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siprofloksasin kullanımı sonrasında gelişen enfeksiyöz komplikasyonların ve bu komplikasyonları kolaylaştıracak risk faktörlerini ortaya çıkarmaktır. Gereç ve Yöntemler: Ekim 2018 ve Ekim 2020 tarihleri arasında gerçekleştirilen toplam 281 TRİB olgunun tıbbi kayıtları retrospektif olarak incelendi. Olgular profilaktik antibiyotik kullanımına göre Grup 1 (siprofloksasin grubu, n=216) ve Grup 2 (fosfomisin grubu, n=65) olmak üzere ikiye ayrıldı. Ortalama yaş, vücut kitle indeksi (VKİ), prostat spesifik antijen (PSA) düzeyi, prostat hacmi (PV), histopatolojik tanı ve sistemik enfeksiyona neden olabilecek risk faktörleri incelendi. Hastaların enfeksiyöz komplikasyonları epididimit, prostatit, pyelonefrit ya da ürosepsis kategorilerinde değerlendirildi. Bulgular: Hastalardan Grup 1 ve Grup 2’ye ayrılanların sırasıyla; ortalama yaşı 64,9±10,8 ve 64,3±7,3 yıl, VKİ 26,6±4,6 ve 27,3±3,8; total PSA düzeyleri 12,3±26,2 ve 11,9±18,4 ng/mL; PV 62,6±80,6 ve 58,9±35,4 cc idi. Grup 1’de 171 (%79,2) hastada, Grup 2’de ise 60 (%92,3) hastada komorbidite saptanmadı. Grup 1’de 5 olguda (%2,3), Grup 2’de bir olguda (%1,5) olmak üzere toplam 6 olguda enfeksiyöz komplikasyon gelişti (%2,1) ve enfeksiyon oranı bakımından gruplar arasında fark gözlenmedi (p=0,21). İki grupta da yaş, VKİ, PV, PSA düzeyi gibi parametrelerle diabetes mellitus ve hipertansiyon gibi komorbiditeler febril komplikasyonları predispoze etmedi (R2=0,085 (Cox-Snell), R2=0,486 (Nagelkerke), p=0,051). Sonuç: TRİB profilaksisinde oral siprofloksasin ve fosfomisin uygulaması benzer enfeksiyöz komplikasyon oranlarına sahiptir. Siprofloksasine karşı antibiyotik direncinin artışı da dikkate alındığında, fosfomisin kabul edilebilir enfeksiyöz komplikasyon oranlarıyla tercih edilebilir bir ajan olarak öne çıkmaktadır

Objective: The best therapeutic option for renal tumours smaller than 7 cm is partial nephrectomy. The aim of this study was to compare the positive surgical margin (PSM) rates, recurrence rates and oncological outcomes between laparoscopic partial nephrectomies and open partial nephrectomies at a single tertiary referral centre. Materials and Methods: We included patients with renal tumours treated with partial nephrectomies between January 2008 and December 2016 in the study. We retrospectively reviewed the patients' demographic data, surgical reports, clinical charts, laboratory results and histopathological reports. Binary regression analysis was used to assess the impact of the tumour diameter, laterality, polarity and localization for PSM. Results: We included a total of 215 patients in the study. The mean preoperative and postoperative haemoglobin and creatinine levels, blood loss, time of surgery and follow-up periods was similar between the two groups. The mean ischaemic time in the open partial nephrectomy group was significantly lower than that of the laparoscopic partial nephrectomy group (p

WOS: 000489555600008 PubMed: 30475702 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 a 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

Introduction No study has compared surgical outcomes and couples’ satisfaction among the 3 types of implants, with all brands available on the markets. Aims To compare long-term complications, mechanical reliability, and couples’ satisfaction with penile implant types and brands in patients who underwent penile prosthesis implantation. We also investigated whether there are risk factors that might predict couples’ dissatisfaction. Methods This retrospective study included 883 patients with erectile dysfunction who underwent penile prosthesis implantation. Of the patients, 349 had malleable penile implant, 26 had 2-piece implants, and 508 had 3-piece implants. Main Outcome Measure Couples’ satisfaction after surgery was evaluated with the modified Erectile Dysfunction Inventory of Treatment Satisfaction questionnaire. Surgical outcomes, mechanical reliability, and couples’ satisfaction were compared according to type and brand of the penile implants in all patients. Results The mean age and follow-up period of the patients were 57.74 ± 9.59 years and 67.81 ± 49.11 months, respectively. The couples’ satisfaction rates were significantly higher in the 3-piece implant group than in the malleable group (P < .001), but there was no significant difference between the 2-piece and 3-piece implant groups. There was no difference in terms of couples’ satisfaction according to the brand of the implants. Of the patients who had malleable implants, 27 (7.7%) underwent 3-piece penile prosthesis implantation due to dissatisfaction; however, only 1 (0.2%) of the patients with a 3-piece implant was switched to a malleable implant (P < .001). The highest rate of revision surgery due to penile corporal perforation was in the malleable group (2.6%), whereas the highest rate of revision surgery due to penile implant malfunction occurred in the 3-piece implant group (5.5%) (P = .021 and .001, respectively). To analyze risk factors, using multivariate analysis, presence of complication was the only predictor that might cause couples’ dissatisfaction (P = .003). Conclusions 3-piece and 2-piece implants have higher couples’ satisfaction rates than the malleable implant. Brands of implants did not have any effect on the couples’ satisfaction. Regarding detail of the complications, the 3-piece implant has a lower rate of penile corporal perforation and a higher rate of penile implant malfunction than the malleable implant. Patients with erectile dysfunction who need a penile implant should be informed about surgical outcomes, brands, and types of penile implants. Prosthesis choice should be customized to individual patient’s expectations/conditions and tailored accordingly.

