Materials and Methods: From May 2013 to April 2018, 604 patients with kidney stone underwent mPNL in our department. The study was designed as retrospective and match-pair analysis was the preferred method for the formation of groups. The 21 Fr mPNL cases were matched with 16.5 Fr mPNL cases at a 1:1 ratio, according to the patients’ age, gender, body mass index, American Society of Anesthesiologists (ASA) score, stone characteristics (stone size, opacity and localization) and hydronephrosis. Patients with solitary kidney, renal anomalies, musculoskeletal abnormalities, and pediatric patients (< 18 years old) were excluded from the study. Both groups (21 Fr and 16.5 Fr) were compared in terms of demographics, stone characteristics, operative data and post-operative outcomes.

Purpose: The miniaturized percutaneous nephrolithotomy (mPNL) can be performed by using a very wide range of different access sheaths (14-22 Fr). It has been well known that tract size is one of the main parameters affecting the complication rates in PNL. We aimed to compare 21 Fr with 16.5 Fr mPNL tract sizes in adult patients. Materials and Methods: From May 2013 to April 2018, 604 patients with kidney stone underwent mPNL in our department. The study was designed as retrospective and match-pair analysis was the preferred method for the formation of groups. The 21 Fr mPNL cases were matched with 16.5 Fr mPNL cases at a 1:1 ratio, according to the patients' age, gender, body mass index, American Society of Anesthesiologists (ASA) score, stone characteristics (stone size, opacity and localization) and hydronephrosis. Patients with solitary kidney, renal anomalies, musculoskeletal abnormalities, and pediatric patients (< 18 years old) were excluded from the study. Both groups (21 Fr and 16.5 Fr) were compared in terms of demographics, stone characteristics, operative data and post-operative outcomes. Results: A total of 260 patients were included in the study (130; 21 Fr mPNL group and 130; 16.5 Fr mPNL group). The operation time was significantly shorter in 21 Fr group (21 Fr; 85.2 37.5, 16.5 Fr; 101.7 37.7 minutes, p = 0.001). Complete stone clearance rates were 76.9% and 62.3% in 21 Fr and 16.5 Fr mPNL, respectively (p = 0.01). There was no significant difference between the groups in terms of overall operative and post-operative complications. However, in subgroups analysis, post-operative fever was higher in 16,5 Fr mPNL (4 patients in 16.5 Fr, no patients in 21 Fr group, p = 0.044); steinstrasse, renal colic and post-operative JJ stent requirement rates were higher in 21 Fr mPNL procedure (p: 0.018, p: 0.031 and p: 0.046, respectively). The hospitalization time was significantly higher in 21 Fr (p = 0.01). Conclusion: Although 21 Fr mPNL procedure has advantages such as better success rates and shorter operation time, some post-operative complications (steinstrasse, renal colic, post-operative JJ stent requirement) are against of 21 Fr mPNL when compared with 16.5 Fr mPNL procedure. Further randomized prospective studies with larger patient volume are needed to confirm these results.

PURPOSE:To evaluate patients, diagnosed with non-muscle invasive bladder cancer, according to patient specific parameters including hemoglobin level, estimated glomerular filtration rate (eGFR), body mass index (BMI) and cigarette smoking and to identify if any of these parameters matters in terms of recurrence prediction.METHODS:231 patients who have undergone transurethral resection of the bladder (TURB) between January 2015 and January 2018 and diagnosed with non-muscle invasive bladder cancer (NMIBC) were included. Patient demographic characteristics including age, sex, BMI and cigarette smoking were assessed. Hemoglobin, creatinine and eGFR values were recorded. Follow-up was performed according to the European Association of Urology (EAU) guidelines' recommendations. Recurrence and progression during follow-up were recorded.RESULTS:231 patients were included in the study. Median patient BMI, Hb levels, and eGFR values were 26.51 kg/m2 (IQR 5.48), 14,2 g/dL (IQR 2.50), and 83.25 ml/min/1.73m2 (IQR 27.83), respectively. Among all patients, 105 (45%) were ex-smokers and 78 (33%) were current smokers, 41 had anemia (17.7%), 37 (16%) patients were obese; 104 (45%) had mildly impaired renal function and 34 (14.7%) had impaired renal function. During follow-up, 67 (29%) patients had disease recurrence and 21 (9.1%) had disease progression (9.1%). Univariate and multivariate analyses revealed significant relationship between recurrence and obesity, impaired renal function and cigarette smoking.CONCLUSIONS:Recurrence is a commonly encountered unfortunate consequence of NMIBC, and obesity, renal failure, history of smoking and anemia seem to increase the rate of recurrence among bladder cancer patients.

