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(1) To evaluate the accuracy and validity of the biparametric MRI (bp-MRI), including T2-weigthed image (WI) and DWI sequences, and the availability of an alternative to the multiparametric MRI (mp-MRI), for the muscle-invasiveness assessment of bladder cancer (BC). (2) To evaluate the diagnostic performance and agreement of readers with different experiences in the abdominal imaging of using both protocols.Preoperative bladder mp-MRI was performed on 128 patients with a initial diagnosis of BC. Two sets of images, set 1 (bp-MRI) and set 2 (mp-MRI), were independently evaluated by both readers. Descriptive statistics, including sensitivity, specificity, accuracy, and area under the curve (AUC), for VI-RADS scores were calculated using ≥ 4 as the cutoff for muscle invasion for each reader and image sets. Inter-reader agreement was evaluated using the Cohen's kappa coefficient.The sensitivity ranged between 90.3-93.5% and 87.1-90.3%, specificity ranged between 96.6-99.1% and 91.6-96.6%, accuracy ranged between 96-97.3% and 91.3-94.6%, and AUC ranged between 0.947-0.951 and 0.919-0.921, for bp-MRI and mp-MRI, and reader 1 and reader 2, respectively. No significant differences were shown in diagnostic performance for either reader between both the protocols (p = 0.238 and 0.318). There was excellent agreement among the readers in the VI-RADS scores, using both protocols.A bp-MRI protocol has a diagnostic accuracy comparable to an mp-MRI protocol for the detection of muscle-invasive BC using the VI-RADS criteria. Also, in both MRI protocols, the reader's experience does not appear to significantly affect diagnostic performance when using the VI-RADS criteria.

BACKGROUND: Creatinine elevation and changes in urinalyse parameters may be seen due to acute kidney injury during COVID-19. In the present study, we aimed to investigate the changes in urinalysis of COVID-19 patients with normal kidney function. METHODS: The data of COVID-19 patients with normal renal functions were retrospectively analyzed. Urinalysis parameters of these patients were recorded. The patients were divided into three groups as mild, moderate and severe with respect to the clinical course of the disease. It was examined whether the urine analysis values in the groups were different from normal reference values and whether these values were different between the groups. In addition, possible relationship between the urinalysis parameters and the clinical severity of the disease was investigated. RESULTS: There are three groups; mild (n:40), moderate (n:38) and severe (n:42). Mean age were significantly higher in the severe group, while gender distribution of the groups was similar. (p=0.033) (p=0.091) Creatinine values of all patients were normal. There were 6.7% glucose positivity, 13.4% protein positivity, 5.8% urobilinogen positivity and 7.5% ketone positivity in urine dipstick analysis and these changes were all significantly higher than the reference values. (p=0.008, p

Summary Background Primary monosymptomatic nocturnal enuresis (MNE) is a common pediatric condition and there are two firstline, evidence-based treatments available; desmopressin and the enuresis alarm. Although there are many studies comparing enuresis alarm and desmopressin treatments in the literature, most were conducted using old formulations of desmopressin. Objective To compare the efficacy of desmopressin MELT formulation and enuresis alarm therapy in patients with MNE. Study design A total of 130 patients who had primary MNE were included in the study. The patients were divided into two groups using simple randomization; desmopressin MELT (Group 1, n = 66) and enuresis alarm (Group 2, n = 64). The patients were invited for a follow-up visit at the fourth, 12th and 24th weeks of treatment. Treatment response and compliance were evaluated using bed-wetting diary and ICSS criteria. Results The mean age of the patients Group 1 and 2 was 11.2 + 3.3 and 10.2 + 3.4 years, respectively (p = 0.104). Complete response rate was similar at 4th week (53% vs. 37.3%, p = 0.162) and at 12th week (68.4% vs. 68.2%, p = 0.257). The relapse rate was significantly higher in the desmopressin MELT group than in the enuresis alarm group (48.9% vs 20.5%, p = 0.007). At the end of the study ten patients were excluded from the study because of loss to follow-up and/or side effects. The overall complete response rate was significantly higher in the enuresis alarm group than in the desmopressin MELT group at the end of the study (41.3% vs 64.9%, p = 0.035). When the intention to treat analysis population was considered, similarly the complete response rate was significantly higher in the enuresis alarm group than in the desmopressin MELT group (40.9% vs 64.1%, p = 0.027). Discussion With regard to the management of children with MNE, our study revealed that desmopressin MELT and enuresis alarm both have high efficacy rates in primary MNE treatment both at 4th and 12th week. However, overall complete response rate was better in enuresis alarm treatment at 24th week. In addition, enuresis alarm treatment also presents as a more favorable relapse rate. Conclusions Enuresis alarm presented a more permanent treatment response and a lower relapse rate than desmopressin MELT formulation. Download : Download high-res image (535KB) Download : Download full-size image Summary Figure

Demirelli, Erhan/0000-0002-0187-2156 WOS: 000514117700001 PubMed: 32072659 Aortic stiffness increases in patients with erectile dysfunction (ED) but it is not known whether aortic stiffness affects the degree of ED. In the present study, we aimed to determine whether there is any relationship between aortic stiffness and the severity of ED. Patients with ED were divided into 3 groups according to the International Index of Erectile Function (IIEF) scores. Mild ED was named as group 1, moderate ED as group 2 and severe ED as group 3. The values of fasting blood glucose (FBG), serum lipid values, total testosterone (T. tes), and free testosterone (F tes) were recorded. Aortic stiffness was determined by pulse wave velocity (PWV) and augmentation index (AIX) measurements. The mean or median values of the laboratory parameters among the groups were similar (p > .05). No statistical difference was found between the groups in terms of AIX value (p = .386). Mean PWV values were calculated as 7.26, 8.30 and 8.78 in group 1, group 2 and group 3 respectively. PWV values were significantly different between groups (p < .0001). PWV values were found to be increased with increasing severity of erectile dysfunction. Scientific Project Office of Giresun University [SAG-BAP-A-200515-30] Scientific Project Office of Giresun University, Grant/Award Number: SAG-BAP-A-200515-30

