprivation. Cases in Group 2 and 3 cases did not show any statistically significant difference with respect to the mean PSA as well as testosterone values during the same follow-up period. Conclusions: Our data clearly indicated that in case of a biochemical progression, switching into another alternative medical treatment was not effective enough in limiting the rising PSA levels in a statistically significant manner when compared with the approaches of switching to surgical castration after initial medical treatment or continuing with regular and close follow-up after initial surgical castration alone.

Stricture formation and obstruction are rare but significant complications after ureteroscopy (URS), and there are controversial studies regarding follow-up. Our study sought to determine the appropriate follow-up for patients without complications.A total of 323 patients were treated with URS for removal of ureteric stones, and their charts were retrospectively reviewed. A semirigid ureteroscope was used in all patients, and stone disintegration was accomplished with a pneumatic lithotriptor. Postoperative evaluation included plain abdominal radiograph of the kidneys, ureters, and bladder (KUB) on day 1, intravenous urography (IVU) and/or ultrasonography at postoperative month 3 and annually thereafter in all patients. A KUB radiograph was also obtained on postoperative day (POD) 10 in patients with residual fragments.Complete records of 268 patients were available. The overall success rate was 95.5%. The KUB radiograph on POD 1 revealed complete stone removal in 217 (80.9%) patients, while residual fragments were seen in 40 (14.9%) patients, who were reevaluated on POD 10. Evaluation on POD 10 showed residual fragments in 15 patients, and URS was again performed in eight patients. Perioperative minor complications were observed in 18 (6.7%) patients. IVU performed in the third postoperative month showed stricture formation in two (0.7%) patients and silent obstruction in one (0.3%). No stricture formation was observed in asymptomatic patients after uncomplicated complete stone removal. After a mean follow-up of 27.4 +/- 13.7 (range 12-58) months, annual radiologic studies did not show any additional complications.Our results indicate that radiologic surveillance for stricture formation and obstruction is not mandatory after complete stone removal with uncomplicated URS.

Objectives A classification (modified Clavien system) has been proposed to grade perioperative complications. We reviewed our experience with percutaneous nephrolithotomy (PNL), grading the complications according to this new classification. Methods A total of 811 PNLs were performed between 2003 and 2006, and charts were retrospectively reviewed focusing on complications observed. According to the modified Clavien classification system, perioperative complications were stratified into five grades. Grade 1 defined all events that, if left untreated, would have a spontaneous resolution or needed a simple bedside intervention. Grade 2 complications required specific medication, including antibiotics and blood transfusion. Grade 3 complications necessitated surgical, endoscopic, or radiologic intervention (3a without general anesthesia, 3b under general anesthesia). Neighboring organ injuries and organ failures were classified as grade 4, and death was considered a grade 5 complication. Kidney stones treated with PNL were also classified as simple and complex and complication rates were compared. Results A total of 255 perioperative complications were observed in 237 (29.2%) patients. There were 33 grade 1 (4%), 132 grade 2 (16.3%), 54 grade 3a (6.6%), 23 grade 3b (2.8%), 9 grade 4a (1.1%), and 3 grade 4b (0.3%) complications, and 1 death (0.1%). Most complications were related to bleeding and urine leakage. Grade 2 and 3a complications were significantly more common in patients with complex renal stones. Conclusions A graded classification scheme for reporting the complications of PNL may be useful for monitoring and reporting outcomes. However, minor modifications concerning auxiliary treatments are needed and further studies are awaited.

