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Purpose: To evaluate whether components of Testicular Dysgenesis Syndrome (TDS) affect testicular germ cell tumor (TGCT) prognosis and oncological outcomes. According to the hypothesis called TDS; undescended testis, hypospadias, testicular cancer and spermatogenic disorders share the same risk factors and have a combined fetal origin. Materials and Methods: We retrospectively evaluated the stages and oncological outcomes of 69 patients who underwent radical orchiectomy between January 2010 and December 2014 due to TGCT in our department. The presence of undescended testis, hypospadias and semen parameters disorders were recorded according to anamnesis of patients. Results: Among 69 patients with TGCT, only 16 (23.1%) had TDS. Significantly higher rate of TDS (36.1% vs. 9.1%) was observed at the advanced stages of TGCT(p=0.008). In the TDS group, the rates of local recurrence (50% vs. 11.3%, p

Inguinoscrotal bladder hernia is rarely encountered relative to the common occurrence of inguinal hernia. Most patients are asymptomatic and diagnosed perioperatively; however, lower urinary tract symptoms along with swelling in the inguinal region and two-stage urination may suggest herniated bladder. Co-occurrence of inguinoscrotal bladder hernia and herniated bladder stone is extremely rare, and there is no consensus on its treatment. Herein, we will present the case of an 81-year-old male patient with an inguinoscrotal bladder hernia and herniated bladder stone. To our knowledge, this is the seventh case reported in the literature thus far.

Objective: Radical cystectomy is the gold standard for the treatment of muscle-invasive bladder cancer. Anterior exenteration with cystectomy is standard practice in female patients. In this study, we aimed to evaluate the necessity of anterior exenteration in female patients who underwent cystectomy for invasive bladder cancer. Materials and Methods: Thirty-one women who underwent open radical cystectomy for bladder cancer between January 2010 and July 2018 were included in the study. The demographic characteristics, pathology results and genital organ involvement of these cases were retrospectively analyzed. Results: The mean age of the patients was 63 (range, 33-80) years. Eleven of the cases underwent anterior exenteration with cystectomy, while only two (6%) of these cases had gynecologic organ involvement of uroepithelial origin. One patient who had positive smear sampling prior to cystectomy also had genital organ involvement in the final pathology. Conclusion: In the light of our findings, anterior exenteration during radical cystectomy is beneficial in patients with no expectation of advanced sexual function or fertility to protect them from gynecological cancers that may develop simultaneously or later. However, in young patients and patients without suspicion of invasion in preoperative evaluation, organ sparing approaches are considered appropriate.

Objective: Treatment modalities applied after orchiectomy in early-stage germ cell tumors (GCTs) include significant changes in each new study. In this study we reevaluated the treatment approaches used in our hospital between 2010-2014 according to current guidelines. Materials and Methods: We retrospectively evaluated the oncologic treatments and follow-up data of 32 patients who underwent radical orchiectomy between January 2010 and December 2014 due to testicular tumor and were diagnosed with early stage GCT in the Urology Clinic of Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital of University of Health Sciences. Results: Of 19 patients diagnosed with stage 1 seminomas, 3 patients in the low risk group were followed. Of 4 patients who received single-dose carboplatin therapy, 2 were at low risk and 2 were at high risk. Therefore, 2 patients at low-risk had overtreatment. Twelve patients were treated with radiotherapy (RT) that was no longer recommended in guidelines after 2014. Two patients in the low risk group of stage 1 non-seminoma were followed. One of them had recurrence at 12 months, and received 3 cycles of bleomycin + etoposide + cisplatin (BEP) according to current guidelines. Four patients with stage 1 non-seminoma underwent 2 cycles of BEP because they were considered at high risk. These patients are now recommended to receive 1 cycle BEP according to the current guidelines. While 4 patients with stage 1 mixed GCT were followed because of low risk, one patient was administered 2 cycle of BEP based on the old guidelines, at that time because of high risk. In the seminoma group that was administered RT, acute myeloblastic leukemia and oligospermia toxicity were detected, but these were not observed in the carboplatin group. One of high-risk non-seminoma patients who received 2 doses of BEP developed Myelodysplastic syndrome. Conclusion: Early-stage GCTs have high cancer-specific and overall survival rates with appropriate treatment approaches. Although there are still controversial issues regarding their management, treatment approaches are changing with each study. Therefore, it is crucial to remain informed about current international guidelines and new scientific studies.