Objective:The aim of this study is to describe a novel transobturator midurethral sling surgery technique by using rectus abdominis fascia. Material and methods:A 54-year-old woman complaining of urinary leakage during effort was diagnosed as pure stress urinary incontinence after detailed questioning, pelvic examination, uroflowmetry and measurement of residual urine volume.She was anxious about complications related to synthetic meshes.However, she was not interested in relatively morbid surgeries such as colposuspension and pubovaginal sling.Autologous transobturator midurethral sling was discussed with the patient.The patient approved the surgery and the surgery was planned.A 5 cm rectus fascia was harvested via suprapubic incision and nonabsorbable stay sutures were placed on its' both edges.Anterior vaginal incision together with paravaginal dissection was performed, as in classical transobturator sling surgery.Groin puncture and blind dissection of adipose tissue was performed.C-shaped trocars were inserted, and advanced through groin punctures and brought up to midurethral incision by finger guidance.Stay sutures were transported via C-shaped trocars to the groin puncture in both sides.Graft was positioned on the midurethral part without any tension and stay sutures were tied to create a tissue bridge on obturator membrane.Incisions were closed and vaginal tampon was placed.Patient was discharged at the first postoperative day.Results: At postoperative third and sixth months, patient was totally dry and did not have any voiding complaints.Small abdominal and vaginal incisions were clean, as well. Conclusion:Autologous transobturator midurethral sling surgery is a safe, effective and feasible surgical option for stress urinary incontinence in the era which mesh-related concerns are rising.Studies with larger volume and long-term follow up periods are needed.

Amaç: Bu çalışmada, stres üriner inkontinans tedavisinde sentetik meşlerle ilişkili komplikasyonlardan kaçınabilmek için sentetik meş kullanmadan midüretral askı cerrahisi tanımlanmak istenmiştir. Bu amaçla modifiye otolog transobturator midüretral askı cerrahisi (m-OTOT) tekniğimizin kısa dönem sonuçları sunulmuştur. Gereç ve Yöntemler: m-OTOT uygulanan 20 hastanın preop ve postop ''The International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS)'' skorları, 1 saatlik ped testi ölçümleri, stres testi sonuçları, yaşam kalitesi ölçeği (QoL) ve postop ''Patients Global Impressions of Improvements (PGII)'' skalasını içeren datalar toplandı. Kategorik değişkenler, eşleştirilmiş bir Student t-testi kullanılarak karşılaştırıldı. Bulgular: Yaş ortalaması 50,5±3,3, beden kitle endeksi 28,9±3,9 kg/m2 olan 20 hastanın ortalama takip süresi 3,9±0,8 aydır. Ortalama ameliyat süresi 42,7±7,5 dakika ve komplikasyon oranı 1/20 (%5) (lokal tedavi ile iyileşen vajinal erozyon)'dir. PGI-I skoru 2 olarak belirtilmiştir ve ameliyat öncesine göre daha iyi olma durumunun karşılığıdır. Pozitif stres test oranı ve 1 saatlik ped testinde ağrılık artışı oranları postoperatif dönemde anlamlı olarak düşüktü. ICIQFLUTS formunda inkontinans bölüm skoru ve inkontinans bölümü yaşam kalitesi skoru postop dönemde anlamlı iyileşme göstermiştir, ayrıca toplam ICIQ-FLUTS skorU ve toplam yaşam kalitesi skoru da anlamlı olarak iyileşmiştir. Sonuç: Stres üriner inkontinans cerrahisinde mesh ile ilişkili komplikasyonlarından kaçınmak için, modifiye transobturator orta üretral sling tekniğimiz, kısa süreli etkinliği ve güvenlik profili ile hastalar ve cerrahlar için uygun bir seçenektir.

Objective: Our aim is to compare the serum SIRT1 levels between patients with hypogonadotropic hypogonadism and healthy subjects.Material and method: Twenty-five male patients diagnosed with isolated hypogonadotropic hypogonadism (IHH) and thirty healthy male as a control group were included in the study. Serum SIRT1, hormone levels and biochemical parameters, age, body mass index and insulin resistance were compared in both groups.Results: Mean serum SIRT1 levels in patient and control group were 20.1 +/- 11.7 ng/ml and 12.8 +/- 7.1 ng/ml, respectively. Difference between both groups was statistically significant (p = 0.02). The difference of Homeostasis Model Assessment-Insulin Resistance index (HOMA-IR) between two groups was also statistically significant. Patient group had more insulin resistance than the control group and it was statistically significant (mean HOMA-IR 2.66 +/- 1.57 vs. 1.38 +/- 0.43; p = 0.002).Conclusions: This is the first human study that investigates SIRT1 levels and its relation with metabolic and hormonal parameters. We demonstrated that serum SIRT1 levels in patients with IHH were significantly higher than controls, and there is a negative correlation between testosterone and SIRT1 levels. The reason for elevated SIRT1 levels may be a compensation mechanism against both hypogonadotropic hypogonadism and insulin resistance. To understand the relation between SIRT1 and androgen deficiency, further large-scale randomized control studies are needed. (C) 2016 Asociacion Espanola de Andrologia, Medicina Sexual y Reproductiva. Published by Elsevier Espana, S.L.U. All rights reserved.