AIMS To our knowledge, this is the first study investigating the impact of high visceral adiposity index (VAI) on female sexual dysfunction (FSD). We aimed to show the impact of increased levels of VAI on FSD compared with body mass index (BMI) and waist circumference (WC) particularly in those with metabolic syndrome (MeTS). METHODS We included 158 participants in two groups: Group 1 (n = 68 with normal sexual function) and Group 2 (n = 90 with sexual dysfunction). Demographic, clinic data, presence of MeTS and comorbidities were recorded. The BMI, WC and the VAI were calculated. Sexual function was assessed using the female sexual function index. RESULTS The mean age and all the anthropometric variables were similar between the groups (P > .05). MeTS was associated with lower arousal and lubrication scores than those without MeTS (P = .023). The higher VAI was associated with lower desire, lubrication and orgasm scores (P

AIMS Erectile dysfunction (ED) is a common condition affected by many factors. We aimed to show the impact of the metabolic syndrome (MeTS) on male sexual function based on visceral adiposity index (VAI). METHODS Participants who met MeTS criteria (Group 1, n = 96) and did not meet MeTS criteria (Group 2, n = 189) were included in this cross-sectional study. The MeTS diagnosis was made in the presence of at least 3 of the following criteria: fasting serum glucose level higher than 100 mg/dL, HDL cholesterol level below 40 mg/dL, triglyceride level higher than 150 mg/dL, waist circumference higher than 102 cm and blood pressure higher than 130/85 mmHg. Demographic data were recorded; biochemical and hormonal tests were measured. Erectile and other sexual function scores were recorded. The VAI was calculated using the [(Waist Circumference/39.68) + (1.88 × body mass index)] × triglyceride/1.03 × 1.31/HDL formula. RESULTS Mean age, smoking volume, testosterone (T) and testosterone/estradiol (T/E2 ) ratios of the groups were similar (P > .05). The mean VAI was two-fold higher in patients in Group 1 (P .05). The METS was associated with an increased risk of ED (P = .001). Logistic regression analysis showed that each integer increase in the VAI was associated with a 1.4-fold increased risk of ED (P

Aims: We aimed to investigate fertilization rates, quality of embryo, pregnancy and live birth rates, endocrine, sexual function, psychological status and quality of life of cases diagnosed with Klinefelter syndrome (KS). Methods: Clinical findings, hormone values and semen analyses in patients with nonmosaic KS (Group 1, n=121) and those with non-genetic nonobstructive azoospermia (NOA) (Group 2, n=178) were retrospectively analyzed. Sperm retrieval outcomes with microdissection testicular sperm extraction (micro-TESE), fertilization rates and embryo quality, pregnancy, abortion, and live birth rates were compared. Sexual functions were assessed using IIEF-15, quality of life was evaluated, and psychological status was assessed. Results: There was no difference in terms of age between groups. Sperm retrieval rates was 38% and 55.6% in Group 1 and 2, respectively (p=0.012). Sperm retrieval rates were higher in Group 1 before 31.5 years than in Group 2 (AUC=0.620, 0.578). Compared to Group 2, the fertilization rate was low in Group 1, whereas embryo quality was similar. Live birth rates were 12.5% and 23% in Group 1 and 2, respectively (p=0.392). The education level, libido, erectile functions, and general health satisfaction were lower in Group 1 than in Group 2 (buraya p değeri yaz). Depression and anxiety levels were higher in Group 2 than Group 1 (p değeri yaz). Conclusion: Higher sperm retrieval rate has been achieved in group 1 younger than 31.5 years. Similar embryo quality is provided between groups. Sexual dysfunction and psychiatric problems were higher in Group 1, with lower satisfaction and general health than Group 2. Patients with KS should be monitored not only with their reproductive functions but also with their general health status.

Aims:Erectile dysfunction (ED) is a common condition affected by many factors. We aimed to show the impact of the metabolic syndrome (MeTS) on male sexual function based on VAI and the impact of increased levels of the VAI was investigated in patients with ED among the patients with and without MeTS. Methods:Participants who met MeTS criteria (Group 1, n=96) and without MeTS (Group 2, n=189) were included in this cross-sectional study. The MeTS diagnosis was made in the presence of at least three of the following criteria: serum glucose level higher than 100 mg/dl, HDL cholesterol level below 40 mg/dl, triglyceride level greater than 150 mg/dl, waist circumference greater than 102 cm and blood pressure greater than 130/85 mmHg. Demographic data were recorded; biochemical and hormonal tests were measured. Erectile and other sexual function scores were recorded. The VAI was calculated using the [(WC/39.68)+(1.88xMI)]xTG/1.03x1.31/HDL formula. Results:Mean age, smoking volume, T and T/E2 ratios of the groups were similar (p>0.05). Mean VAI was two-fold higher in patients in Group 1 (p0.05). The METS was associated with an increased risk of ED (p=0.001). Logistic regression analysis showed that each integer increase of the VAI was associated with a 1.4-fold increased risk of ED (p

Background To our knowledge, there is no study in the literature that has investigated a cutoff value of the visceral adiposity index (VAI) for erectile dysfunction (ED) in men. Aim To show a possible relationship between ED and VAI levels representing adipose tissue dysfunction and to identify a cutoff value of the VAI for ED. Methods This prospective cross-sectional study included 276 participants in 5 groups: non-ED, mild ED, mild-moderate ED, moderate ED, and severe ED. The VAI was calculated. Fasting glucose, triglyceride, high-density lipoprotein, testosterone (T), prolactin, and estradiol were measured. Erectile function, sexual satisfaction, orgasm, desire, and general satisfaction scores were recorded using the International Index of Erectile Dysfunction 1–15 questionnaire. The participants were divided into BMI1 (30.0) categories based on body mass index (BMI) and WC1 (102 cm) categories based on waist circumference (WC). Outcomes The VAI was investigated as an independent risk factor for ED, compared with BMI and WC. Results The median VAI progressively increased, but a marked increase was recorded in groups 4 and 5 (P = .001). A significant increase in ED was observed for a VAI score higher than 4.33 (P = .001). Each integer increase of the VAI was associated with a 1.3-fold increased risk of ED. The odds ratio of ED for the VAI = 4.33 was 4.4 (P < .001). The WC and BMI significantly increased as the degree of ED increased (P = .001), but statistical analysis showed a significant decrease only in moderate and severe ED groups (P < .05). Starting from non-ED patients, serum triglyceride increased and high-density lipoprotein decreased progressively in all ED groups (P = .001). T/E2 slightly reduced as the severity of ED increased (P > .05). T decreased in ED groups (P = .022). Regardless of the ED level, other sexual subdomains decreased in ED patients (P = .001). The ED rates in 3 increasing BMI and WC categories were similar (P > .05). For VAI = 4.33, BMI ≥ 30.0 kg/m2, and WC > 102 cm, sensitivity and specificity were 61.2% and 73.8%, 31.6% and 90.5%, and 54.3% and 69.0%, respectively. Clinical Implications The VAI should be considered as a reliable independent risk factor for ED as a predictor of visceral adipose dysfunction. Strengths & Limitations The main strength is that this is the first study to investigate the association between the VAI and sexual dysfunction in men. The low number of participants is the limiting factor. Conclusion The findings suggest that the VAI can be used as a reliable independent risk factor marker for ED as a predictor of visceral adipose dysfunction.