WOS: 000519233300001 PubMed: 31586281 Purpose We aimed at comparing the success and complications of early semirigid ureteroscopy (URS) and elective URS in ureteral calculi with renal colic that do not respond to analgesics. Methods We retrospectively analyzed the data of 690 patients with obstructive ureteral stones who underwent URS with stone retrieval. 247 patients who underwent early URS within the first 12 h were classified as group I and 443 patients who underwent elective URS as group II. Both groups were compared in terms of age, sex, creatinine, eGFR, stone size, laterality, location and number of stones, type of lithotriptor, presence of hydronephrosis and success and complication rates. Results The mean age of the patients was 50.4 (18-89 years) (p > 0.05). There was no statistically significant difference between the groups in terms of age, eGFR, side, presence of hydronephrosis, fever, mucosal damage, stone migration, perforated ureter, ureteral avulsion, ureteral stent insertion at the end of the surgery and sepsis (p > 0.05). Both groups had male dominance (p > 0.05). Creatinine was significantly lower in Group I (p < 0.05). The mean stone size was also significantly lower in Group I ( p < 0.05). Middle and proximal ureteral calculi were more common in Group II (p < 0.05). Multiple stones were higher in Group II (p < 0.05). The dominant type of lithotriptor used was pneumatic in Group I and laser in Group II (p < 0.05). Stone-free rates (SFRs) were higher in Group I (98% vs 90% in the first month) (p < 0.05). Postoperative hematuria and infection were more common in Group II (p < 0.05). Conclusions In selected cases, early ureteroscopy is an effective and safe method for distal ureteral calculi smaller than 10 mm that are painful and resistant to analgesic treatment.

WOS: 000454525500003 Objective: To investigate the potential effect of smoking on pathological staging in clinically low-risk patients. Subjects and methods: Data of 59 patients who were diagnosed with a bladder tumor for the first time and had a single lesion radiologically and endoscopically smaller than 3 cm were investigated, retrospectively. A total of 33 patients who currently smoke or smoked were classified as Group I and 26 patients who did not ever smoke were classified as Group II. Pathological diagnoses of the patients in both groups were compared. Results: A total of 9 patients (27.3%) in Group I and 18 patients (69.2%) in Group II had Ta disease (p < 0.05). Moreover, 19 patients (57.6%) in Group I and 5 patients (19.2%) in Group II had stage T1 disease (p < 0.05). The number of patients with low grade (LG) tumor were 8 (24.2%) and 19 (73.1%) in Group I and in Group II, respectively (p < 0.05). The number of patients with high grade (HG) tumor were 25 (75.8%) and 7 (26.9%) in Group I and in Group II, respectively (p < 0.05). Ta high grade (TaHG) was detected in 9 (27.3%) patients in Group I. In contrast, no patients in Group II had Ta HG disease (p < 0.05). The number of patients with T1 high grade (T1HG) was 17 (51.5%) in Group I and 2 (7.69%) in Group II (p < 0.05). Conclusion: Smoking seems to associate with pathologically worse stage and grade in patients with primary, single

WOS: 000474443200012 PubMed: 30201079 Objective: We compared the number of interstitial cells (ICs), nerves, presence of fibrosis and inflammation at the level of full-thickness human ureteropelvic junction (UPJ) tissues obtained from normal subjects, and patients with UPJ obstruction with and without crossing vessels. Material and methods: Normal UPJ tissues (n=12) histopathologically confirmed to be without tumor involvement were obtained from subjects who underwent radical nephrectomy for kidney mass. Additional UPJ tissues were obtained from patients who underwent pyeloplasty due to UPJ obstruction. Crossing vessel was identified in 17 patients. In 57 patients, no crossing-vessel was noted. ICs were stained immunohistochemically with anti-human CD117 (c-kit) antibody. Neural tissue was stained with S-100. The numbers of ICs and neurons were compared between the groups: controls with normal UPJ (Group I), Ureteropelvic junction obtruction (UPJO) with crossing vessel (Group II) and UPJ obstruction without crossing vessel (Group III). Groups were also compared in terms of the presence of fibrosis and inflammation. Results: The mean age of total population included in the study was 30.5 +/- 18.5 years. No significant differences were detected between the three groups regarding mean and median numbers of ICs at the level of UPJ (lamina propria and muscle layer) and mean and median numbers of neurons at the level of lamina propria (p>0.05). Likewise, no significant differences were detected between the three groups regarding the presence of fibrosis and inflammation (p>0.05). Conclusion: Number of ICs, neurons, presence of fibrosis and inflammation seem to be similar in the intact UPJ and UPJ with obstruction with and without crossing vessel. Cellular function rather than the number ICs might play a role that warrants further research.

Introduction: We investigated the potential effect of smoking on pathological staging in clinically low-risk patients. Material-Methods: Data of 59 patients who were diagnosed with a bladder tumor for the first time and had a single lesion radiologically and endoscopically smaller than 3 cm were investigated, retrospectively. A total of 33 patients who currently smoke or smoked were classified as ever smokers group and 26 patients who did not ever smoke were classified as never smokers group. Pathological diagnoses of the patients in both groups were compared. Results: A total of 9 patients (27.3%) in ever smokers group and 18 patients (69.2%) in never smokers group had Ta disease (p

We investigated the effect of cigarette smoking on pathological staging in clinically low-risk patients. Data of 59 patients who were diagnosed with bladder tumor for the first time and had a single lesion radiologically and endoscopically smaller than 3 cm were investigated retrospectively. 33 patients who smoked were classified as Group I, and 26 patients who did not smoke were classified as Group II. Pathological diagnoses of the patients in both groups were compared. The mean age of the patients were 64.8 (20–86) years. In Group II, 5 (19.2%) were female and 21 (80.8%) were male (p < 0.05). Nine patients (27.3%) in Group I and 18 patients (69.2%) in Group II had Ta disease (p < 0.05). Nineteen patients (57.6%) in Group I and 5 patients (19.2%) in Group II had T1 disease (p < 0.05). The number of patients with low grade (LG) tumor were 8 (24.2%) and 19 (73.1%) in Group I and in Group II, respectively (p < 0.05). The number of patients with high grade(HG) tumor were 25 (75.8%) and 7 (26.9%) in Group I and in Group II, respectively (p < 0.05). TaHG was detected in 9 (27.3%) patients in Group I. In contrast, no patients in Group II had TaHG disease (p < 0.05). The number of patients with T1HG was 17(51.5%) patients in Group I and 2 (7.69%) patients in Group II (p < 0.05). Smoking is associated with pathologically HG and stage in patients with first time bladder tumor which is single and smaller than 3 cm.