Metabolic syndrome is a cluster of cardiovascular disease risk factors. We assessed the impact of these medical disorders on the outcome of percutaneous nephrolithotomy (PCNL).Data from 430 consecutive PCNL procedures were retrospectively reviewed. The presence of serum lipid abnormalities (SLA), hypertension (HT), diabetes (DM), and obesity was investigated. Patients were determined to have the metabolic syndrome according to the definition of the International Diabetes Federation. Success rate, need for auxiliary procedures, and major complication rates of PCNL were analyzed separately for patients with or without DM, SLA, HT, obesity, and the metabolic syndrome, and were compared.SLA, HT, and DM were observed in 123 (28.6%), 108 (25.1%), and 44 (10.2%) patients, respectively. Body mass index was30 kg/m2 in 74 (17.2%) patients. Metabolic syndrome was diagnosed in 41 (9.5%) patients. An overall success rate of 96.3% for PCNL was achieved. Success rates were not significantly (P0.05) influenced by the presence of SLA, HT, DM, obesity, or the metabolic syndrome. Major complications were encountered in 49 (11.4%) patients and were 2.5 to 2.7 times more common in patients with DM, HT, and the metabolic syndrome. In patients with DM, auxiliary treatment alternatives were necessary in 20.5%, while they were indicated in 10.9% of patients without DM (P = 0.046). Presence of the metabolic syndrome was also associated with an increased necessity for auxiliary treatments after PCNL (P = 0.048).Our results indicate that the metabolic syndrome and its components (DM and HT) significantly augment auxiliary treatment and complication rates after PCNL.

Subcutaneous emphysema is a very rare and good-natured complication after transurethral resection of prostate (TURP). It has been reported as colon perforation, diverticulitis, and bladder perforation associated complication previously. We report the first case of a wide subcutaneous emphysema due to microperforations of prostatic capsule, without a bladder perforation after TURP. Any sign of clinic situation should lead to ceasing of the procedure immediately; otherwise, it can cause a life-threatening problem of abdominal compartment syndrome.

To determine the effects of two different radiation doses on sperm parameters and the role of testosterone treatment on rat spermatogenesis.The experimental animal study was conducted at Marmara University, Istanbul, Turkey, from September 2012 to January 2013. Male Sprague Dawley 4-6 months old rats weighing 300-350g were randomely divided into 5 equal groups as control, low dose irradiation, testosterone administration following low dose irradiation, high dose irradiation, and testosterone administration following high dose irradiation. The animals were kept at a constant temperature in a room with 12h light and dark cycles. After the group-wise intervention, sperm concentration, testicular size, and histopathological examination of seminiferous tubules were noted. SPSS 10 was used for statistical analysis.The 40 rats in the study were divided in 5 groups of 8(20%) each. In low dose radiation, adverse effects were only temporarily observed with the return of almost normal testicular function at the end of two months with or without testosterone supplementation. In contrast, in high dose radiation, hormonal treatment effect was controversial.Testosterone treatment had no significant effect upon recovery after irradiation. In order to prevent the untoward effects of radiation, shielding of the remaining testis in a proper manner is crucial to avoid the harmful effects of the scattered radiation.

Gastrointestinal injuries that occur during or after laparoscopic and robot-assisted surgery are serious side effects that affect patient outcome. In this review, we attempt to highlight the identification, incidence and management of gastrointestinal and visceral complications of laparoscopic and robot-assisted surgery. A search of Medline and PubMed databases was performed using the following terms: gastrointestinal complications of laparoscopy, laparoscopic, kidney and robotic surgery. A total of 1,072 papers related to the subject were analyzed. Forty-six of these papers were included in the present review. These papers reported high numbers of participants and had a high level of evidence. Gastrointestinal complications during laparoscopic and robot-assisted surgery are rare, but similar, and can occur at any time between access and closure. Despite their infrequency, these complications can result in mortality. The early recognition and management of gastrointestinal complications is very important. Unrecognized or delayed identification of gastrointestinal complications may cause sepsis and death.

Non-obstructive azoospermia (NOA) is characterised by absence of sperm in the ejaculate. Significant relationship between the pattern of the testis histopathology of NOA and successful sperm retrieval rate is well known. In this study, we assess efficacy of testicular histopathology on sperm retrieval rates and intracytoplasmic sperm injection results after microdissection testicular sperm extraction in cases of non-obstructive azoospermia. It is a retrospective analysis of 111 NOA patients who have histopathological confirmation. According to histopathological findings, the patients were divided into three groups: Sertoli-cell-only syndrome (SCOS), maturation arrest (MA) and hypospermatogenesis. Sperm retrieval rate was significantly higher in hypospermatogenesis group compared with that in SCOS and MA groups. In terms of fertilisation and clinical pregnancy rates, there was no significant difference between the groups. As a result, compared with MA and SCOS, hypospermatogenesis has higher sperm retrieval rates. Our study revealed that once successful sperm retrieval is achieved, fertilisation and clinical pregnancy rates are similar in NOA patients.