Objective:To present our initial experience on laparoscopic transperitoneal nephrectomies and to report the perioperative and postoperative outcomes in patients with kidney tumor.Materials and Methods:We retrospectively evaluated clinical data, laboratory results and radiological findings of 40 patients who underwent laparoscopic renal surgery performed by a single surgeon in a single center between November 2017 and May 2019. Thoracoabdominopelvic computed tomography was performed in all patients.Results:A total of 40 patients (26 males (65%), 14 females (35%) with a median age of 58.7 years underwent laparoscopic transperitoneal nephrectomy. Sixteen patients underwent laparoscopic simple nephrectomy (LSN) for nonfunctional kidney, 20 patients with solid renal tumors underwent laparoscopic radical nephrectomy (LRN), and four patients underwent laparoscopic partial nephrectomy (LPN) for solid renal mass. The mean operative time was 207.9±79.1, 218.9±57.5 and 175.0±75.0 minutes for LSN, LRN and LPN, respectively. The mean length of hospital stays was 3.0±1.3, 2.7±0.6 and 2.7±1.5 days, respectively. Conversion to open surgery was done in 2 patients who underwent LRN and in two patients who underwent LSN due to intraoperative bleeding and intraperitoneal adhesions, respectively. We experienced postoperative complication only in one patient (2.5%) who underwent LSN.Conclusion:Advances in technology and surgical experience have led to an increase in laparoscopic kidney surgery even for advanced renal tumors. Serious complications may occur mainly in the early stages of the learning curve, but complication rates and operative time significantly decrease by the surgeons’ experience. Complicated and more extensive tumors make surgeons more experienced in advanced laparoscopic treatment techniques.

Asci, Ramazan/0000-0002-2119-8963; Akdeniz, Ekrem/0000-0002-0666-9579; Bolat, Mustafa Suat/0000-0002-4650-2271; Asci, Ramazan/0000-0002-2119-8963 WOS: 000418637700003 PubMed: 28742406 Background: Erectile dysfunction (ED) is a disorder that is frequently observed in people with chronic kidney disease who undergo hemodialysis (HD). In the context of evidence-based medicine, we aimed to investigate the effect of low-dose tadalafil on sexual function in patients undergoing HD. Methods: The medical records of 30 males (aged 29-65 years) with end-stage renal disease (ESRD) on a HD program, and who had received 5 mg tadalafil twice weekly, were retrospectively evaluated. Changes in erectile and ejaculatory function were evaluated using the International Erectile Function Index questionnaire, the Erection Hardness Scale (EHS), and the Male Sexual Health Questionnaire (MSHQ). Results: The mean age of the patients was 47.6 +/- 10.1 years, their mean body mass index was 24.3 +/- 4.2 kg/m(2), their mean hemoglobin was 11.9 +/- 0.9 g/dL, and their mean creatinine clearance was 5.8 +/- 1.1 mL/min. At the third month of treatment, 36.6% of the patients had no ED, 40% had mild ED, 10% had mild-to-moderate ED, and 13.3% had moderate ED. The mean MSHQ scores (p < .05) and the mean EHS scores (p = .001) were significantly improved. There was no significant difference between Beck's Depression Inventory scores (p > .05), but Hamilton anxiety rate scores decreased significantly (p = .001). The quality-of-life score improved throughout the study period (p < .05). Conclusions: Tadalafil therapy is an effective therapeutic option in patients with ESRD who undergo HD, not only for the treatment of ED, but also for ejaculatory function, with acceptable adverse effects.

Asci, Ramazan/0000-0002-2119-8963 WOS: 000495786500003 PubMed: 31493104 Purpose To describe a novel method for the control of pain during prostate biopsies, infiltration free local anesthesia technique (INFLATE) for transrectal prostatic biopsies with no further needle insertions for local anesthetic infiltration. Methods A total of 138 men with elevated prostate-specific antigen levels and/or abnormal digital rectal examination findings were included in the study. Of the patients, 73 were assigned to the INFLATE group and 65 to the TRUS-PNB group. Demographic data, PSA levels, findings of digital rectal examinations, and multiparametric prostatic magnetic resonance imaging were recorded. In the INFLATE group, a two-channel TENStem eco basic device with two electrodes was used for pain control during the biopsy. For the TRUS-PNB group, 60 mg lidocaine gel was given intrarectally in addition to infiltration of a prilocaine and bupivacaine mixture (5 mL of 2% prilocaine + 5 mL of 0.25% bupivacaine). Pain perception was assessed using a linear numeric rating scale. Results The mean ages, BMIs, prostate volumes, and PSA levels were similar between the two groups (p > 0.05). Of the 56 participants with prostate adenocarcinoma, 28 were in the INFLATE group, and 28 were in the TRUS-PNB group with a 40.6% overall cancer detection rate. The mean preoperative and post-operative pain scores during probe insertion, biopsy and post-biopsy were similar between the groups (p > 0.05). Conclusion The results of the study confirmed that INFLATE for transrectal prostate biopsy using a TENS device could safely and effectively be used for pain control with the advantage of two fewer needle attempts with no increase in significant complications.

