Renal hücreli karsinom (RHK) insidansı, yaşla birlikte düzenli olarak artmakta ve yaklaşık 75 yaş civarında en yüksek düzeye ulaşmaktadır. Küresel ölçekte yaşlı nüfusun giderek artması, RHK tanısı alan geriatrik hasta popülasyonunun da anlamlı ölçüde artacağı öngörüsünü güçlendirmektedir. Bu hasta grubunda tedavi planlaması yapılırken, yalnızca onkolojik sonuçlar değil; kanser dışı mortalite nedenleri ve genel yaşam beklentisi de göz önünde bulundurulmalı, bireyselleştirilmiş yaklaşımlar benimsenmelidir. Bu bağlamda, geriatrik RHK hastalarının yönetimine yönelik evrensel olarak kabul edilmiş ideal bir algoritma bulunmamaktadır. Böbreğe lokalize RHK’da parsiyel nefrektomi altın standart tedavi yöntemini oluşturmaktadır. Ancak, yüksek komorbidite yüküne sahip geriatrik hastalarda kriyoablasyon, radyofrekans ablasyon gibi minimal invaziv yöntemler ile “bekle–gör” veya aktif izlem stratejileri cerrahiye alternatif olarak değerlendirilebilmektedir. Lokal ileri RHK olgularında radikal nefrektomi güncelliğini korumakta olup, belirli hasta gruplarında adjuvan pembrolizumab tedavisi önerilebilmektedir. Metastatik RHK’da ise immün kontrol noktası inhibitörleri, tirozin kinaz inhibitörleri ve anti-vasküler endotelyal büyüme faktörü (anti-VEGF) tedavileri temel seçenekler arasında yer almaktadır. Bununla birlikte, ciddi komorbiditeleri bulunan yaşlı hastalarda aktif izlem stratejileriyle gereksiz tedavi maruziyetinin önlenebileceği düşünülmektedir.

Objectives: The study investigates whether multiparametric magnetic resonance imaging (mpMRI) targeted biopsy (MRI-TB) is necessary in the setting of prostate-specific antigen (PSA) 20-100 ng/mL and normal digital rectal examination (DRE). Materials and Methods: Patients undergoing MRI-TB and concomitant systematic biopsies (SB) with a PSA 20-100 ng/mL and normal DRE were retrospectively reviewed in Prostate Cancer Database of Turkish Urooncology Association. Pathological data of MRI-TB was compared to the SB data. All patients underwent mpMRI followed by transrectal/transperineal MRI-TB of any Prostate Imaging Reporting and Data System lesion and 12-core SB. The prostate cancer (PCa) and clinically significant PCa (csPCa) (grade group >= 2) detection on MRI-TB, SB and MRI-TB+SB were determined for all patients. A subgroup analysis of combined (MRI-TB+SB) group was also performed to identify performances of MRI-TB alone, SB alone and combination of MRI-TB+SB for the prediction of final pathology at radical prostatectomy (RP). Statistically significance was set at p<0.05. Results: In the study 65 patients were evaluated. Among them, 35 have PCa and 32 of them were csPCa. The detection rate of PCa for MRI-TB+SB, MRI-TB and SB were 53%, 46% and 36%, respectively, and csPCa detection rates were 49%, 41% and 33%, respectively. TB added 31.4% of any grade PCa and 31.25% csPCa detection over SB. csPCa detection rate improved with increased PSA density for TB. Among 15 patients who underwent RP,6 patients were found to have csPCa on final pathology which went undetected or undergraded with SB biopsy initially. Conclusion: MRI-TB based on mpMRI presents a valuable addition to SB in patients with PSA 20-100 ng/mL and normal DRE.