WOS: 000361339400008, PubMed: 26067745, Objective: To determine the impact of percutaneous nephrolithotomy (PNL) on global and regional renal function in children. Methods: In total, 40 children (41 renal units) undergoing PNL were included in this prospective study. All patients were evaluated using quantitative single-photon emission computed tomography (QSPECT) with technetium-99 m-dimercaptosuccinic acid (Tc-99m-DMSA) examinations before and 3 months after surgery. Results: The mean age was 9.5 years (range, 3-16), and the mean stone size was 3.4 cm (range, 2-6.5). Of the cases, 39 (95%) were managed as being stone-free after a single session of PNL. After additional treatment procedures, 40 (97.5%) of the cases were managed as being stone-free. Of the 41 renal units, new focal cortical defects on Tc-99m-DMSA scans were seen in 4 (9.7%) patients. Total relative uptake in the treated kidneys increased from 42.3% to 44.1%. The mean creatinine level before PNL was 1.18 +/- 0.45 (0.8-1.6) mg/dL compared with 1.16 (0.7-1.5) mg/dL by the end of the follow-up period (not statistically significantly different, p>0.05). Conclusions: PNL in children is a safe and feasible method for the maximal clearance of stones. QSPECT of Tc-99m-DMSA confirmed that renal function is preserved or even improved after percutaneous stone removal.

Aim: Weaimed to investigate the effects of varicocelectomy on semen analysis andpregnancy in infertile men. Patients and Methods: We retrospectively reviewed the medical records of patientsunderwent varicoselectomy between 2009 and 2014 in two referal hospitals, and180 infertile patients with complete records were included. All surgeries were performed by using amicroscope or loop. The preoperative and postoperative sperm parameters andspontaneous pregnancy rates were evaluated. Results:Mean age of the patients was 29.6 (17-46) years. 99 (55%) of the patientsachieved spontaneous pregnancy after the surgery. 81 (45%) of the patients wereguided to infertility polyclinics for assisted reproductive methods. When thesperm parameters were analyzed, the rate of the patients who had improved spermconcentrations were 22.7%; the rate of the patients who had improved spermmotility (a+b) was 59.4%; the rate ofthe patients who had improved sperm morphology was 51.1 (p, Amaç: Primerinfertil erkeklerde mikroskobik varikoselektomi ameliyatının semen analizi vegebelik üzerine etkilerini değerlendirmeyi amaçladık.Hastalar ve Yöntem: İki merkezde 2009-2014 yılları arasında, tek taraflı ya da bilateralmikroskobik varikoselektomi yapılan hastaların verileri retrospektif olarakincelendi ve kayıtları tam olan 180 primer infertil hasta çalışmaya dahiledildi. Tüm hastalarda büyüteç olarak mikroskop ya da loop kullanılarak işlemgerçekleştirildi. Hastaların preoperatif ve postoperatif sperm parametreleri vespontan gebelik oranları karşılaştırıldı.Bulgular:Hastaların yaş ortalaması 29.6 (17-46) yıl idi. 99 (%55) hastada cerrahisonrası spontan gebelik sağlanırken, 81 (%45) hasta yardımcı üreme yöntemleriiçin infertilite polikliniğine yönlendirildi. Sperm parametreleriirdelendiğinde, konsantrasyonunda düzelme saptanan hasta oranı %22.7;hareketlilikte (a+b) düzelme saptanan hasta oranı %59.4; morfolojide düzelmesaptanan hasta oranı oranı ise %51.1 olarak tespit edildi (p

To determine the perioperative risk factors for postoperative infections among patients undergoing flexible uretero-renoscopy with laser lithotripsy (FURSLL). In addition, the resistance patterns of pathogens isolated from positive preoperative urine cultures were investigated.We retrospectively reviewed data from 492 consecutive patients who had undergone FURSLL for stone disease in our department. Postoperative infection was defined as fever (? 38°C) with pyuria (? 10 white blood cells per high power field), or systemic inflammatory response syndrome, or sepsis. Pre-operative and intra-operative characteristics between patients with and without postoperative infectious complications were compared using univariate analyses. Significant variables on univariate analyses were included in a multivariatelogistic regression analysis to evaluate risk factors associated with postoperative infection following FURSLL.42 (8.5%) of 492 patients had postoperative infectious complications after FURSLL. 59 (12%) of 492 patients had a positive preoperative urine culture. 19 (32.2% of 59) patients had multidrug resistance (MDR) isolates recovered from positive preoperative urine cultures. 75% (9/12 cultures) of the positive preoperative urine cultures of patients in whom a postoperative infectious complication developed consisted of gram-negative pathogens. On multivariate analysis positive preoperative MDR urine culture (OR:4.75;95%CI:1.55-14.56; P = .006) was found to be significant with the dependent variable as the postoperative infectious complications despite appropriate preoperative antibiotic therapy.We found that positive preoperative MDR urine culture is a significant risk factor for infectious complications after FURSLL. Our findings point to the need for further research on assessment of risk factors forMDR infections to reduce the rate of postoperative infectious complications.