The Intrauterine device (IUD) is one of the most popular female contraceptive methods over the globe (Taras and Kaufman 2010). Although complications have rarely been reported, serious complication...

Objective: A debate is open on the effects of lipid-lowering drugs on sexual function. We aimed to investigate the effect of atorvastatin use on penile intracavernosal pressure (ICP) and cavernosal morphology. Material and methods: Fourteen mature male Sprague-Dawley-rats were randomly assigned to either the control group (which received standard food and water ad libitum) or the atorvastatin group (which received standard food, water, and statin) for twelwe weeks. At the end of the study, ICPs were measured with cavernosometry. Penectomy specimens were histologically examined. Results: The following mean values were obtained for the control and atorvastatin groups, respectively: pre-study body weights (350±16.9 g and 331.4±24.9 g); post-study body weights (356±18 g and 368±22.5 g (p>0.05); ICPs at 5 V (5.96±5.16 mmHg and 2.11±1.22 mmHg (p=0.07)); ICPs at 10 V (18.28±14.1 mmHg and 5.56±5.58 mmHg) (p=0.09); testosterone (1.23±0.78 and 0.78±0.58 mmol/dL) (p=0.39); blood glucose (151±22 mg/dL and 168.6±16.2 mg/dL) (p=0.12); triglyceride (93.4±19.8 mg/dL and 52.1±18.6 mg/ dL) (p=0.01); total cholesterol (50.2±7.2 mg/dL and 47.7±6.6 mg/dL) (p=0.51); and low-density lipoprotein (LDL) cholesterol (10.0±4.4 mg/dL and 3.5±2.1 mg/dL) (p=0.01). The mean collagen thickness was similar (p=0.09); but the mean elastin thickness increased in the atorvastatin group (p=0.01). Conclusion: The present study showed that the use of atorvastatin reduced the intracavernosal pressure in 10 V stimulation, and minimally decreased testosterone levels in rats, within a short period of time. When statin treatment is considered for its protective properties on cardiovascular system or for its lipid-lowering effect. It should be kept in mind that atorvastatin may also adversely contribute to erectile dysfunction. © 2019 by Turkish Association of Urology.

Asci, Ramazan/0000-0002-2119-8963; Asci, Ramazan/0000-0002-2119-8963; Gulsen, Murat/0000-0001-5371-0960 WOS: 000463161400008 PubMed: 30689241 Impacts of a subinguinal microsurgical varicocelectomy on the sperm parameters and fertility rates were investigated in three different ages according to their age at the time of the varicocelectomy: Group 1 was = 31 years old. The patients were also classified both preoperatively and post-operatively according to the total motile sperm count (TMSC) into the following categories: invitro fertilisation, intrauterine insemination and naturally fertile. The proportion of patients who upgraded to a higher TMSC category level was calculated, and natural fertility rates were recorded. The mean infertility duration was statistically longer in Group 3, compared to Group 1 and 2. The mean TMSCs and normal sperm morphology rates increased in all groups. The mean post-operative natural fertility rates were similar. The highest rate of TMSC upgrade was observed in Grade 3 varicocele patients under 20 years of age, compared to other grades of varicocele in patients older than 20 years. A microsurgical subinguinal varicocele repair, which is an effective treatment modality reduces the need for any type of ART, has an important impact on the TMSC increase in patients, particularly in the younger population.

PNET of the kidney are rare, aggressive tumors that occur mainly in adolescents. The diagnosis of PNET is difficult, but is possible with pathognomonic radiological findings. Since a radical nephrectomy is generally not sufficient for PNET of the kidney, early diagnosis and treatment is essential for successful recovery.