Prostate cancer is among the tumors that contribute to the increasing male mortality rate due to cancer worldwide. Treatment options for prostate cancer include active surveillance, radiation therapy, chemotherapy, hormonal therapy, focal therapy, and surgery. Ongoing research investigates alternative treatment modalities, such as traditional medicine and natural products, to address prostate cancer, drug resistance, and the side effects linked to current treatment options. Sesquiterpenes are a group of substances that are naturally made up of three isoprene units, hence fifteen carbons bound together. An extensive number of naturally occurring products—nearly 5000 in total—are categorised as secondary metabolites in the context of medicinal plants, marine organisms and fungi. Numerous of them possess many biological activities, anti-inflammatory, antioxidant, antimicrobial, and especially cytotoxic activity. Sesquiterpenes are an interesting group that was investigated due to their widespread occurrence and promising effects. Several studies have shown significant effects of sesquiterpenes on many types of cancer, including prostate cancer. Therefore, this review aims to include in vitro, in vivo and clinical studies of sesquiterpenes in prostate cancer. Based on the ring system, this review categorises sesquiterpenes as acyclic, monocyclic, bicyclic sesquiterpenes and other sesquiterpenes and their derivatives. A summary of sesquiterpenes' current status as cytotoxic with the potential for anticancer therapy agents is given concerning prostate cancer.

Objective:To determine which preoperative patient characteristics are predictive of intraoperative complications (IOC) and postoperative complications (POC) in patients undergoing nephrectomy for non-oncological diseases.Materials and Methods:Demographics, pre-operative characteristics, the surgical technique and perioperative outcomes of 295 adult patients who had underwent simple nephrectomy between 2002 and 2019 in a single reference institution were analyzed retrospectively. Univariate and multivariable statistical analyses were performed to determine the factors affecting POC (Clavien-Dindo score ≥1) and IOC. All statistical analyses were performed using the Statistical Package for the Social Sciences v. 24.0 (SPSS Inc., Chicago, IL, USA) software for Windows.Results:The mean age of the patients was 44.84±15.51 years, with a female-to-male ratio of 154/141. The statistically significant factors associated with IOC in the multivariable analysis were male gender, higher American Society of Anesthesiologists (ASA) score and urgent surgical intervention (p=0.002, p=0.001, p=0.021, respectively). In multivariable analysis, preoperative anemia, emergency surgery and open surgery were found to be statistically significant and associated with POC (p<0.001, p=0.004, and p=0.049, respectively).Conclusion:Improved surgical outcomes can be achieved through treatment adapted to individual preoperative characteristics such as ASA score, pre-operative hemoglobin level and male gender. An elective laparoscopic approach should be used whenever possible.

Aim: Determination of the effect of neo-adjuvant docetaxel chemotherapy combined with radical prostatectomy (RP) on surgical outcome and survival. Material and Method:The data of 132 non-metastatic prostate cancer (PC) patients, considered high-risk according to the D'Amico Risk Stratification System and who underwent radical prostatectomy, among those who applied to the Hacettepe University Faculty of Medicine Urology Clinic between August 1987 and August 2017, were retrospectively evaluated.Data from 28 patients selected via pair matching from the group operated without chemotherapy and 14 patients identified to have received neoadjuvant androgen deprivation therapy (NADT) preoperatively were compared regarding biochemical recurrence, survival, surgical outcomes, and some additional variables. Results:The findings of our study revealed that, while NADC is usually tolerated well by patients and can be administered without severe side effects, it has no statistically significant advantage on PSA values (p=0.145),Gleason scores, and pathologic stages (p=0.273,p=0.109), biochemical recurrence risk (p=0.040) and overall survival (p=0.527).It did not affect surgical complication rates, may have benefitted malignant involvement of lymph nodes, and prolonged biochemical relapse-free survival time. Conclusion:In high-risk PC patients, the ineffectiveness of neoadjuvant androgen deprivation therapy in combination with RP suggests the presence of castration-resistant cell clones that exist at the time of the diagnosis and brings up treatment options that could be effective on castration-resistant clones as systemic treatments.As a neo-adjuvant treatment, combining docetaxel chemotherapy with RP can be beneficial.