Objective: We aimed to compare the oncologic and functional outcomes of patients who underwent subcapsular or total orchiectomy for surgical castration in prostate cancer. Materials and Methods: We studied 65 patients who underwent total or subcapsular orchiectomy with a diagnosis of prostate cancer between April 2014 and May 2017. At postoperative 3-month follow-up, prostate specific antigen (PSA) and total testosterone levels were measured and patients were asked about their psychological status due to organ loss. Results were compared between the groups. Results: Sixty-five patients were evaluable: 23 had subcapsular and 42 had total orchiectomy. The mean age of the cases was 71.4 (60-83) years, the mean PSA level was 45.4 ng/dL (4-3800 ng/dL), and 41 cases had metastatic foci. There was no significant difference between the complication rates of the groups, but duration of the operation was significantly shorter in the subcapsular orchiectomy group. The two groups had similar mean PSA and testosterone levels at postoperative 3 months, but significantly more patients with total orchiectomy reported psychological problems due to organ loss. Conclusion: Subcapsular orchiectomy should be preferred for surgical castration because of the short duration of operation and the advantage of organ presence within the scrotal sac after surgery. In terms of oncologic outcomes, subcapsular orchiectomy shows no difference from total orchiectomy and is a safe alternative.

Objective: Prostate cancer is the most common malignancy in men and the second cause of cancer-related mortality. Prostate biopsy and the Gleason score guide treatment decisions in prostate cancer. Several studies have investigated the correlation between biopsy scores and radical prostatectomy specimen scores. We also evaluated the correlation of Gleason scores of these specimens in our patient series. Materials and Methods: We retrospectively reviewed the data of 468 men who were diagnosed with prostate cancer and underwent radical prostatectomy between 2008 and 2017. Patients’ age, prostate-specific antigen levels at diagnosis, and prostate biopsy and radical prostatectomy specimen Gleason scores were recorded. Upgrading and downgrading were defined as increase or decrease of Gleason score of radical prostate specimen compared to Gleason score of prostate biopsy. Results: A total of 442 men diagnosed with prostate cancer were included in the study. The mean age of the patients was 62.62±6.26 years (44-84 years) and mean prostate specific antigen level was 9.01±6.84 ng/mL (1.09-49 ng/mL). Prostate biopsy Gleason score was 7 in 27 (6.1%) men. Radical prostatectomy specimen Gleason score was 7 in 62 (14%) men. Gleason correlation was highest in the 240 patients (71.6%) with score

Objective Urodynamic studies (UDS) include assessments of the physics and physiology of the lower urinary tract (LUT). It is an invasive test and patients can feel fear and anxiety, especially at the beginning of the test. The aim of this study was to determine whether listening to music during urodynamic study decreases patient anxiety and pain. Methods Sixty-two patients who underwent urodynamic study were randomized into the following groups: no music (group 1, n = 30) or classical music (group 2, n = 32) during the procedure. Patient anxiety levels were quantified using the State-Trait Anxiety Inventory (STAI) and Beck's Anxiety Inventory (BAI). A visual analog scale (VAS) was used for self-assessment of discomfort and willingness among patients to have a repeat urodynamic study. Results Demographic characteristics, mean age, duration of procedure, systolic and diastolic blood pressure (SBP and DBP) and heart rate before procedure were statistically significantly similar between the two groups. Statistically significant differences were detected between the two groups in the mean pain score on VAS (4.1 ± 1.4 vs 2.6 ± 1.8), mean post-procedural STAI score (46 ± 5.8 vs 37.3 ± 5) and mean BAI score (14.2 ± 1.7 vs 3.5 ± 0.7). SBP and DBP and heart rate were similar between the groups. Conclusion Music is a cheap, safe and effective intervention that has gained increasing recognition as an effective tool to reduce pain and anxiety. Listening to music during urodynamic study reduced patient pain and anxiety.

Objective:Various techniques for vascular ligation are used during laparoscopic surgery. We aimed to compare the Endo GIA stapler and Hem-o-lok polymer clips in laparoscopic radical nephrectomy.Materials and Methods:The charts and costs were reviewed for all 56 patients who underwent laparoscopic radical nephrectomy at our institution from May 2014 to October 2017. Patients’ demographic characteristics, tumor size, blood loss, complications, operative time, and length of hospital stay were evaluated retrospectively. The obtained data were compared statistically.Results:Forty-six patients eligible for the study were divided into 2 groups according to the use of vascular staples or polymer clips. Amount of blood loss, postoperative drainage volume, and operative time were lower in cases using vascular stapler, while polymer clips were advantageous in terms of cost.Conclusion:Both techniques have advantages in terms of vascular ligation in laparoscopic radical nephrectomy. These techniques may be chosen based on surgeon preference or patient compatibility; however, it is more appropriate to use the material with which the surgeon is experienced.