Introduction: In this study, we describe a new approach called the double-layer on and prepucial flap technique in order to prevent fistula or fissure development. Material and Method: Twenty-seven patients with subcoronal hypospadias were enrolled. The prepared prepucial flap was divided into two equal parts. A double-layer flap was formed and used for reinforcing of the neourethra. Uroflowmetric analysis was used for evaluating the urethral stricture at the end of the first year. A blinded urologist and the patients' themselves evaluated the aesthetic appearance. Results: The mean age was 12.17 ± 2.79. All cases were primary. All evaluated parameters were at the end of the first year. Only three (3/27, 11.1%) of the patients had minimal external mea stricture that managed with urethral dilatation. None of them had any fistula, fissure, or dehiscence as well as infection and hematoma. The mean Qmax value was 17 ml/s and the Qave value was 9 ml/s. The mean scores with standard deviations with regard to the appearance of the patients' penis before and after operations were 3.08 ± 0.77 and 8.25 ± 0.73, respectively and this difference was statistically significant (p < 0.001). Conclusion: The double-layer dartos flap technique is a candidate to be the least risky technique to prevent complications as well as to increase the aesthetic appearance up to satisfactory levels.

Introduction: We investigated the monopolar and bipolar energy effects on prostate and correlated the results with the type of pathology, thus determining the relationship between tissue damage and the PSA level. Material and Methods: One hundred and twenty four patients underwent TURP and according to the energy source, 2 groups were designed as monopolar (Group 1) and bipolar energy (Group 2). Hemoglobin and free and total PSA were measured preoperatively and 6 hours postoperatively, and differences were calculated. The weight of resected tissue and operation time were also recorded. Two groups were also formed later according to the pathology as chronic prostatitis (CP) and BPH. The findings were analyzed. Results: There were no statistical differences between the groups in terms of age; prostate volumes; resected tissue; operation times; pre- and postoperative Hb, total-free PSA, IPSS, PVR, and quality of life scores; or postoperative maximum flow rates. Changes in total-free PSA (25.7 and 10.8 ng/dl for PSA; 13.2 and 5.76 ng/dl for free PSA for Groups 1 and 2, respectively) were significantly different between Groups 1 and 2. There was a statistical difference in total PSA between the groups among CP patients (28.18 and 11.73 ng/dl for Groups 1 and 2, respectively). But no statistical difference existed among BPH patients. The change in Hb differed based on pathological results. Conclusion: Bipolar TURP is less invasive than monopolar TURP on the basis of postoperative PSA levels. In addition, bleeding during TURP is affected not by the kind of energy, but by the pathology.

Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) is a chronic pain condition and a com­mon problem in urology clinics. Although many different etiologies and mechanisms exist, the exact cause of the disease has been unknown. Central sensitization (CS) is defined as an augmentation of responsiveness of central cortical neurons to input from peripheral nociceptive structures. Somato-sensory evoked potentials (SEPs) is an electroneurophysiological method to assess cortical activity in somatosensory area of brain related to sensorial stimuli. We aimed to determine the presence of CS using the SEPs of dorsal penile nerve stimulation in patients with CP/CPPS.Seventeen male patients diagnosed CP/CPPS and 17 male healthy controls were pro­spectively included in the study. For SEP study, electrical stimulus was applied with penile ring electrodes. Re­cording electrodes were placed as active to Cz' and reference electrode on Fz' according to the 10-20 Interna­tional System. Latency of N50 was defined as the second negative (up-ward) deflection of the W-shaped averaged cortical waveform.N50 latencies were significantly shortened in the patient group compared to the healthy controls (P.001).These results support the presence of central sensitization because of exaggerated trans-mission of pain sensation to the somatosensory cortex. Therefore, normalization of transmission might be an important step in treatment of pain in patients with CP/CPPS. This study can be counted as an important guiding on pathogenesis and treatment of disease.