Objectives To determine whether artery only (AO) clamping promises any advantage over artery and vein (AV) clamping in patients undergoing partial nephrectomy with minimally invasive surgical techniques. Material and methods We retrospectively analyzed the data of 68 partial nephrectomy patients who were treated with minimally invasive techniques (robot-assisted laparoscopic or pure laparoscopic) for solitary, unilateral, cT1 renal masses during the period of 2008-2019 in a single institution. Patients were divided into two groups according to clamping strategy (AO and AV). The two groups were compared to each other in terms of perioperative outcomes and long-term functional results. Results The mean patient age and median follow-up period were 56.8 +/- 10.8 years and 13.5 (9-44.5) months, respectively. Warm ischemia time, estimated blood loss, transfusion rate and length of hospital stay were similar between the two groups, while operative time was significantly higher in the AO clamping group (p = .726, p = .604, p = .675, p = .103, and p = .038, respectively). Patients who underwent AV clamping had a significantly lower estimated glomerular filtration rate (eGFR) and higher chronic kidney disease rates six months postoperatively (p = .001 and p = .044, respectively) and at the last follow-up (p = .020 and p = .048, respectively). The percentage of eGFR change at six months and the last follow-up was higher in the AV clamp group but the difference was not statistically significant (p = .056 and p = .082, respectively). Conclusions Our findings suggest AO clamping is safe and comparable to AV clamping. In our study, AO clamping was found to be superior to AV in terms of long-term eGFR preservation.

Several nonmodifiable factors are associated with worse postoperative renal function in patients that have undergone nephron sparing surgery. Also, a positive correlation between renal disease and the calcification of renal arteries has been shown. This study aimed to investigate whether the calcification of renal arteries and aorta may be risk factors for developing chronic kidney disease after nephron sparing surgery Introduction: This study aims to investigate whether the calcification of renal arteries and aorta may be risk factors for developing chronic kidney disease (CKD) after Nephron sparing surgery (NSS). Materials and Methods: The patients that underwent either open or laparoscopic NSS from 2000 to 2019 in 4 different centers were retrospectively assessed. Of these patients, 328 had a non-contrast-enhanced computer tomography. Calcium scores of the renal arteries and abdominal aorta were measured in the non-contrast-enhanced images with the calcium score plugin (version 2.0) of Horos (TM). Univariate and multivariate logistic regression analysis was performed to determine significant risk factors for developing CKD at the last check-up. Roc curve analysis was performed to determine the optimal cut-off values of age and abdominal aorta calcium scores. Results: A total of 302 patients, of which 52 (16,6%) with CKD and 252 (83,4%) without CKD at the last check-up, were included in the analysis. The mean warm ischemia duration was significantly higher in patients with CKD (18,79 +/- 6,72 vs 16,38 +/- 5,57 minutes, p=0,016). The mean size of the tumor diameter and the number of the patients with >= stage T1b were higher in the group with CKD (p=0,024 and 0,005, respectively). The median calcium scores of the aorta and renal arteries were higher in the group with CKD (p <0,001 and p< 0,001, respectively). In multivariate analysis, age >60 years (OR:3,65, p=0,022), calcium score of the aorta (OR:4,07, p=0,029), tumor diameter (OR:1,03, p=0,026) and pre-operative CKD stage (OR:10,13, p, 0,001) found the be significant factors for predicting last check-up CKD. Conclusion: The calcium score of the aorta may be used as an additional risk factor to predict post-operative CKD risk after NSS with sensitivity over 80%. (C) 2021 Elsevier Inc. All rights reserved.

OBJECTIVE:To compare perioperative outcomes of minimally invasive surgery for ≥5 cm and <5 cm adrenal lesions.STUDY DESIGN:Retrospective cohort study.PLACE AND DURATION OF STUDY:Hacettepe University School of Medicine, Ankara, Turkey, between October 2007 and September 2019.METHODOLOGY:Data of 83 patients operated for adrenal lesions was collected retrospectively. Patients were categorized into two groups based on the size of the adrenal gland as <5 cm and ≥5 cm. The groups were compared in terms of perioperative outcomes.RESULTS:The median age of the patients was 51 (41-60) years, with a female-to-male ratio of 27/56. The median follow-up period was 27 (11.5-91) months. Of 83 adrenal masses, 60 (72.3%) were in the <5 cm group and 23 (27.7%) were in the ≥5 cm group. Fifteen (18.1%) patients underwent adrenalectomy for lung cancer metastasis, whereas three (3.6%) for renal cell carcinoma metastasis. The overall rate of post-operative complications was 10.8%. Post-operative complication rates were similar in each group (p=0.433). Operation time was found to be significantly higher in patients with large adrenal masses (p=0.003).CONCLUSION:Minimally invasive surgical techniques have the same perioperative results in the group with adrenal lesions ≥5 cm compared to <5 cm and may be safely employed in this group of patients.KEY WORDS:Laparoscopy, Robotic assisted laparoscopy, Adrenalectomy, Metastasectomy, Adrenal gland neoplasms.