Purpose: To investigate whether or not the age of spontaneous resolution of monosymptomatic nocturnal enuresis (MNE) was familial. Patients and Methods: A questionnaire was administered to more than 1,500 people, and 100 appropriate participants were identified from four referral hospitals. We included the participants who had MNE and whose parents also had MNE with spontaneous resolution. Then the association between the spontaneous resolution time of MNE in parents and that in their children was investigated. Results: The mean ages of spontaneous resolution were 10.7 (10-30 years), 9.4 (6-17 years) and 10.9 (6-18 years) in participants, their mothers and their fathers, respectively. According to the statistical analysis, there was a positive correlation between participants and both their mothers and fathers (p < 0.05). In addition, it was revealed that familial MNE history based on first- and second-degree relatives, in addition to their parents, was also associated with the increased spontaneous resolution age of MNE (p < 0.05). According to our results, gender and parents' education status were not statistically associated with the spontaneous resolution (p > 0.05). Conclusion: As a conclusion, the age of spontaneous resolution of MNE is familial. Although the exact reasons of spontaneous resolution still remain a mystery; further genetic investigations may be able to resolve this mystery.

WOS: 000440545900004 PubMed: 29633793 Objective: To evaluate the impact of ureteral stent insertion following semirigid ureterorenoscopy (URS) in patients with perirenal fat stranding (PFS) due to ureteral stones. Material and methods: Data of 600 patients who underwent URS were analyzed retrospectively. Seventy-two patients detected to have PFS accompanying ureteral stone were included. Patients who did not undergo double J (DJ) stent insertion following semirigid URS were classified as Group I (n: 52), while those who underwent stent insertion were classified as Group II (n: 20). Side distribution; localization of the stones, stone size, presence of fever, urinary tract infection (UTIs) and urosepsis rates were compared in the two groups. Results: The average age of the patients was 44.4 (20-71) years. Male/female ratio and side of the stone location showed similar distribution in both groups (p > 0.05). Fever occurred in 23 cases (44.2%) in Group I and in 15 cases (75%) in Group II (p = 0.038). UTIs occurred in 15 cases (28.9%) in Group I and in 12 cases (60%) in Group II (p = 0.03). Urosepsis presented in 3 (5.8%) and 5 (25%) of the patients in Group I and II, respectively (p = 0.033). Conclusions: According to our results, ureteral DJ stent insertion following URS in patients with PFS due to ureteral stone caused an increase on postoperative infection related complications.

Objective: To compare the safety and efficacy of en bloc stapling and separate ligation techniques for renal vascular control during laparoscopic nephrectomy. Patients and Methods: Clinical data were collected from 60 patients who underwent laparoscopic nephrectomies using en bloc stapling (n = 27, group 1) or the separate ligation method (n = 33, group 2). Comparative analysis was carried out between the two groups, examining operative times, blood loss, intra- and postoperative complications and hospital stay. Results: Compared with the separate ligation method, the en bloc hilar control technique was associated with a shorter total operating time (98 vs. 121 min, p = 0.029). However, both groups were similar in terms of estimated blood loss, hemoglobin drop, changes in creatinine level and postoperative hospital stay. The total complication rates in group 1 and 2 were 3.7 and 15.1%, respectively, with a statistically significant difference. There were no complications related to the use of the endo-GIA stapler and no patients required conversion to open surgery in group 1. In group 2, 2 patients required conversion to open surgery, including 1 due to renal vein bleeding secondary to inaccurate vascular control and the other due to bleeding from the vena cava during dissection. In addition, 1 patient had a superficial bowel injury that was repaired laparoscopically and another had a superficial liver tear that was managed without conversion or transfusion. Conclusion: En bloc ligation of the renal hilum is an easy and reliable technique that allows safe and fast control of the renal pedicle.

To determine the metabolic risk factors in children and adults with urinary system stone disease.Between September 2008 and February 2011, 257 patients who underwent 24-h urine analysis because of urinary system stone disease were included in the present study. Group I and II include only adult patients. The first-time stone formers were named as Group I (n = 106), and recurrent stone formers were named as Group II (n = 107). Group III was occurred by pediatric patients (n = 44). Control group includes 105 people was called as Group IV. This group was divided into two subgroups. Group IVa includes 70 adult people, and Group IVb includes 35 children. The metabolic evaluation results of patients and control groups were compared.Hypercalciuria (35.8, 44.9, and 47.7 % for Group I, II, and III, respectively) and hypocitraturia (42.5, 40.2, and 50 % for Group I, II, and III, respectively) were most common risk factors for stone formation. However, unlike the literature, we have seen that hypomagnesiuria is also an important risk factor in adults and children. Hypomagnesiuria was defined at 36.4 % in Group I, 29 % in Group II, and 56.8 % in Group III (p0.05 for each group). These three parameters were significantly different between patient and control groups.Hypomagnesiuria, hypocitraturia, and hypercalciuria are the most important risk factors for stone formation in adults and pediatric patients.

To evaluate the treatment alternatives of total avulsion of the ureter from both ends including ureteropelvic junction (UPJ) and ureterovesical junction (UVJ). Total ureteral avulsion on both ends of the ureter was examined in 4 cases performing ureteroscopy. In two male patients of the four cases, avulsion was noticed intraoperatively and ureteral re-anastomosis at UPJ and re-implantation at UVJ were performed immediately. Boari flap was performed for one female patient immediately and for the other female patient who was referred from another hospital after the ureteroscopy, 4 days later. One patient who had ureteral re-implantation was followed with 3-month intervals by ultrasonography and abdominal X-ray. At the end of 1 year, it was determined that kidney parenchyma was normal and the patient had kidney and upper ureteral stones. Percutaneous nephrolithotomy was performed, and the patient was stone-free at the end of the operation. Two years after the surgery, both kidneys were normal. This is the only case who had a successful ureteral re-implantation in literature. The other patient turned up a year later for routine checks after the ureteral stent was removed. Then, hydronephrosis and renal atrophy were detected. The patient did not accept nephrectomy or any other intervention and he was lost to follow-up. Boari flap procedure was performed after UPJ repair for the other two female patients. Their kidneys were both normal 3 months after the operation. In case of ureteral avulsion from both ends of the ureter in the male patients, as bladder capacity is not enough for a Boari flap, proximal anastomosis and distal re-implantation could be a good choice for the management of this untoward event. This new approach also saves time for reconstructive treatments if necessary. If bladder capacity is enough to reach UPJ, Boari flap could be a good choice in female patients.