Introduction: We prospectively analyzed parental anxiety and outcomes of the SmartClamp circumcision and the classic surgical dissection technique.Methods: A total of 250 boys underwent circumcision between 2009 and 2012 at Kars State Hospital and Kafkas University Faculty of Medicine in Turkey. The initial 125 children were circumcised by conventional dissection method and the remaining children were operated on with a SmartClamp device. Children in both groups were compared in terms of bleeding, infection, penile edema, operative time, cosmetic result, length of the inner mucosal layer, and parental anxiety. We used a State-Trait Anxiety Inventory (STAI) form to gauge how the circumcision affected parental anxiety. This form was completed by parents on postoperative day 2.Results: There were no statistically significant differences among the 2 groups in terms of age, bleeding, infection, and cosmetic displeasure (p > 0.05). The STAI scores of the parents from the SmartClamp group were statistically higher than that of the other group (p < 0.001). Penile edema was more common in the SmartClamp group (p = 0.039). However, the mean operative time was statistically shorter (p < 0.001) and the inner mucosal length was significantly longer in the SmartClamp group (p < 0.001).Conclusion: Circumcision with the SmartClamp device was faster. Cosmetic results and complication rates were similar. Unfortunately, this technique seemed to entail the disadvantages of longer mucosal length, penile edema, and higher parental anxiety. Urologists should keep these points in mind when choosing a technique.

INTRODUCTION: Extracorporeal Shock Wave Lithotripsy (ESWL) remains the preferred least invasive treatment for urinary tract stones. The main purpose of this study was to compare two treatment modalities for pain control during the ESWL procedure. MATERIAL AND METHODS: From 2013 to 2014, 220 patients received ESWL for kidney stones. Before the procedure, the weight and height were measured to determine the body mass index (BMI); in addition, oxygen saturation and the pulse of the patients, as well as pain level were determined. The pain control provided included two different methods: diclofenac sodium plus hyoscine-N-butyl bromide in the first group and pethidine plus diazepam in the second group. The pain level of the patients was determined using two different scales: the Wong-Baker and the Visual Analogue scales (VAS). At the end of three sessions, all patients were evaluated for the stone fragmentation rate by plain abdominal X-ray, and the findings were recorded and analyzed. RESULTS: A total of 220 patients were enrolled in this study. There were 91 patients in the first group (diclofenac sodium + hyoscine-N-butyl bromide) (male/female: 63/28) and 129 (male/female: 83/46) patients in the second group (pethidine HCL +diazepam). The mean age with SD according to each group was 42.03 (±16.43) and 42.56 (±14.23), respectively (p = 0.8). With regard to pain scores (using the Wong-Baker and VAS scales), the responses were significantly lower in the second group (p

Aim: Improvements in extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy have almost eradicated the need for open surgery in ureteral stones. The aim of this study was to assess characteristics of patients who underwent open ureterolithotomy. Methods: During a 5-year period, a total of 654 patients with ureteral stones were treated. Initial management consisted of ureteroscopy in 524 patients, ESWL in 62 patients and percutaneous nephrolithotomy (PCNL) in 12 patients. Open surgery was performed in 56 patients. Stone location, size and success rates were retrospectively analyzed. Results: Ureteroscopy resulted in successful stone removal in 94%, 98% and 98.5% of proximal, mid and distal ureteral stones, respectively. A total of 14 patients with ureteroscopy failure were referred for open surgery. ESWL treatment resulted in success in 55 patients (88%), and those with ESWL failure were referred for either ureteroscopy (n = 3) or open surgery (n = 4). Open surgery was performed in a total of 56 patients, 38 of whom had been referred from other centers. Stone location was proximal ureter in 25 (44.6%) patients (stone size: 2–12 cm2), mid ureter in five (8.9%) patients (stone size: 2–6 cm2) and distal ureter in 26 (46.4%) patients (stone size: 4–9 cm2). A history of previous unsuccessful endourological procedure was observed in 33 (58%) of 56 patients. Children under age 16 (range 1–15 years) comprised 17.8% of patients undergoing open surgery. Conclusion: Open surgery, which is nowadays being replaced with laparoscopic techniques, is generally indicated for failed endourological procedures (58%), particularly in centers that do not have flexible ureteroscopy or laser lithotriptor, and in patients with larger stones (>3 cm). Children (17.8%) are also candidates for open surgery, if specifically designed endourological equipment is not available.