PURPOSE This study evaluated single center results of endovascular treatment in renal angiomyolipoma (AML) to determine whether there is clinical relevance of adding proximal coil embolization to distal particle embolization in terms of safety, efficacy and retreatment rates. METHODS A retrospective analysis was performed to evaluate patients undergoing transarterial embolization for renal AMLs from January 2007 to October 2020. Parameters regarding patient and tumor characteristics, embolization technique, treatment outcome and complications were recorded. Patients were divided into two groups as A (only particle group) and B (particle + coil group) based on the type of embolic agent used for treatment. Comparative analysis was performed between the two groups in terms of tumor size reduction, retreatment and complication rates. RESULT Forty-two patients (37 (88.1%) female, 5 (11.9%) male) harboring 48 AMLs were included in the study. The mean age was 43.46 (range 20 to 78). The technical success rate was 95.8% (46 of 48 procedures). The mean size reduction was 1.94±1 cm (p < 0.001) after treatments however, no significant difference was seen between groups in terms of tumor size reduction. Retreatment rates were 3.1% (1 of 32 cases) in group A and 14.3% (2 of 14 cases) in group B (p = 0.21). No significant difference was found between groups in terms of bleeding and complication rates during the perioperative period. Mean follow-up duration was 26.48±25.71 (range from 2 to 102) months. CONCLUSION In this study, no clear supplementary benefit was observed in terms of safety, and efficacy with the adjunction of coils to distal particle embolization in the management of AMLs.

Aim: Androgen receptor splice variants (AR-Vs) produced by alternative splicing of the AR play an important role in the treatment resistance and progression of prostate cancer (PCa). In this study, two most common AR variants and how they associate with the inflammatory response (NF-K beta) and regulatory transcriptional activity (HSP-27) genes were investigated in patients with PCa and metastatic PCa (Met-PCa). Methods: Our study was carried out with the whole blood obtained from 25 healthy control subjects, 25 PCa patients and 39 Met-PCa patients. We examined the expression levels of AR, AR-V7 and AR-V567es genes via Real-time PCR and those of HSP-27 and NF-K beta via ELISA method. Results: AR, AR-V7 and AR-V567es expressions were observed in 84.61%, 64.1%, 23.07% of Met-PCa patients respectively. The expression levels of full-length AR and variants (AR-V7 and AR-V567es) were associated with the prostate cancer stage. In the Met-PCa, the expression levels of AR, AR-V7 and AR-V567es were associated with the Gleason Scores but not with the PSA levels. AR-V7 expression levels in stage T4 patients significantly increased. NF-K beta and HSP-27 protein levels were significantly higher in Met-PCa patients. Discussion: Our findings highlight the targeting of the proteostasis and inflammation pathways through inhibiting HSP-27 and NF-K beta. This might be a valuable strategy to overcome anti-androgen resistance and improve drug therapy in Met-PCa patients whose gene expression levels of AR-V7 and AR-V567es variants are high.