WOS: 000410005000014 PubMed: 28861302 Objective: We aimed to investigate factors related to early postoperative pain after retrograde intrarenal surgery (RIRS). Material and methods: A prospective data analysis of 250 patients who underwent RIRS due to kidney stones was performed. Postoperative pain was evaluated in all patients by using visual analogue scale (VAS). Patients with severe pain (VAS score >= 7) were separated and included in Group I (n=46). While patients without pain or with insignificant pain were included in Group II (n=204). The impact of patient-related (age, gender, renal anomalies, shock wave lithotripsy history, preoperative hydronephrosis) stone-related (stone number, side, size, location and opacity) and operation-related (preoperative and postoperative ureteral Jstenting, ureteral injury, postoperative bleeding and fever, stone-free rates, size of access sheath, and sheath indwelling time) factors on early stage postoperative pain (if any) were investigated. Results: Female gender increased the risk for pain 3.6-fold (p

Objective. Circumcision is practiced worldwide. Currently, the effect of age at the time of circumcision on wound healing is not fully known. This study aimed to determine the effect of age at the time of circumcision on wound healing. Methods. The study included 382 male patients aged ≤16 years that were circumcised between January 2014 and December 2014. Data for 345 patients that were followed-up regularly were evaluated retrospectively. Circumcision was performed using a bipolar diathermic knife. Circumcision wounds were considered healed when the 2 suture lines were observed to be completely apposed. Wound healing time was analyzed according to age at the time of circumcision. Results. Mean age of the patients was 7.2 years (range; 6 days-16 years). Mean duration of surgery was 327.5 sec and mean healing time was 4.3 days. The patients were classified according to age as group 1 (0-2 years; n=114; 32.9%), group 2 (3-6 years; n=60; 17.3%), and group 3 (7-16 years; n=171; 49.8%). Mean duration of surgery in groups 1-3 were 280.9 sec, 320.2 sec and 356.5 sec; respectively, and healing times were 4.1, 4.2 and 4.5 days; respectively. Healing time was significantly longer in group 3 than in groups 1 and 2 (p0.05). Conclusion. Wound healing time was shorter in the patients aged 0-6 years than in those aged 7-16 years.

Aykac, Aykut/0000-0001-7078-0135 WOS: 000380066200022 PubMed: 27286120 Purpose: The aim of this study was to examine whether the duration of breastfeeding during infancy was associated with the time of spontaneous resolution of monosymptomatic enuresis (SRME). Materials and Methods: A total of 1500 people were surveyed at four centers. One hundred and eighty-one people with a history of monosymptomatic enuresis (ME) who received no treatment and had no day time symptoms were included in the study. The relationship between the duration of breastfeeding and SRME was assessed by considering the duration of breastfeeding as both continuous and categorical (cut-off value 5 months) variable. The multivariate general linear model was used to identify independent predictors such as gender, family history, and educational status of parents. Results: Pearson correlation analysis of the age of SRME and duration of breastfeeding found no statistically significant relationship. However, there was a significant difference in the age of SRME of those who were breastfed for 5 months or less compared to those who were breastfed for more than 5 months. According to the multivariate analysis, gender and educational status of parents were not effective on the age of SRME. Stepwise linear regression model showed that breastfeeding for five months or less and family history could affect the age of SRME. The regression formula was: age of SRME= 9.599 + (3.807xfive months or less of breastfeeding) + (1.258xpositive family history). Conclusions: It was found that when breastfeeding lasted for more than 5 months, there was a positive contribution to SRME.

Objectives: It was aimed to evaluate the effectivenessof combined use of ultrasonography (US) and plain radiography(PR) in the postoperative follow-up of patientsundergoing retrograde intrarenal surgery (RIRS).Materials and methods: The charts of 207 patients whounderwent RIRS for renal stones in a 3-years-periodwere retrospectively reviewed. Fifty-eight patients wereincluded to study who were evaluated with combinationof urinary US, PR and computed tomography (CT) at 1month after surgery.Results: Of 58 procedures with perioperative completestone fragmentation, 49 were completely stone-free(84.4%), while fragments (≥ 3 mm) were observed in 9patients and hydronephrosis was detected in 5 patients(8.6%) on the CT. Of the 9 residual stones and 5 hydronephrosis,the radiologists truly diagnosed 6 stones (66.6%)and 5 hydronephrosis (100%) by using the combination ofUS and PR. The sensitivity, specificity, positive and negativepredictive values of US and PR for detecting presenceof residual stone and hydronephrosis were 66.6%and 100%, 98% and 98%, 85.7% and 83.3%, 94.2% and100%, respectively.Conclusions: A combination of urinary US and plain filmhas clear advantages about lack of radiation exposureover CT scan and it is a highly specific and sensitive testfor detecting hydronephrosis. However this procedurehas limited accuracy for detecting small residual stones,so we believe that CT scan is only necessary when patienthas persistent pain or sonographic evidence of hydronephrosisis present.Key words: Renal stone, plain abdominal film, retrogradeintrarenal surgery, ultrasonography

To present our experience with retrograde intrarenal surgery (RIRS) for managing renal stones in patients with spinal deformities.We retrospectively reviewed the records of eight patients with congenital scoliosis (n=6), ankylosing spondylitis (n=1), or spina bifida (n=1) who had undergone RIRS for renal stones. Stone-free status was determined by CT 30 days after the procedure and was defined as the absence of stones in the kidney or residual fragments ≤ 1 mm.Mean patient age was 32.5 years (8-51 years), and mean stone size was 15.8 mm (9-20 mm). The average operative time was 46.5 minutes (25-75 min), and postoperative hospital stay was 1.12 days (1-2 days). A stone-free status was obtained in six (75%) patients, and two patients were considered to have treatment failure. A Double-J stent was placed at the end of the procedure in five (62.5%) patients. Double- J stent discomfort was reported by one (20%) patient who was treated conservatively. No severe complications, either from anesthesia or the surgical procedure, were observed, and no blood transfusion was reported.The good clearance rate with a low incidence of complications shown by the present study has demonstrated that RIRS is a safe and effective procedure for renal stones in patients with spinal deformities.