AMAÇ: Şişirilebilir üç parçalı IPP (3pIPP) rezervuarının rutin uygulamada yerleştirildiği bölge transversalis fasyasının altındaki Retzius alanıdır. Geçirilmiş majör pelvik cerrahiden sonra fibrozis gelişmesi olasılığı, Retzius boşluğuna penil protez rezervuarının yerleştirilmesini zorlaştırabilir. Penoskrotal transvers insizyon ile penil protez rezervuarının Retzius boşluğuna yerleştirilmesi ile ilgili olası komplikasyonları ve güvenlik kaygılarını ele almak amacıyla deneyimlerimizi gözden geçirdik. GEREÇ ve YÖNTEMLER: 2010–2017 yılları arasında transvers skrotal kesi ile 3pIPP implantasyonu yapılan 122 hastanın 39’unda lokalize prostat kanseri (PKa) nedeniyle açık retropubik radikal prostatektomi öyküsü mevcuttu (ARRP grubu). ARRP grubundaki hastaların 7’sine AMS LGX, 18’ine AMS 700 CX ve 14’üne Coloplast TITAN protez, radikal prostatektomi ve pelvik cerrahi öyküsü olmayan Non-ARRP grubu olarak belirlenen 83 olgunun 6’sına AMS LGX, 19’una AMS 700 CX ve 58’ine Coloplast TITAN protez yerleştirildi. Yerel etik kurul onayı alındıktan sonra grupların demografik özellikleri intraoperatif bulguları, postoperatif izlem verileri karşılaştırıldı. BULGULAR: ARRP ve Non-ARRP grubunun yaş ortalamaları sırasıyla 62,2±6,5 yıl ve 58,6±9,5 yıl idi (p=0,06). Sırasıyla ARRP ve Non-ARRP gruplarında ortalama cerrahi süreleri 57,2±11,3 ve 56,7±5,3 dakika (p=0,32); ortalama izleme süreleri ise 58,7±36,9 ve 50,1±27,5 ay idi (p=0,33). Toplam 58 aylık ortalama takip süresince ARRP grubunda birer olguda mekanik bozukluk (%2,6) ve protez enfeksiyonu (%2,6) gelişti. Non-ARRP grubunda ortalama 56 aylık takiplerde bir olguda inguinal herni gelişimine bağlı rezervuar dislokasyonu (%2,6); 3 olguda mekanik bozukluk (%3,6) ve bir olguda ise protez enfeksiyonu (%1,2) gözlendi. İPP implantasyonundan memnuniyet oranları ARRP ve Non-ARRP gruplarında sırasıyla 86,8±11,3 ve 85,8±12,2 idi (p=0,91). SONUÇ: Açık radikal prostatektomi öyküsü olan hastalarda, penoskrotal insizyonla üç parçalı penil protez ve rezervuarı retropubik Retzius boşluğuna düşük komplikasyon oranlarıyla ve yüksek tedavi memnuniyet oranları ile güvenle yerleştirilebilir. Nadiren gerekse de ektopik rezervuar yerleştirilmesi alternatif bir prosedür olarak akılda tutulmalı ve cerrahi sırasında bu aparat yedek olarak bulundurulmalıdır, OBJECTIVE: The traditional placement area of three-pieces inflatable penile prosthesis (3pIPP) reservoir is the space of Retzius (SOR) below the transversalis fascia. Likelihood of developing of fibrosis after previous pelvic surgery may be a challenging factor that can make difficult to place reservoir in the SOR. We reviewed our experience to address potential complications and safety concerns regarding the placement of the penile prosthesis reservoir in the SOR using transverse scrotal incision. MATERIAL and METHODS: Of the 122 consecutive patients underwent 3pIPP placement from 2010 to 2017, 39 had a history of open radical retropubic prostatectomy (ORRP) for localized prostate cancer (PCa) (ORRP group). Of these patients, 7 were placed MS-LGX, 18 were placed AMS-700 CX, and 14 were placed Coloplast Titan device using penoscrotal incision. Eighty-three patients had no history of ORRP (Non-ORRP group). Six patients were placed MSLGX, 19 were placed AMS-700 CX, and 58 were placed Coloplast Titan device using penoscrotal incision. The groups were compared in terms of demographic characteristics, intraoperative findings, and postoperative follow-up data. RESULTS: The mean ages of the ORRP and Non-ORRP groups were 62.2±6.5 and 58.6±9.5 (p=0.06); the mean surgery times were 57.2±11.3 and 56.7±5.3 min (p=0.32); the mean follow-up periods were 58.7±36.9 and 50.1±27.5 months (p=0.33), respectively. Mechanical failure in one patient (2.6%) and prosthesis infection in one patient (2.6%) was observed in the ORRP group. In the Non-ORRP group, reservoir dislocation due to inguinal hernia in a patient (2.6%), mechanical failure in three patients (3.6%), and prosthesis infection in a patient (1.2%) was observed. The mean postoperative treatment satisfaction rates (EDITS) were 86.8±11.3 and 85.8±12.2 in ORRP and Non-ORRP groups, respectively (p=0.91). CONCLUSION: With low complication rates, 3pIPP with its reservoir can safely be placed in patients with a history of open radical prostatectomy using penoscrotal incision. Rarely, ectopic reservoir placement is required, and this apparatus should be available at the time of surgery.

Objective The purpose of this study was to evaluate the analgesic effect of a prilocaine + bupivacaine combination in patients undergoing periprostatic nerve block (PNB) by comparing its effects with those of prilocaine alone. Design Single center, single-blind, prospective descriptive study. Subjects Four hundred patients with transrectal prostate biopsy pain. Methods The patients in this prospective, randomized controlled study were divided into two groups. The first group received prilocaine during PNB (Group 1), whereas the second received a prilocaine + bupivacaine combination (Group 2). Results The mean visual analog scale (VAS) scores immediately after biopsy were 2.52 ± 0.7 and 2.53 ± 0.9, respectively (P = 0.35). VAS values were significantly lower in Group 2 at one and six hours following the procedure. The most painful part of the biopsy according to many patients was the probe insertion. Conclusions The prilocaine + bupivacaine combination is an effective analgesic method during prostate biopsies and for one and six hours after prostate biopsy.

Akdeniz, Ekrem/0000-0002-0666-9579; Bolat, Mustafa Suat/0000-0002-4650-2271 WOS: 000479018900003 PubMed: 30237068 Objective: We aimed to investigate the effect of major thoracic surgery on sexual functions and psychogenic aspects of men who underwent surgery for lung cancer. Material and methods: This study was conducted to assess depression and erectile function in patients who underwent surgical treatment for lung cancer. The data of 50 patients in the study group, and 39 participants in the control group who met the criteria were analyzed. Erectile dysfunction (ED) and symptoms of depression were assessed in patients before and three months after surgery. Results: The mean ages were 58.4 +/- 11.6 and 61.3 +/- 6.9 years; the mean BMIs were 25.6 +/- 4.3 kg/m(2) and 24.8 +/- 5.7 kg/m(2); the mean forced vital capacities (FVC) were 3.1 +/- 0.6 L and 3.4 +/- 1.4L; the mean FEV1/FVC were 86.1 +/- 10.3 and 80.3 +/- 4.1; the mean Beck Depression Inventory scores were 9.3 +/- 6.9 and 6.0 +/- 6.2, and the mean FVC% were 82.9 +/- 14.9 and 82.0 +/- 26.2 for the study and control groups, respectively. The mean preoperative International Index of Erectile Function (IIEF-5) scores were 14.1 +/- 4.1 and 10.8 +/- 4.7 postoperative in the study group, and 17.4 +/- 8.6 in the control group. The logistic regression analysis showed that postoperative complications resulted in a 3.95-times higher risk of suffering from ED. Conclusion: Our study supported that surgical treatment of lung cancer adversely affected psychogenic status and sexual function due to its stringent nature. The fear of death affects the quality of life and the psychogenic aspect of the patients with lung cancer. Clinicians should thoroughly inform the patients about sexual dysfunction and psychogenic disorders, and when needed providing an appropriate sexual counseling and treatment is necessary. Good communication contributes to a better quality of life. (C) 2018 Asociacion Espanola de Andrologia, Medicina Sexual y Reproductiva. Published by Elsevier Espana, S.L.U. All rights reserved.