OBJECTIVES:To assess the largest stone composition data available and to present the variations in the stone composition according to gender and different climatic environments in Turkey.METHODOLOGY:Data for a total of 24 768 urinary stone patients from the Turkish Mineral Research and Exploration Institute were evaluated. X-ray diffraction crystallography was used for analysis and the Köppen-Trewartha classification was used to assess the climatic features of the cities. After the assessment, the cities were divided into two groups-those with a continental climate (Dc) were defined as inland areas and the others (Non-Dc) were defined as coastal areas.RESULTS:The male-to-female ratio was 2.2:1. Amongst the patients, 53.7% had pure stones, while 46.3% had mixed-type stones. The most common type of stone was calcium oxalate in both pure and mixed stone groups. Given the climate patterns, the stone ratio between regions with a Dc climate and a Non-Dc climate was approximately 2:3. Cystine and uric acid stones were observed more frequently in inland regions, while calcium oxalate, whewellite, and struvite stones were observed more frequently in coastal areas (P = .005, P < .001, P < .001, P = .002, P = .002, respectively). Calcium oxalate stones were found at a higher rate in men, while cysteine, struvite, and calcium phosphate stones were more common in women (P < .001, P = .003, P < .001, P < .001, respectively).CONCLUSION:This study provides the most comprehensive data on the stone disease in Turkey. Considering the distribution of stone disease in Turkey, the frequency of analysed stones had parallels with the temperature averages and climate features, presenting crescent-like distribution.

Introduction:To compare percutaneous nephrolithotomy (PCNL) outcomes between the elderly and young age groups and examined differences between young-old, old-old, and oldest-old patients. Methods:A retrospective analysis was conducted on 8191 renal units that underwent PCNL between September 1997 and March 2020 at three Turkish academic institutions. Patients were classified into young (18-64 years) and elderly (65+ years) age groups. The elderly age group was classified into young-old (65-69 years), old-old (70-79 years), and oldest-old (80+ years). Demographics, stone features, and perioperative and postoperative outcomes were compared between groups. The factors affecting stone-free rates and complications were determined in the elderly age group. Results:The patients' median age was 47 years (18-100) and the female to male ratio was 1:1.72. The stone-free and complication rates were 78.9% and 16.4%, respectively. General complications, blood transfusion, postoperative urinary tract infections, and major complications rate were similar between the young and elderly age groups (P = .902,P = .740,P = .659,P = .219, respectively). The stone-free rate was higher in the elderly age group (P = .002). Presence of partial or complete staghorn stones and number of stones were independently associated with stone-free rates for elderly age group patients (P = .006,P < .001, respectively). Stone burden (>= 400 mm(2)) and presence of partial or complete staghorn stones were significantly associated with complications for the elderly age group patients (P = .038,P = .014, respectively). Conclusions:In the young-old, old-old, and oldest-old age group, PCNL appears like the preferred treatment with high stone-free rates but similar complication rates compared to their younger counterpart.

PURPOSE:The aim of this study is to identify the changes in patient age and stone sizes with technological advancement over time.METHODS:This study was conducted retrospectively with 404 patients (504 renal units) who underwent percutaneous nephrolithotomy (PCNL) between January 1997 and June 2020. Patient characteristics and trends on instrument preferences were investigated.RESULTS:Median age was 7 (1-18) years. Male to female ratio was 1.48:1 (301/203). Median stone burden was 2 cm2 (0.20-25) and median operative time was 90 minutes (20-240). The stone-free rate was 74.6%. Patients were divided into four groups according to the size of the instrument. It was found that the size of sheath used increased significantly with increasing age and stone burden. The micro-PCNL group had the shortest hospitalisation and lowest blood transfusion rate. Chronologically categorised four equal groups were compared to analyse changing patient profiles and trends. Median patient age, stone burden, operation time, sheath size, blood transfusion and complication rates decreased significantly with time. However, the use of tracts smaller than 20F and the number of patients with previous intervention increased significantly.CONCLUSION:Our study demonstrated that the patient's age and stone size at the time of initial diagnosis decrease over time while miniaturisation techniques increase in paediatric urology.