Granulomatous prostatitis, first described by Tanner and McDonald in 1943, is a histopathological diagnosis that includes mixed type inflammation with granulomas in the prostatic tissue. Granulomatous prostatitis comprises 0.8-1% of benign inflammatory conditions of the prostate. Prior surgery, intravesical bacillus Calmette-Guérin treatment, or systematic tuberculosis are some causes of granulomatous prostatitis. It mimics prostate cancer clinically, histologically, and biochemically. Granulomatous prostatitis has a specific and nonspecific type, with the nonspecific type being more common. In this study, we report a patient who had high prostate-specific antigen level and underwent transrectal ultrasound-guided prostate biopsy, and histologic examination revealed nonspecific granulomatous prostatitis.

Objective: There are some treatment choices such as surgery and radiotherapy in the treatment of high-risk prostate cancer. Today, some centers prefer surgical pro­cedures in high-risk group due to increasing surgical ex­perience. In our clinic, we evaluated the functional and oncological outcomes of patients who underwent open radical prostatectomy in high-risk prostate cancer. Methods: Data on 203 patients underwent radical prosta­tectomy between February 2011 and February 2015 were investigated. There were 20 cases in high-risk group. Characteristics and demographic datas of these patients were collected retrospectively. The characteristics of high-risk patients with other risk cases were compared statistically. Parameters associated with biochemical re­currence were examined in high-risk patients. Results: Mean age of patients was 63.1 years (range 56-69 years), the average PSA level were 14.2 ng / ml (range 9-46 ng / mL) and median follow-up was 27.85 months in high-risk prostate cancer. Biochemical recurrence was detected in 11 cases (55%). A statistically significant cor­relation was seen biochemical recurrence between semi­nal vesicle invasions in high-risk patients. Conclusion: Surgical options should be first preference in high-risk patients considering age, co-morbidity and patients choice in the result of these findings. Gleason score is the most important factor in predicting oncologi­cal outcomes and organ-confined disease may be in 20% of clinical stage T3. There is no significant difference between high risk and low risk patients in oncologic and functional outcomes but should be kept in mind additional treatment may need after surgery.

To compare the effectiveness and reliability of retrograde intrarenal surgery (RIRS) and micro-percutaneous nephrolithotomy (micro-perc) for the management of kidney stones in pediatric patients.A retrospective analysis was made of pediatric patients aged18 years with kidney stones that ranged from 10 to 20 mm in size, who underwent RIRS (n = 36) or micro-perc (n = 45) in referral centers.In the RIRS group, the mean age of patients was 8.39 ± 4.72 years and in the micro-perc group, it was 5.62 ± 4.50 years (p = 0.01). The mean stone size was 12.80 ± 3.03 mm in the RIRS group and 13.97 ± 3.46 mm in the micro-perc group (p = 0.189). The success rate was 86.2% (n = 31) in the RIRS group and 80.0% (n = 36) in the micro-perc group (p = 0.47). The mean complication rate was 16.6% and 13.3% in the RIRS and micro-perc groups, respectively (p = 0.675). Hospital stay and radiation exposure were significantly lower in the RIRS group (all p 0.001). The mean anesthesia session was 1.94 in the RIRS group and 1.26 in the micro-perc group (p 0.001). The mean hemoglobin drop was 0.53 ± 0.87 g/dL in the micro-perc group, and none of the cases required blood transfusion.The results of this study suggested that micro-perc and RIRS were highly effective methods for the treatment of moderately sized renal stones in children, with comparable success and complication rates. Patients and their parents should be informed about the currently available treatment options, and of their efficacy and safety. However, further clinical trials are needed to support these results.

Objective Obturator nerve injuries may be seen during pelvic lymph node dissection in oncological surgery and although not common it is an important complication. According to the shape and location of the injury, tingling and loss of sensation may develop on the inner surface of the leg, together with loss of motor function of the adductor muscles. In this study an evaluation was made of these complications encountered in our clinic and the management strategies applied to these patients. Material and methods The data were retrospectively reviewed of 843 patients who underwent open radical retropubic prostatectomy between January 2002 and May 2016. To confirm obturator nerve palsy, electrophysiological investigation (ENG-EMG) was performed immediately postoperatively and 3 weeks later. Results A total of 6 obturator nerve injuries occurred during pelvic lymphadenectomy (0.7%). Reapproximation end to end with sutures was applied in 3 case and sural nerve graft in 1. In the other 2 patients, just clips were placed and these were removed early during the operation. After the treatment period, neurotropic medications or physiotherapy were given in some cases according to the neurological examinations. Conclusion Obturator nerve injury can be prevented by having a comprehensive knowledge of pelvic anatomy, and avoiding the use of electrocautery during lymph node dissection. The repair should be performed as soon as possible, with a tension-free reapproximation of the ends, using electrophysiological tests with a multidisciplinary approach and benefit should be taken from physiotherapy and medical treatment when needed.