Aim: To assess the diagnostic accuracy of PI-RADS v2.1 using multi-parametric magnetic resonance imaging (mpMRI) to detect prostate cancer (pCa) and comparison with transrectal biopsy/radical prostatectomy results.Material and Methods: Between June 2017 and April 2019, 124 patients who underwent mpMRI prior to transrectal biopsy/ radical prostatectomy were evaluated by a pathology results-blinded uroradiologist using PI-RADS v2.1 categories, retrospectively. PIRADS v2.1 category results were compared with transrectal biopsy/radical prostatectomy results. All clinical data were used in statistical analysis.Results: The sensitivity, specificity, positive predictive value, negative predictive value and accuracy values of mpMRI using PI-RADS v2.1 categorization were 96%, 44%, 73%, 88% and 75%, respectively. A significant correlation was observed between a high PI-RADS score and high pathological grade (p0.001). The inter observer agreement expressed as the ICC was 0.65 (95% CI: 0.33–0.84, p 0.001).Conclusions: The mpMRI, used in conjunction with PI-RADS v2.1, is a useful and promising imaging method in detection of pCa. Keywords: Prostate cancer; multiparametric MRI; PI-RADS; transrectal biopsy; radical prostatectomy.

Treatment of patients with solitary kidney having complex stones is one of the most challenging problem in urology. We present our experience with percutaneous nephrolithotomy (PCNL) in treating 16 patients with staghorn stones in a solitary kidney to determine long-term renal functional results. We retrospectively reviewed the records of 16 patients with complex caliceal or staghorn stones in a solitary kidney treated with PCNL. Demographic data, number and location of accesses, hemoglobin values, stone analyses, and complications were studied. Serum creatinine, glomerular filtration rate (GFR), systolic and diastolic blood pressure, new onset hypertension, and kidney morphology were determined preoperatively and postoperatively at 1 month and 1 year. Male to female ratio was 14:2 and mean age was 49.6 years (range 31-55). Of these, 10 (62.5%) patients required a single tract, while 6 (37.5%) required multiple tracts. The calculi were extracted or fragmented successfully in 13 (81.3%) patients and complete stone clearance was achieved after the first stage. In two patients with residual calculi, a double-J catheter was inserted and extracorporeal shock wave lithotripsy (SWL) was performed. There were no significant intraoperative problems except in one patient, who had bleeding from an infundibular tear attributable to torquing. During the 1-year study period, none of the patients progressed to end-stage renal disease requiring dialysis. We demonstrated a significant improvement in creatinine and GFR levels from preoperatively to 1-year follow-up. The number of patients with hypertension before PCNL was 5 and by the end of follow-up there was no new onset hypertension. The demonstrated effectiveness, small number of complications at short-term, not any poorly effect on renal function and blood pressure at the long-term follow-up confirm that PCNL is not only effective but is also safe in the solitary kidney with staghorn calculi.

The relationship between the results of penile duplex Doppler ultrasound (PDDU) and response to vardenafil was investigated in patients diagnosed with erectile dysfunction (ED). Data from 148 patients with ED were analyzed retrospectively. Patients who did not respond to therapy were classified in to Group I (n = 32), those who responded partially were classified into Group II (n = 40), and complete responders were classified into Group III (n = 76). Age, comorbidities, and vascular and penile pathologies were compared among the three groups. While diabetes mellitus (DM) and dyslipidemia positivity adversely affected the response to treatment, the presence of hypertension (HT), Peyronie’s disease and priapism increased the therapeutic response to the treatment (p < 0.05). Arterial insufficiency was present in 20 (30.3%), 25 (37.9%) and 21 (31.8%) of the patients in Group I, Group II and Group III, respectively (p = 0.001). Venous insufficiency was observed in three (14.3%) patients in Group I and in eight (85.7%) patients in Group III (p = 0.001). Arterial/venous insufficiency was seen in 9 (30%), 14 (46.7%) and 7 (23.3%) of the patients in Group I, Group II and Group III, respectively (p = 0.001). The response rate to treatment was highest in normal patients according to PDDU, followed by patients with venous insufficiency. In addition, it was found that DM decreased the response to treatment, whereas the response increased in cases with HT, priapism and Peyronie’s disease.

Fibroepithelial polyps (FEPs) are the most common benign lesions of the ureter. However, FEPs of the ureter accompanied by calculi are rare. In this study, we reviewed our experiences with five children having FEP associated with ureteral calculi to define more clearly this entity and its outcome following observation.We identified five children who were intraoperatively found to have FEP associated with ureteral calculi during the period 2000-2008.The patients included four males and one female, and the average age of these patients was 6.4 years (range 4-9). The main symptoms were flank pain (five patients), hematuria (four patients), and dysuria (two patients). Radiographically, all patients showed complete ureteral obstruction due to distal ureter stone and hydronephrosis. Fibroepithelial polyps and stones were located left distal ureter in all children. These polyps were 1-2 cm, with a mean size of 1.5 cm. Stone sizes ranged from 5 to 13 mm (mean 8.8 mm). The stones were smashed into smaller fragments using a pneumatic lithotriptor, and the pieces were removed with forceps. After the lithotripsy, the polyps were grasped with biopsy forceps and punch biopsies were done. FEPs were diagnosed in all cases by postoperative histological examination. During the follow-up period of these patients, none of the FEPs displayed any growth or symptom.Due to the potential complications during the ureteroscopic resection, our opinion is to observe the small FEPs without joint symptoms and hydronephrosis.