Objective: To investigate the impact of variant histology (VH) of urothelial carcinoma (UC) of the bladder on oncologic outcomes after radical cystectomy (RC). Materials and Methods: We identified 125 patients with cT2-T4N0M0 UC who underwent RC without perioperative systemic therapy between 2014 and 2019 at a single tertiary care referral center. The Mann-Whitney U test and chi-square test were used to compare the statistically significant differences in medians and proportions, respectively. The Kaplan-Meier method and Cox regression analyses tested the effect of different VH on cancer-specific survival (CSS) and overall survival (OS). Results: Of 125 patients, 70 (56%) had pure UC, whereas 55 (44%) had VH. The mean patient age and the median follow-up were 63.6 +/- 9.7 years and 12.5 (3-72) months. The female to male ratio was 13/112. The presence of lymphovascular invasion, locally advanced stage (>= pT3), and recurrence status were significantly higher in patients with VH than those with pure UC. In all patients, the presence of VH was not significantly associated with the presence of lymph node (LN) metastasis. In the multivariable Cox regression analyses, the type of UC [hazard ratio (HR) 1.80, 95% confidence interval (CI) 1.00-3.24, p=0.050[ and age (HR=1.050, 95% CI 1.016-1.086, p=0.004) was associated with the OS, whereas the LN metastases was associated the CSS (HR-2.962, 95% CI 1.456-6.027, p=0.003) and OS (HR=3.211, 95% CI 1.778-5.799, p<0.001). Conclusion: Our study demonstrated that VH in bladder cancer was associated with unfavorable clinicopathological features and a poorer OS prognosis. However, VH is not independently significant with the CSS. In addition, this study confirms that the LN metastasis represents a robust and independent predictor of inferior CSS and OS.

MicroRNAs (miRs) modulate the expression of target genes in the signal pathway on transcriptome level. The present study investigated the 'epigenetic-based miRNA (epi-miRNA)-mRNA' regulatory network of miR-34b, miR-34c, miR-148a, miR-152, miR-200a and miR-200b epi-miRNAs and their target genes, DNA methyltransferase (DNMT1, 3a and 3b), phosphate and tensin homolog (PTEN) and NK3 Homeobox 1 (NKX3.1), in prostate cancer (PCa) using reverse transcription-quantitative PCR. The expression level of NKX3.1 were not significantly different between the PCa, Met-PCa and control groups. However, in the PCa and Met-PCa groups, the expression level of DNMT1 was upregulated, while DNMT3a, DNMT3b and PTEN were downregulated. Overexpression of DNMT1 (~5 and ~6-fold increase in the PCa and Met-PCa groups respectively) was accompanied by a decreased expression in PTEN, indicating a potential negative association. Both groups indicated that a high level of DNMT1 is associated with the aggressiveness of cancer, and there is a a directly proportional relationship between this gene and PSA, GS and TNM staging. A significant ~2 to ~5-fold decrease in the expression levels of DNMT3a and DNMT3b was found in both groups. In the PCa group, significant associations were identified between miR-34b and DNMT1/DNMT3b; between miR-34c/miR-148a and all target genes; between miR-152 and DNMT1/DNMT3b and PTEN; and between miR-200a/b and DNMT1. In the Met-PCa group, miR-148a, miR-152 and miR-200b exhibited a significant association with all target genes. A significant negative association was identified between PTEN and DNMT1 in the Met-PCa group. It was also revealed that that miR-148a, miR-152 and miR-200b increased the expression of DNMT1 and suppressed PTEN. Furthermore, the 'epi-miRNA-mRNA' bidirectional feedback loop was emphasised and the methylation pattern in PCa anti-cancer therapeutics was highlighted.

Introduction The dissection of perirenal fat is of critical importance to kidney surgery and ease of dissection is more important when using minimally invasive approaches. This study aimed to determine the clinical, radiological, and pathological significance of adherent perirenal fat(APF). Materials and Methods This prospective study included 22 patients scheduled for partial nephrectomy and 40 patients for donor nephrectomy. Intra-operative fat dissection time was recorded and the complexity of perirenal fat dissection was surgeon-classified as easy, moderate, and difficult. Perirenal fat and subcutaneous fat thickness was measured. Measurement of perirenal fat depth, and the Hounsfield unit(HU) for both perirenal and subcutaneous fields was performed using CT images. All specimens were submitted for histopatological analysis. Researchers in each arm were blinded to other researchers’ data. Results Mean age of the patients was 51.3±12.7years. Mean perirenal fat dissection time was 15.0±13.5min. Patient demographics, BMI, nor occupational status differed between the 3 complexity of perirenal fat dissection groups. Radiological findings showed that there was a significant correlation between perirenal fat depth and complexity of perirenal fat dissection(p<0.05), but not with HU measurements or subcutaneous fat thickness. Surgeon classification of the complexity of perirenal fat dissection was in accordance with the duration of dissection(p<0.05). Perinephric fat contained more fibrous tissue in the patients with histologically proven APF than in those without(p<0.05). Conclusions APF is a challenge during kidney surgery. Difficult dissection prolongs the duration of surgery, which can lead to complications. Perirenal fat thickness measured via pre-operative CT might be used to predict APF.