Asci, Ramazan/0000-0002-2119-8963; Akdeniz, Ekrem/0000-0002-0666-9579; Asci, Ramazan/0000-0002-2119-8963 WOS: 000435208900003 PubMed: 29795527 The aim was to compare the differences between daily 5 mg and on-demand 20 mg tadalafil use in diabetic patients with erectile dysfunction (ED), and the effects of two different tadalafil protocols on ejaculatory and lower urinary tract symptoms (LUTS). Of the 63 diabetic patients with ED, 31 were given 5 mg tadalafil once a day, and 32 were given 20 mg tadalafil on-demand four times a month over three months. Erectile function, erectile hardness, ejaculatory function, and LUTS were assessed at pretreatment, first-and third-month controls. Both tadalafil protocols increased International Index of Erectile Function (IIEF) scores in all patients under 65 years, whereas patients older than 65 years did not benefit. Ejaculatory function, the quality of the hardness of an erection, and LUTS improved in both groups in the study. Tadalafil improved sexual function with acceptable side effects in diabetic men with ED. Both protocols equally improved LUTS and the quality of the erection. Daily use of 5 mg of tadalafil significantly improved the quality of ejaculation and LUTS more than the on-demand use of 20 mg of tadalafil. It may be beneficial to give 5 mg tadalafil daily to patients over 65 years old who do not benefit from treatment with 20 mg of tadalafil or in patients who have LUTS over 65 years old.

Objective We aimed to show the effect of retrograde JJ stenting and intraoperative antegrade JJ stenting techniques on operative time in patients who underwent laparoscopic pyeloplasty. Material and methods A total of 34 patients were retrospectively investigated (15 male and 19 female) with ureteropelvic junction obstruction. Of the patients stentized under local anesthesia preoperatively, as a part of surgery, 15 were retrogradely stentized at the beginning of the procedure (Group 1), and 19 were antegradely stentized during the procedure (Group 2). A transperitoneal dismembered pyeloplasty technique was performed in all patients. The two groups were retrospectively compared in terms of complications, the mean total operative time, and the mean stenting times. Results The mean ages of the patients were 31.5±15.5 and 33.2±15.5 years (p=0.09), and the mean body mass indexes were 25.8±5.6 and 26.2.3±8.4 kg/m2 in Group 1 and Group 2, respectively. The mean total operative times were 128.9±38.9 min and 112.7±21.9 min (p=0.04); the mean stenting times were 12.6±5.4 min and 3.5±2.4 min (p=0.02); and the mean rates of catheterization-to-total surgery times were 0.1 and 0.03 (p=0.01) in Group 1 and 2, respectively. The mean hospital stays and the mean anastomosis times were similar between the two groups (p>0.05). Conclusion Antegrade JJ stenting during laparoscopic pyeloplasty significantly decreased the total operative time.

Introduction No study has compared surgical outcomes and couples’ satisfaction among the 3 types of implants, with all brands available on the markets. Aims To compare long-term complications, mechanical reliability, and couples’ satisfaction with penile implant types and brands in patients who underwent penile prosthesis implantation. We also investigated whether there are risk factors that might predict couples’ dissatisfaction. Methods This retrospective study included 883 patients with erectile dysfunction who underwent penile prosthesis implantation. Of the patients, 349 had malleable penile implant, 26 had 2-piece implants, and 508 had 3-piece implants. Main Outcome Measure Couples’ satisfaction after surgery was evaluated with the modified Erectile Dysfunction Inventory of Treatment Satisfaction questionnaire. Surgical outcomes, mechanical reliability, and couples’ satisfaction were compared according to type and brand of the penile implants in all patients. Results The mean age and follow-up period of the patients were 57.74 ± 9.59 years and 67.81 ± 49.11 months, respectively. The couples’ satisfaction rates were significantly higher in the 3-piece implant group than in the malleable group (P Conclusions 3-piece and 2-piece implants have higher couples’ satisfaction rates than the malleable implant. Brands of implants did not have any effect on the couples’ satisfaction. Regarding detail of the complications, the 3-piece implant has a lower rate of penile corporal perforation and a higher rate of penile implant malfunction than the malleable implant. Patients with erectile dysfunction who need a penile implant should be informed about surgical outcomes, brands, and types of penile implants. Prosthesis choice should be customized to individual patient’s expectations/conditions and tailored accordingly. Cayan S, Asci R, Efesoy O, et al. Comparison of Long-Term Results and Couples’ Satisfaction with Penile Implant Types and Brands: Lessons Learned From 883 Patients With Erectile Dysfunction Who Underwent Penile Prosthesis Implantation. J Sex Med 2019;16:1092–1099.

Objectives. We aimed to investigate the effect of a carbohydrate-rich diet on detrusor contractility in rats. Materials and Methods. Sprague-Dawley rats were randomized into two groups. The control group received regular food and water. The study group received carbohydrate-rich diet for six weeks. The rats’ detrusor muscle was isolated for pharmacological and histopathological examinations. Results. In the control and study groups, mean body weights were 431.5 ± 27.6 g and 528.0 ± 36.2 g, respectively (p < 0.001). Electrical stimulation of the detrusor strips of the control group resulted in gradual contraction. A decreased contractile response was shown in the study group. Acetylcholine in 10-7-10-3 molar concentration produced a decreased contractile response in the study group, compared to the control group (p < 0.01). The study group showed marked subepithelial and intermuscular fibrosis in the bladder. Conclusion. Carbohydrate-rich diet causes marked subepithelial and extracellular fibrosis and changes in contractility in the detrusor within a six-week period. Changes have higher costs in therapeutic choices and correction of these changes remains difficult. Putting an end to carbohydrate-rich diet would seem to be more cost-effective than dealing with the effects of consuming it in high proportions which should be the national policy worldwide.