WOS: 000380066200025 PubMed: 27286123 Purpose: to investigate whether patients with lichen planus (LP) are really prone to urolithiasis or not. Patients and Methods: We performed a prospective analysis of 40 patients diagnosed with lichen planus (LP) (group I), and 40 volunteers did not have LP before (group II). Participants were all checked for urolithiasis by radiological investigations. Blood samples were analyzed for biochemistry parameters including calcium and uric acid. 24-h urine samples were analyzed to investigate oxalate, citrate calcium, uric acid, magnesium, sodium and creatinine. Results: Men/women ratio and mean age were similar between group I and II (p> 0.05). A presence or history of urolithiasis was detected in 8 (20%) and 2 (% 5) patients in group I and II, respectively (p< 0.05). Hypocitraturia was the most common anomaly with 35% (n: 14) in group I. The rate of hypocitraturia in group II was 12.5% (n: 5) and the difference was statistically significantly different (p= 0.036). In group I, hyperuricosuria and hyperoxaluria followed with rates of 27.5% (n: 11) and 25% (n: 10), respectively. The rate of hyperuricosuria and hyperoxaluria were both 5% (n: 2) in group II and the differences were significant (p< 0.05). Hyperuricemia was another important finding in the patients with LP. It was detected in 13 (32.5%) patients in group I and in 1 (2.5%) participant in group II (p= 0.001). Conclusion: According to our results, metabolic disorders of urolithiasis were highly detected in the patients with LP. However, similar to the etiology of LP, the exact reasons for these metabolic abnormalities in LP remain a mystery.

WOS: 000374234000009 PubMed: 26345399 The aim of this study was to investigate the frequency of nocturnal sperm emissions (NSE) in varicocele patients after varicocele surgery. A total of 127 patients, 96 varicocele (Group 1) and 31 patients with inguinal hernia (Group 2) were included in this study. Mean age, laterality of surgical procedures, spermiogram results, marital status, and postoperative serum hormone levels were noted for all patients. Two groups were compared in terms of Beck depression score (BDS) and anxiety scores (AS). The frequency of NSE and libido changes in the patients during 10 days postoperatively was evaluated. The number of the patients who had NSE and increased libido were significantly higher in the varicocelectomy group when compared with the control group. No significant difference was noted between the groups in terms of BDS, AS, and serum hormone levels. No association was reported between BDS, AS, and serum hormone levels and the presence of NSE in Group 1. The incidence of NSE was higher in younger men. Increased libido was significantly associated with NSE in Group 1. Cord dissection during surgery may be a factor on increased frequency of NSEs in varicocele patients.

Summary Objective In recent years, there has been increased incidence of urolithiasis in children. Changing nutritional patterns and sedentary lifestyles predispose to urolithiasis, as well as to the global rise in obesity. It has been established that the prevalence of high body mass index (BMI) is increasing in the pediatric population. The aim of the present study was to incorporate 24-h urine metabolic analysis results with BMI values to evaluate the tendency towards stone formation in children. Methods Eighty-four children were recruited to the study, stratified into three BMI categories as low, normal, or upper. All patients were evaluated with 24-h urine analysis results. Patients with a secondary cause of stone formation such as hyperparathyroidism, cystinuria, primary hyperoxaluria, inflammatory bowel disease, cystic fibrosis, history of prematurity and/or use of drug, recurrent urinary tract infection, and urinary tract anomaly were excluded. Additionally, it was ensured that none of the patients were taking specific medication or diet that could alter their acid-base metabolism and calcium, oxalate, and uric acid levels. Results Mean BMI of patients was 21.6 ± 2.9 kg/m 2 . LBMI was found in 52 (61.9%), N-BMI in 20 (23.8%), and U-BMI in 12 (14.3%) of the patients. No significant differences were present between the three groups for stone sizes and numbers. The patients' characteristics and 24-h urine parameters for BMI groups are presented in the Table. Discussion In the literature, several studies have focused on the relationship between obesity and pediatric urinary stone disease. However, only a few evaluated the urinary metabolic analysis in pediatric patients. We have encountered different results from mainly adult studies and some pediatric studies. Our study shows that U-BMI children are not under greater risk for urolithiasis than the other groups. An important portion of our study group was in the L-BMI group; nevertheless we cannot conclude that having a low BMI predisposes to urolithiasis based on the urinary metabolic evaluation as well as the stone sizes and numbers. The N-BMI group has increased risk factors for urolithiasis rather than the other groups, according to results of 24-h urine analysis. Conclusion The results of our study indicate that BMI itself could not be considered as a separate and definite risk factor for urolithiasis development in children. Although the mechanisms and causative factors for urinary stone formation are better defined in adults, further studies investigating these parameters in children are warranted. Table . Patients' characteristics and 24-h urine parameters for BMI groups. L-BMI mean ± SD N-BMI mean ± SD U-BMI mean ± SD p Sex Male 28 8 6 0.575 Female 24 12 6 Age (years) 6.9 ± 4.0 9.2 ± 4.5 9.4 ± 5.5 0.071 BMI (kg/m 2 ) 15.5 ± 1.6 20.8 ± 1.5 30.1 ± 2.9 Stone number 1.6 ± 1.0 2.0 ± 1.5 1.7 ± 0.8 0.709 Stone size (mm) 13.7 ± 10.2 13.8 ± 10.5 13.0 ± 9.6 0.951 Ca (mg/kg/24 h) 3.7 ± 3.0 4.2 ± 3.9 1.3 ± 0.9 0.021 Citrate (mg/1.73 m 2 /24 h) 362 ± 442 461 ± 391 622 ± 450 0.057 Uric acid (mg/kg/24 h) 4.6 ± 4.0 3.2 ± 2.7 1.8 ± 1.4 0.017 a Oxalate (mg/1.73 m 2 /24 h) 7.4 ± 10.6 12.0 ± 12.4 9.9 ± 6.2 0.003 Magnesium (mg/kg/24 h) 4.0 ± 3.3 3.3 ± 2.1 3.2 ± 2.2 0.609 Sodium (mmol/24 h) 91.3 ± 46.9 108.2 ± 76.1 88.3 ± 45.9 0.897 a Difference between L-BMI and U-BMI groups.