The first-line management of metastatic prostate cancer is hormonal therapy. However, resistance to this treatment will emerge within an average of 24 months. Our purpose was to determine the course of metastatic prostate cancer under treatment. A total of 56 patients who were diagnosed with metastatic prostate cancer were enrolled. As initial management, 3 kinds of hormonal therapy consisting of bilateral orchiectomy (BSO) alone, BSO + anti-androgene (AA) and LH-RH + AA were applied. The patients were followed until the emergence of hormone resistance. Serum PSA levels at the time of first diagnosis, post-treatment nadir PSA levels, time to nadir PSA, time to hormonal resistance and PSA levels at hormonal resistance were assessed, retrospectively. The localization and number of metastases and the survival term from the beginning of the emergence of hormone resistance until death were investigated No significant differences could be established between the groups. The mean time to reach hormone refractory status was 30.3 months for the whole study group. The average term of survival was 42.7 months for the whole group. Distance metastases were found in 8 patients during follow-up. There were no statistical differences between the groups in terms of treatment modalities applied for metastatic prostate cancer. Patients with androgen independent prostate cancer demonstrated progression despite chemical or surgical castration, and had poor prognosis. Initial hormonal therapy failed after an average of 2 years in metastatic prostate cancer. Electronic supplementary material The online version of this article (doi:10.1186/2193-1801-3-725) contains supplementary material, which is available to authorized users.

Introduction Endometriosis can be defined as the presence of endometrial glandular and stromal tissue outside the uterus. Affected sites of endometriosis can even be the urinary tract. Here, we present the case of a 30-year-old woman with right ureteral endometriosis. This case was important due to the unusual localization and no signs of the disease except for hydroureteronephrosis. Case presentation A 30-year-old Caucasian woman with para 2 was admitted to our department for right side flank pain, dysuria and suprapubic pain. She had no complaints of vaginal discharge, bleeding or painful menstruation. Her menstrual cycles were normal and lasting for three to four days. She did not have a history of any surgical interventions. A physical examination revealed a right side costovertebral angle and suprapubic tenderness. Laboratory test results including a complete blood count, serum biochemical analysis, urine analysis and urine culture were normal. Urinary ultrasonography showed right side hydroureteronephrosis with renal cortical thinning. We suspected a right ureteral stone obstructing the ureter and a computed tomography scan was performed. The computed tomography scan revealed similar right side hydroureteronephrosis with obstruction of the ureter. No signs of stone were observed on the scan. Retrograde pyelography and diagnostic ureterorenoscopy were performed and they showed a focal stricture with a length of approximately 3cm at the distal ureteral part and secondary hydroureteronephrosis. Open partial ureterectomy and ureteroneocystostomy with Boari flap were performed. The pathologic specimen of her ureter demonstrated intrinsic endometriosis of the right ureter with endometrial glandular cells and stromal tissue. Conclusions Clinicians should suspect ureteral endometriosis in premenopausal women with unilateral or bilateral distal ureteral obstruction of uncertain cause. The main goals of the treatment should be preservation of renal function, relief of obstruction and prevention of recurrence.