Paratesticular rhabdomyosarcomas (RMS) constitute 7% of all RMS. Paratesticular RMS are malignant tumors and although many of them are seen in children and adolescents, 24% of them are seen in adults. A patient in the older age group had inguinal orchiectomy due to non-discrimination of scrotal mass, continuing clinical suspect of scrotal mass and high level of tumor possibility, after was determined to have paratesticular RMS. The patient was discussed in this case report.

Klinigimizde mesane tumoru tanisiyla opere edilen olgular retrospektif olarak degerlendirildi. Bu olgulardan nadir patolojiye sahip olanlar belirlendi. Literatur incelenerek mesanenin nadir gorulen tumorleri arastirildi. Klinigimizdeki tani ve tedavi algoritmalari literatur ile karsilastirildi. Mesanenin nadir gorulen tumorleri cogu urolog ve patolog tarafindan taninamamaktadir. Bu nedenle ilk tani esnasinda ve tedavi sirasinda zorluklara neden olabilmektedir.

Objective. The cancer of the prostate risk assessment (CAPRA-S) postsurgical score predicts recurrence, metastasis, and cancer-specific survival after radical prostatectomy (RP). We evaluated the relation between CAPRA-S score and biochemical recurrence (BCR) in prostate cancer after RP in our clinic.Materials and Methods. This study was performed on 203 patients with prostate carcinoma who underwent open RP and regional lymph node dissection in our clinic between 2008 and 2013. We calculated the CAPRA-S scores including prostate-specific antigen (PSA) at diagnosis, pathology Gleason score, surgical margin, seminal vesicle invasion, extracapsular extension, and lymph node involvement. The patients were divided into 3 risk groups (low, intermediate, and high risk) according to risk scores.Results. Recurrence occurred in 17.8% of the patients (36 patients out of 203 patients) with a median of 11.7-month follow-up. The average recurrence-free survival time is 44.6 months. Surgical margin invasion and seminal vesicle invasion significantly correlated with BCR especially in high risk group (11 and 13 of 15 patients,p<0.05, resp.).Conclusion. CAPRA-S score can be easily calculated and it is useful in clinical practice in order to timely propose adjuvant therapies after surgery.

Several studies evaluating the tolerance of transrectal ultrasound (TRUS)-guided needle biopsies showed that moderate-to-severe pain was associated with the procedure. Additionally, prebiopsy anxiety or rebiopsy as a result of a prior biopsy procedure is mentioned as factors predisposing to higher pain intensity. Thus, in this study, we investigated the effects of hypnotherapy during transrectal ultrasound-guided prostate needle biopsy for pain and anxiety. Sixty-four patients presenting for TRUS-guided prostate needle biopsy were randomly assigned to receive either 10-min presurgery hypnosis session (n = 32, mean age 63.5 ± 6.1, p = 0.289) or a presurgery control session (n = 32, mean age 61.8 ± 6.8, p = 0.289). The hypnosis session involved suggestions for increased relaxation and decreased anxiety. Presurgery pain and anxiety were measured using visual analog scales (VAS), Beck Anxiety Inventory (BAI), and Hamilton Anxiety Scale (HAS), respectively. In our statistics, p

Spermatocele is cystic dilatation of epididymis. These cysts are usually located outside of the tunica vaginalis and show transillumination as hydrocele. They are detected during a scrotal ultrasound incidentally. Although the etiology of most spermatoceles is idiopathic, trauma, infection or inflammatory process may lead to the development of spermatocele. Our case is a 69-year-old male patient with localized prostate cancer. He was admitted to our hospital with scrotal pain 3 months after open radical retropubic prostatectomy. His scrotal examination revealed 2 soft-density masses measuring 3-4 cm in diameter in the left scrotum and one measuring 5-6 cm in the right scrotum. Scrotal color Doppler ultrasonography showed two cystic masses filled with liquids one measuring 5.5 cm in the right scrotum and one measuring 2.4 cm in the left scrotum. Bilateral scrotal exploration was done and two spermatoceles, one measuring 3.4 cm in the left scrotum and the other measuring 5.6 cm in the right scrotum, were removed.