A 28-year old man presented with left flank pain and dysuria. Plain abdominal film and computed tomography showed a left giant ureteral stone measuring 11.5 cm causing ureteral obstruction and other stones 2.5 cm in size in the lower pole of ipsilateral kidney and 7 mm in size in distal part of right ureter. A left ureterolithotomy was performed and then a double J stent was inserted into the ureter. The patient was discharged from the hospital 4 days postoperatively with no complications. Stone analysis was consistent with magnesium ammonium phosphate and calcium oxalate. Underlying anatomic or metabolic abnormalities were not detected. One month after surgery, right ureteral stone passed spontaneously, left renal stone moved to distal ureter, and it was removed by ureterolithotomy. Control intravenous urography and cystography demonstrated unobstructed bilateral ureter and the absence of vesicoureteral reflux.

WOS: 000440260100015 PubMed: 25847901 Objectives: To investigate the situations in which ureteral double-J stent should be used after retrograde intrarenal surgery (RIRS). Patients and Methods: Patients with no ureteral double-J stent after RIRS constituted Group 1, and those with double-J stent after RIRS constituted Group 2. Patients' age and gender, renal stone characteristics (location and dimension), stone-free status, VAS score 8 hours after surgery, post-procedural renal colic attacks, length of hospitalization, requirement for re-hospitalization, time to rehospitalization and secondary procedure requirements were analyzed. Results: RIRS was performed on 162 renal units. Double-J stent was used in 121 (74.6%) of these after RIRS, but not in the other 41 (25.4%). At radiological monitoring at the first month postoperatively after RIRS, complete stone-free status was determined in 122 (75.3%) renal units, while residual stone was present in 40 (24.6%). No significant differences were observed between the groups in terms of duration of fluoroscopy (p = 0.142), operation (p = 0.108) or hospitalization times (p = 0.798). VAS values determined routinely on the evening of surgery were significantly higher in Group 1 than in Group 2 (p = 0.025). Twenty-eight (17.2%) presentations were made to the emergency clinic due to renal colic within 1 month after surgery. Double-J catheter was present in 24 (85.7%) of these patients. Conclusions: Routine double-J stent insertion after RIRS is not essential since it increases costs, morbidity and operation time.

To review our experience with ureteroscopy (URS) in the treatment of ureteral calculi and stratify intraoperative complications of URS according to the modified Satava classification system.We performed a retrospective analysis of 1,208 patients (672 males and 536 females), with a mean age of 43.1 years (range 1-78), who underwent ureteroscopic procedures for removal of ureteral stones. Intraoperative complications were recorded according to modified Satava classification system. Grade 1 complications included incidents without consequences for the patient; grade 2 complications, which are treated intraoperatively with endoscopic surgery (grade 2a) or required endoscopic re-treatment (grade 2b); and grade 3 complications included incidents requiring open or laparoscopic surgery.The stones were completely removed in 1,067 (88.3%) patients after primary procedure by either simple extraction or after fragmentation. The overall incidence of intraoperative complications was 12.6%. The most common complications were proximal stone migration (3.9%), mucosal injury (2.8%), bleeding (1.9%), inability to reach stone (1.8%), malfunctioning or breakage of instruments (0.8%), ureteral perforation (0.8%) and ureteral avulsion (0.16%). According to modified Satava classification system, there were 4.5% grade 1; 4.4% grade 2a; 3.2% grade 2b; and 0.57% grade 3 complications.We think that modified Satava classification is a quick and simple system for describing the severity of intraoperative URS complications and this grading system will facilitate a better comparison for the surgical outcomes obtained from different centers.

PubMed ID: 23920001, Objectives: To examine the feasibility of retrograde intrarenal surgery (RIRS) in a porcine model. Materials and Methods: Female pigs (n = 3) were placed in a dorsal lithotomy position under general anesthesia, and stone material was inserted into the renal pelvis of the pigs. The bladder was entered with a cystoscope, and a 0.038-inch hydrophilic guidewire was passed into the renal pelvis. Following successful placement of the guidewire, a ureteral access sheath (9.5/11.5 Fr) was placed to allow for optimal visualization. A 7.5-Fr flexible ureteroscope (Karl Storz Flex-X2) and a 200-µm laser fiber were used for lithotripsy. When basketing was deemed necessary, zero-tipped nitinol stone baskets were used. Trainees then practiced all these manipulations on the model. Results: Urologists with moderate experience in advanced endourologic surgery were trained using this model. However, there were some surgical difficulties due to the urinary system anatomy of the pig. Intravaginal location of the urethra, bladder neck location of the ureters, tight ureteric orifices, tortuous ureters, longitudinally elongated renal pelvis, narrow infundibulopelvic angle and shallow calices made the passage of the instruments and maneuverability of the flexible ureteroscope more difficult than in a human model. Conclusions: Despite some difficulties, our porcine model was very effective, because all the trainees successfully practiced the RIRS manipulations on this model. Copyright © 2013 S. Karger AG, Basel.

Purpose: To review our intraoperative complications of retrograde intrarenal surgery (RIRS) for kidney calculi and stratify these complications according to the modified Satava classification system (SCS). Patients and Methods: 230 patients (119 males, 111 females) who underwent RIRS because of kidney calculi were analyzed. We documented and stratified the intraoperative complications according to the modified SCS. There are four grades for this classification: grade 1 complications include events without consequences for patients; grade 2a complications include events that could be treated with endoscopic surgery intraoperatively; grade 2b complications include events which were treated with endoscopic treatment in another session, and grade 3 describes the events requiring laparoscopic or open surgery. Results: Mean age was 39.1 years (range 1-78). The stone-free rate after one session was 81%. Intraoperative complications were recorded in 30.4% of the patients. According to the modified SCS, grade 1 complications were documented in 15.9%, grade 2a complications were documented in 5.6%, and grade 2b complications were documented in 8.9% of the patients. Grade 3 complications were not detected in any of the patients. Conclusion: In our opinion, the modified SCS can facilitate patients to understand the safety of this surgery and can make it easier to compare the results of different institutes and surgeons.

Undecended testes which effects 1% of children throughout life is an important condition for children and can affect the fertility of males. In addition, it can be associated with testicular malignancy. In the present review article, we present an overview on the currently-accepted pathophysiology, genetics and management protocols of unilateral undescended testes.