Asci, Ramazan/0000-0002-2119-8963; Mustafa Suat Bolat, FEBU and Assoc Prof in Urology/0000-0002-4650-2271; Asci, Ramazan/0000-0002-2119-8963 WOS:000415329200006 PubMed: 29047457 The current therapy for penile fracture is immediate surgical repair, but sexual and psychosocial effects of the repair have been poorly investigated. We aimed to assess the impact of surgical correction of penile fracture on psychosocial status, sexual function, and erectile quality. Sixty-four patients classified into two subgroups according to follow-up: 2-24 months (Group 1), and longer than 24 months (Group 2), and 28 healthy men (Control group). The mean overall follow-up period was 39.1 +/- 32.7 months. The number of sexual intercourse origin was 44 (68.8%), the mean time interval from incident-to-surgery was 13.6 +/- 9.3 h. The mean sexual relationship score decreased during first year (P = 0.001), and significant recovery was observed over 12-24 months. The mean overall relationship scores and the mean self-esteem scores of the study groups decreased until the end of the 24 months (P < 0.05). The mean erectile function domains remained stable in all groups (P > 0.05). The mean EHS scores were lower but the difference was not significant in the study groups (P > 0.05). Penile fracture repair have no detrimental effect on sexual function, but psychogenic aspect may be adversely affected. This article concludes lower complication rates can be reached with immediate surgical correction of the penile fracture whereas psychogenic recovery might prolonged.

Various etiological factors have been studied which negatively affect female sexual function, but theeffects of ureteroscopic stone surgery on women's sexual dysfunction remain unknown. The aim of this study wasto investigate the effect of ureteroscopic stone surgery with postoperative stenting on female sexual function.This study included 30 sexually active female patients who underwent ureteroscopicstone surgery with JJ stenting (study group) and 26 age-matched female patients with ureteral stone surgerywithout JJ stenting (control group). Sexual function was assessed at preoperative and at the first and 3rd monthspostoperative using the Female Sexual Function Index. Overall satisfaction in relation to the age, operation time,presence of stents, body mass index, educational status, previous operations, income status, and psychogenic statuswas evaluated.Sexual function was adversely affected by ureteroscopic stone surgery with JJ stenting; but psychogenic,educational and income status remained stable. Mean individual female sexual function subscores were statistically significant between the study and control groups, but the differences in the mean Beck scores minimally improved between the two groups at preoperative (p = 0.19) visit, whereas first month (p = 0.08) and third month (p = 0.31) of postoperative controls were deteriorated but the differences were not statistically significant, respectively.Ureterorenoscopy with JJ stenting has considerably negative effects on female sexual function. JJ stenting causes temporary sexual deterioration in women and it generally ceases at the end of the 3rd month after ureteroscopic surgery. Therefore, JJ stenting should be avoided or used for as short a time as possible. If JJ stenting is inevitable, patients should be warned about a temporary decline in their sexual function during the first month of the operation that resolves at most in three months.

Objective: We aimed to investigate the effects of a Carbohydrate-rich diet on vas deferens contractility and histology. Materials and Methods: Twenty mature male rats were subjected into two groups. The control group received regular food and water and the study group received regular food and a carbohydrate-rich liquid diet mixture of 37–40% fructose, 30–36% sucrose and 27–30% glucose instead of water and prepared stock diet was diluted with 50% water. Animals were weighted and sacrificed after six weeks and the vas deferens has been evaluated with in vitro studies. Five rats from both the control and study groups, were separated into subgroups for dapoxetine administration 4 hours before they were sacrificed. Results: At the beginning of this study, the mean body weights were 228.6±6.7 g (range: 205-237) and 231.4±9.6 g (range: 202-243) in control and study groups, respectively. The mean body weights were 247.1±4.8 g (236-252) in the control group and 318.8±9.3 g (314-326) in the study group ( p 0.05). Responses to Adenosine Three Phosphate (ATP) were also not significant ( p >0.05). The contractile responses at the same frequencies of electrical field stimulation (EFS) were similar in both groups ( p >0.05). Histological examinations showed no abnormalities in either group. Conclusion: Carbohydrate-rich diet caused no increase in fibrotic activity, and pharmacological and histological properties remained stable, but caused significant weight gain over a short time period. Furthermore, dapoxetine had no effect on the contractility of the vas deferens.

Acute urinary retention in women is a rarely seen phenomenon due to pharmacological, neuromuscular, anatomical, functional and infectious causes. Human papillomaviruses causing condyloma acuminata is one of the rarely reported viral infectious cause of acute urinary retention in case reports. A 45-year-old woman with acute urinary retention was found to have a round solid lesion on external urethral meatus. Histopathological examination revealed as condyloma acuminata. Urethral condyloma can be treated by local excision as an effective method for early improvement of voiding function. Even if the genital condyloma can be locally excised, patients should be referred to the gynecologists for cervical cancer screening.Pan African Medical Journal 2016; 24

Introduction:Urethral stricture is characterized by decrease in urethral flow severe enough to cause acute urinary retention. Urethral strictures may develop after traumas to urethral epithelium and/or corpus spongiosum. Complication rates due to untreated urethral stricture are very high. Although various treatment methods have been described, the second most common method after urethral dilation in practice is cold-knife internal urethrotomy. The purpose of this study is to evaluate data of patients who were treated with internal urethrotomy in our clinic. Methods:This study included patients who were treated with internal urethrotomy due to internal stricture between January 2011 and May 2015. Demographic, clinical, radiological, uroflowmetric (maximum and mean urine flow rate) and operative datas of the patients were retrospectively evaluated and recorded. Results:This study included 155 patients with a mean (±standard deviation) age of 71.70 (±13.7). Etiologically the most common reason was urological surgical procedures (67%) and the most common stricture was seen at bulbomembranous urethra region (85.2%). Mean length of stricture was 5.4±2.4mm. Mean duration to remove the catheter was 1.8±1.3 days. Regional anesthesia was used in 67.7% of the patients. Our success rate was 78,1%. Comparison of maximum and mean urine flow rates pre and postoperatively revealed significant increases postoperatively. Conclusion:Internal urethrotomy is a first line treatment method for urethral strictures because it is easily applied, has a low complication rate, and can be applied with local aenesthesia in high risk patients who are unable to take general anesthesia. Although recurrence rate is high, repeatability is its greatest advantage and it causes significant relief in patients with urethral strictures, but it must be kept in mind that definitive treatment is urethroplasty.