Objectives: The objectives of the study were to compare the operative features, complication rates, functional, and pathological outcomes of laparoscopic partial nephrectomy (LPN) and robotic-assisted partial nephrectomy (RPN). Methods: The demographics, perioperative, and follow-up data of patients who underwent partial nephrectomy between January 2007 and April 2020 with minimally invasive methods were retrospectively analyzed. Patients with minimum 3 months follow-up were enrolled in the present study. Perioperative and pathological outcomes were compared between the patients underwent LPN and RPN. Results: A total of 85 patients (65 LPN and 20 RPN) were included in the present study. The mean patient age at the time of surgery was 56.31±10.48 years. Female-to-male ratio was 30/55. Patients in the RPN group had higher R.E.N.A.L. and PADUA scores (p=0.039 and p=0.030, respectively). Median warm ischemia time, median operation time, median intraoperative estimated blood loss, mean post-operative hemoglobin change, and median hospitalization time were similar between groups (p=0.133, p=0.753, p=0.079, p=0.882, and p=0.473, respectively). Artery-only clamping rate was significantly higher in RPN group (p=0.033). The cost of RPN was significantly greater than LPN (p<0.001). Transfusion rates, post-operative complication rates, percent of estimated glomerular filtration rate change at the last follow-up, and trifecta achievement were similar between the groups (p=0.622, p=0.238, p=0.428, and p=0.349, respectively). Conclusion: In this series, similar perioperative and functional outcomes were achieved by RPN compared to LPN in more complex renal masses.

Objective: Prostate fusion biopsy could be performed either transrectal or transperineal route. Interestingly, the risk of infective complications after transperineal approach does not seem fewer than transrectal approach. Even when transperineal approach is chosen surgeons may have to deal with fecal contents during the biopsy procedure. We have developed a simple modification to minimize perineal contamination during transperineal prostate fusion biopsy. In this study, the results of patients who underwent transperineal fusion biopsy by using our novel technique were presented. Materials and Methods: Targeted prostate fusion biopsy was performed in 91 patients who underwent mutliparametric magnetic resonance imaging (Philips Intera 3.0 T) and had Prostate Imaging Reporting and Data System 3 or higher lesions, under general anesthesia, with the guide of transrectal ultrasonography (SmartUS, Telemed), with the help of transperineal stepper (CIVCO, EX3) by using MIM Symphony (MIM Software, Cleveland) software between May 2016 and May 2019 with a suspicion of prostate cancer. In the first 24 patients, both targeted fusion biopsy and systematic biopsy were taken only by transperineal approach, while in the 67 patients who were followed up, fusion biopsy was taken by transperineal method and systematic biopsy was taken by transrectal method. In the original technique, a condom filled with 120 mL saline was placed into the rectum; whereas in our modified technique, initially an empty condom was placed into the rectum and filled with 100 mL ultrasound gel and then fixed to the anus by using a standard ileostomy adapter. Results: We performed only transperineal biopsy in 24 patients and both transperineal and transrectal biopsies in 67 patients. A total of 139 lesions with an average size of 9.6-4.4 mm (4-25) were sampled by transperineal route in 91 patients. The mean number of core biopsies was 5.2-1.7 (2-13) for each of 139 lesions. Pathological examination revealed prostate adenocarcinoma in 33 lesions (23.7%) out of 139 lesions. None of the patients had fever or urosepsis after transperineal approach however, only 1 (p=0.43) patient who underwent transperineal and transrectal biopsies developed urosepsis symptoms and treated with intravenous antibiotic in the hospital. Conclusion: Our novel and simple technique to reduce infective complications after transperineal biopsies seems feasible and safe. Further comparative studies with larger number of patients are needed to demonstrate its clinical benefit.