Background and objectives The search for the perfect suture is going on and has resulted in the introduction of many different suture types into the market. The purpose of this study is to investigate the holding strength (HS) of different sutures in the renal parenchyma in an experimental study on pig kidneys. Methods The HS that caused sliding of the suture was investigated in 5 adult porcine kidneys with 7 suture variants. HS-caused tearing of the kidney was investigated with 3 suture types on 5 kidneys. The third investigation, performed on 5 porcine kidneys, was a comparison between 2-0 Vicryl sutures with a Hem-o-lok clip and 2-0 V-Loc sutures with 1 knot. The Friedman test was used to compare the groups. Post hoc analysis was performed with the Wilcoxon signed ranks test (Bonferroni corrected). Results For HS causing sliding of the suture, the mean HSs of the tested sutures were as follows: 2-0 Vicryl with 1 Hem-o-lok clip, 3.26 ± 0.55 N; 2-0 Vicryl with 2 Hem-o-lok clips, 4.1 ± 0.46 N; 2-0 V-Loc, 2.52 ± 0.63 N; 4-0 V-Loc, 1.62 ± 0.17 N; 0 Quill, 0.48 ± 0.16 N; 2-0 Vicryl with 1 Hem-o-lok clip (halfway), 3.62 ± 0.66 N; and 2-0 V-Loc (halfway), 1.02 ± 0.40 N. For HS causing tearing of the kidney, the mean value of 2-way 2-0 Vicryl (Hem-o-lok in the middle) was 13.28 ± 1.38 N, 2-0 2-way Vicryl (Hem-o-lok at the end) was 5.86 ± 0.75 N, and 2-way 2-0 V-Loc was 3.98 ± 1.60 N. For the third group, the difference between the 2 suture variants was not statistically significant. Conclusion Our study revealed that 2-0 Vicryl (polyglactin 910) sutures with 2 Hem-o-lok clips had the maximum HS in renal parenchyma when compared with other sutures.

Introduction: We evaluate the efficacy and outcomes of plasmakinetic vaporization (PKVP) and plasmakinetic resection (PKR) to treat benign prostatic hyperplasia (BPH).Methods: A total of 183 patients with BPH underwent plasmakinetic prostatic surgery between 2008 and 2012 at Kars State Hospital and Kafkas University Faculty of Medicine, Turkey. After clinical and preoperative evaluation, the patients were randomized to PKRP or PKVP groups sequentially by using computer-generated numbers. Group 1 included 96 patients treated with PKR. Group 2 included 87 patients treated with PKVP. Patients in both groups were compared in terms of hemoglobin drop, operation time, catheter duration, reobstruction, incontinence and recatheterization.Results: When we compared the maximum flow rates (Qmax values) at the 12th month, there was no statistical difference between 2 groups. Group 1 had a mean Qmax value of 17.92 ± 3.819 and Group 2 had a 18.15 ± 3.832 value (p > 0.05). There was a statistical difference between the groups in terms of hemoglobin drop, catheter duration and operation time. The mean catheter duration in Group 1 was 3.74 ± 1.049 days, and in Group 2 it was 2.64 ± 0.849 days (p < 0.05). Operation time was statistically longer in Group 2 (PKVP) and hemoglobin drop was statistically higher in Group 1 (PKR).Conclusion: PKVP for BPH is safe and effective. When compared with PKRP, it provides a significantly shorter catheter duration and less bleeding due to hemostasis control with similar IPSS and Qmax improvements after 1 year.

To evaluate the efficacy of cystoscopy, computed tomography (CT), transcavitary ultrasound (TCUS) and cytology, separately and in combination, for the diagnosis and evaluation of superficial bladder cancer. Initial cystoscopy and wash-out cytology were performed for 1548 patients. Of these, 206 with proven bladder tumors were included in this prospective study. CT and TCUS were performed for patients with bladder tumors without knowledge of their cystoscopy results. The lesions were classified as low- (pTa) and high- (pT1) risk superficial tumors according to multiplicity and size. Patients were divided into three categories according to their cystoscopically evaluated tumor size: ≤1 cm (88 patients, 42.7%), 1–3 cm (51 patients, 24.8%) and ≥3 cm (67 patients, 32.5%). TCUS identified 46 (22.3%) high-risk patients with/without invasion and 160 (77.7%) low-risk patients with no invasion. Overall, the sensitivity, specificity, positive predictive value and negative predictive value of TCUS for tumor detection were 77.4%, 60%, 94.7% and 22.2%, respectively. Cystoscopy remains the most widely used technique for the diagnosis of bladder cancer. The combined use of CT, TCUS and cytology detected 72% of cystoscopically proven tumors. Among the three, TCUS findings exhibited the strongest correlation with cystoscopy findings.