Objective: Higher morbidity rates, extensive scar tissue formation and longer hospitalization periods of the standard open surgical methods for ureteropelvic obstruction has led to acceleration of minimal invasive techniques. Success rate and clinical outcomes of laparoscopic pyeloplasty has become comparable with open surgery. Purpose: The aim was to evaluate the clinical results and complications of transperitoneal laparoscopic pyeloplasty in ureteropelvic obstruction. Material and Methods: Thirty-three patients with ureteropelvic obstruction were enrolled into this study. Eighteen patients underwent Anderson-Hynes dismembered Pyeloplasty and 15 underwent Y-V plasty. Patients were followed-up at postoperative 3., 6. months and then yearly. Partial or total relief of symptoms and improvement in diuretic renogram were accepted as success. Results: Median age was 34.5±15.5(13-74) years, number of males were 13 (39.4%) and females were 20 (60.6%). Median Body Mass Index (BMI) was 25.3±15.4(18.5-33.4). Eight were asymptomatic, and 23 had intermittent pain, preoperatively. Fourteen cases had left ureteropelvic obstruction (42.4%) and 19 had in the right kidney . Intraoperatively 19 cases had aberrant vessel. Mean surgery time was 127.9±38.9 (68-245) minutes, median anastomosis time was 20.8±7.3 (8-39) minutes. Median blood loss was 57.1±28.3 (20-150) mL, median postoperative drainage time was 2.6±1.1 (2-7) days. Only one had prolonged ileus and peritoneal irritation findings. Median narcotic and nonnarcotic requirements were 21.5±4.8 (15-30) and 132.6±37.2 (75-200) mg/day, respectively. Median follow-up period was 35.1±13.6 (11-59) months. Conclusions: Laparoscopic pyeloplasty, is minimally invasive and reliable technique replaces open pyeloplasty in many institutions. Shorter hospitalization, lower postoperative morbidity rates, better cosmetic results and higher success rates can be easily achieved..

Following any injury to neural components of distal urinary tract, neuro-urological problems emerge inevitably. Neurogenic dysfunctions of distal urinary tract may be symptomatic or asymptomatic. The most feared complication is the loss of renal function due to secondary damage. We report a case with advanced Parkinsonism with a huge neurogenic bladder that extends through epigastric region whose symptoms were remainly related to gastrointestinal obstruction without urinary symptoms.

Purpose: Unilateral or bilateral testicular pain lasting more than 3 months is called as chronic orchialgia. Aproximately 25-50% of chronic orchialgia is idiopatic origin. This study aimed the effectiveness of Transcutaneous Electrical Nerve Stimulation (TENS) therapy due to Idiopathic Chronic Orchialgia (ICO). Methods: Five patients were included into this study with ICO that diagnosed with physical examination, urine analyses, urinary system x-ray film, and scrotal doppler ultrasound. Medical history revealed that multiple conservative therapy attempts failed to alleviate the pain. Two of the patients had right sided ICO. Traditional TENS device is placed to the most painful points. TENS applied 3 times in a week with duration 30 minutes for 4 weeks. Before and after TENS application, patients were evaluated by using Visual Analog Scale (VAS) at first and third months. Results: Median age of patients was 26.20±2.38 (22-30). Mean VAS value was 6.52 ± 0.89 before the procedure. After 1 month VAS value was 3.82 ± 0.83 (p0.05). None of the patients needed any analgesics after during the one month. No complications, hyperemia or hypoesthesia of the scrotal or penile skin, occurred after the procedure. Conclusion: TENS reduces pain by increasing endorphin release in the spinal cord dorsal horn. TENS is very effective method for first 1 month in patients with ICO but its effect reduces by the time. There is no standard therapeutic protocol for idiopathic chronic orchialgia. Therefore TENS may be an alternative for patients who do not benefit from medical therapy and do not want invasive procedures. Short-term use of TENS and low number of the patients are the limitations of this study. Randomized, placebo-controlled, and longer follow-up period studies are needed to better assess the efficacy of TENS for ICO.

Pain is the most complaint symptom of patients in post-operative period. Main causes of post-operative pain are tissue damage, drenaige apparatus and surgical complications due to surgery. Inadequate post-operative pain management may cause increase in morbidity, mortality, hospitalization stay, respiratory and tromboembolic complications, risk of developing chronic pain and decrease in quality of life. Pain management is synonymous with patient comfort. Therefore, clinicians responsible for the treatment of pain management should have sufficient knowledge and experience.

Pharmacologic effects of nicotine are multifaceted and complicated. Despite numerous studies, the effect of smoking on lower urinary tract functions, have not been yet studied in detail. In this study, we aimed to investigate the effects of smoking addiction on lower urinary tract and sexual functions on the basis of respiratory functions.A total of 186 male patients who have been evaluated between May 2014 and January 2015 were recruited in this study. Smoking history, respiratory symptoms, respiratory function tests, uroflowmetry parameters relating to lower urinary tract symptoms (LUTS), prostate volume, post-voiding residual urine volume and sexual functions of patients have been retrospectively investigated.We determined that as the mean number of cigarettes smoked daily increases, post-void residual urine volume and International Prostate Symptom Score (IPSS) also increase. Moreover in accordance with this finding, mean urinary flow rates and quality of life scores were statistically significantly decreased. In smoking addicts who have high mean package/year, post-void residual urine volume and IPSS levels were increased but proportionately maximum urinary flow rate and average urinary flow rate plus quality of life scores were found to be statistically significantly decreased. In patients with forced expiratory volume in first second:forced vital capacity (FEV1/ FVC) ratio less than 80%, mean urinary flow rates were found to be statistically significantly low. Also, we determined that in smoking addicts who have high mean package/year, erectile functions were statistically significantly impaired.We showed negative impacts of smoking addiction on LUTS, patient's quality of life, and sexual functions.