To audit the cost of laser versus pneumatic semirigid ureteroscopic lithotripsy and to analyze their relative initial outcomes and cost.Hundred and eighty-seven patients who underwent semirigid ureteroscopic lithotripsy were analyzed retrospectively in terms of age and sex of the patients; location and size of the stones; the type of probe and ancillary equipment such as guide wire, basket catheter, JJ stent requirements; irrigation amount; operation time; the cost of the anesthesia and further treatments such as a JJ stent removal operation and shock wave lithotripsy requirements and their costs. Two groups were formed based on this type of lithotripters, pneumatic and laser lithotripsy.Operation times (min.) in terms of the stone size, for stones100 and100 mm(2) were 20.75 ± 10.78 and 25.82 ± 14.23, respectively (p = 0.007). Operation times for the pneumatic and laser groups were 33.05 ± 11.36 and 15.25 ± 6.14, respectively (p0.05).The stone-free rates for pneumatic and laser groups were 89.6 % (n = 69) and 98.2 % (n = 108), respectively (p = 0.01). The mean cost of the operations for each of the study groups was 261.5 ± 66.13 and 311.7 ± 51.97 US$, respectively (p = 0.001). The mean cost in terms of the stone size, for stones100 and100 mm(2), was 272.86 ± 53.05 and 323.71 ± 66.88 US$, respectively (p = 0.01).It seems that usage of laser lithotripsy (LL) in patients with ureteral stones is more effective than pneumatic lithotripsy (PL) in terms of operation time and SF rate. On the other hand, the mean cost of LL seems to be more expensive than PL. Urologists should think these parameters before the choice of these two treatment modalities. The higher the effectiveness, the greater the cost.

To investigate and compare the stone clearence and complication rates of flexible ureteroscopy (URS) with semirigid URS in patients having proximal ureteral stones.The data of 124 patients with proximal ureteral stones who underwent semirigid or flexible ureterorenoscopic lithotripsy between March 2008 and December 2012 were retrospectively investigated. The patients were divided into 2 groups according to the operation types. Group 1 included 63 patients who were treated with semirigid URS and group 2 was consisted from 61 patients who underwent flexible URS. Each group was compared in terms of stone diameter, successful access to the stone, operation time, reoperation rates, stone free status at postoperative 1st and 3rd month and complications.Successful access was achieved in 48/63 (76%) of the cases in group 1 and 57/61 (93%) of the patients in group 2 (P.05). Initial stone free status was 63.4% (40/63) and 86.8% (53/61) in groups 1 and 2, respectively (P.05). Third month radiologic investigations revelaed a stone free rate of 77.7% (49/57) in group 1 and 93.4% (57/61) in group 2 (P.05). Reoperation was required in 20.6% (13/63) of cases in group 1 and this value was only 6% (4/61) in group 2 (P.05). There was not any statistically significant difference between 2 groups in terms of complication rates (P.05).Flexible URS is a favorable option for patients having proximal ureteral stones with higher stone free rate; on the other hand semirigid URS seems a less successful alternative for treatment of proximal ureteral stones.

We aimed to establish the relationship between lymph nodes (LNs) counts that were removed with standard pelvic lymph node dissection (sPLND) and different disease parameters in patients who underwent radical prostatectomy (RP).A total of 70 patients who underwent sPLND during RP were scanned retrospectively. The scanned parameters were levels of serum PSA, the total weight of the removed prostate, the amount as a percentage of the tumor in the prostate tissue, the stage of the tumor, the total Gleason score (GS) and the number of standard pelvic lymph nodes that were removed from both right and left sides.The average age of the patients was 59 years. A positive correlation was found between the total GS and the number of lymph nodes; while this correlation was significant (p = 0.0038), there was no significant difference between lymph nodes counts and other scanned parameters. The average pelvic lymph node numbers of patients with GS of 6-7 and 8 were 10.4-11.5 and 13.2, respectively. Lymph nodes metastases were found in 3 (4.2 %) patients whose average pelvic lymph node number was 17.3.The chance of cure or decreased recurrence is much more possible in patients who had received extended PLND or at least standard one, because of the removal of much more lymph node tissues that have a high probability of disseminating cancer cells. This position can especially be considered in patients with high GS.