OBJECTIVE:To compare two different doses of lidocaine used for periprostatic nerve block on pain perception during transrectal ultrasound (TRUS) guided prostate biopsy. MATERIAL AND METHODS:A total of 288 patients with elevated prostate specific antigen (PSA) levels and/or abnormal digital rectal examination who underwent TRUS-guided prostate biopsy were included in the study. The patients were divided into 3 groups: Group 1 (n=103) prostate biopsy were performed after administering perianal intrarectal application of 10 mL 2% lidocaine gel, Group 2 (n=98) 2 mL of 2% lidocaine injection on each side following rectal installation of lidocaine gel and Group 3 (n=87) 4 mL of 2% lidocaine injection on each side after rectal instillation of lidocaine gel. Patients' pain scores during biopsy procedure were reported using visual analogue score (VAS). Independent sample t test, ANOVA test and Tukey test were used for statistical evaluation. RESULTS:The mean age, prostate volume and PSA level were 65.6±8.4 years, 58.2±34.8 mL, and 11.8±3.4 ng/mL respectively. There were no statistically significant differences in baseline characteristics between the groups. The mean VAS scores were 2.4±1.8 in Group 1, 2.5±1.9 in Group 2 and 1.6±1.6 in Group 3. Patients in Group 3, reported significant pain reduction compared with patients in Groups 1 and 2 (p=0.002, and 0.001, respectively). However, there was no statistically significant difference in VAS scores between Groups 1 and 2 (p=0.815). CONCLUSION:According to our results we recommend the use of perianal intrarectal lidocain gel application, and periprostatic nerve block with injection of 4 ml 2% lidocaine per side combination in TRUS-guided prostate biopsies. Further large-scale randomized control studies are needed to validate these finding.

BACKGROUND The aim of this study was to determine the duration that antibiotherapy should have in order to make total prostate-specific antigen (tPSA) levels decrease to normal ranges in patients without prostatitis symptoms but with total PSA levels around 4.01-9.9 ng/dL. METHODS A total of 129 male patients were enrolled and divided into either study group (N.=102) or control group (N.=27). The study group received a 21-day treatment with ofloxacin 400 mg/day, while the control group did not receive any treatment. tPSA and free PSA levels were measured on the 7th, 14th and 21st day, and at the 3rd, 6th, and 12th month of the study. tPSA levels and the number of patients whose tPSA levels decreased ≤4.0 ng/dL levels was recorded and analyzed for statistical significance. RESULTS At 7, 14, and 21 days mean tPSA values were all lower than baseline values and the differences were statistically significant (P<0.05). Of 102 patients 31, 38 and 36 patients had decreased tPSA levels at 7, 14, and 21 days, respectively. But when we compared 7th day mean tPSA levels with days 14 and 21, we found no statistical differences (P>0.05). Sixty-six patients had persistently high tPSA levels and 64 of them underwent prostate biopsy. Prostate cancer was detected in 8 of them (12.5%). CONCLUSIONS A seven-day course of antibiotherapy is enough to normalize PSA levels in gray-zone patients. If recurrence of PSA increase is seen during follow-up, antibiotherapy can be useful again in those patients who previously benefited from it, while it will prove unnecessary in those who did not have their tPSA level normalized by it.

Fifteen patients with small testicular masses not suspected to be malignant were included in the study, and permanent and frozen section analyses were evaluated. As a result frozen analysis, preoperative externalization of the suspected malignancy with a physical examination, ultrasonographic evaluation, and serum tumor marker analysis were concluded as key points for accurate decision making between TSS and radical orchiectomy.Background: We aimed to determine the safety, efficacy, and the concordance of permanent and frozen section analysis (FSA) of testis-sparing surgery (TSS) in patients who had small testicular masses that were not suspected to be malignant. Patients and Methods: Fifteen patients who underwent TSS were included in the study. TSS was performed for the patients who had testicular lesions <25 mm and testicular lesion volume <30% of the whole testis. All patients had normal serum tumor marker levels and ultrasonographic evaluation did not indicate malignancy. Surgery was performed via an inguinal approach with temporary cord occlusion and FSA of the lesions. Benign findings allowed for TSS, and cancer prompted total orchiectomy. Results: The mean patient age was 25.33 (range, 20-36) years. The predominant complaint was swelling (9 patients). The mean lesion diameter was 16 mm (range, 5-26 mm). Fourteen of all cases (93%) had benign pathology and underwent TSS. Only 1 patient, whose FSA revealed malignant formation, underwent radical orchiectomy. Final pathology of this patient was seminoma. Complete histopathologic concordance was observed between the results of frozen and permanent sections. TSS was performed with no intra-or postoperative complications. After a mean follow-up of 23 months (range, 6-44 months) all patients, except 3 who were lost to follow-up, were free of disease. Conclusion: The main key points for accurate decision-making between TSS and radical orchiectomy are intraoperative FSA and preoperative externalization of possible suspected malignancy with physical examination, ultrasonographic evaluation, and serum tumor marker analysis.

PURPOSE: The purpose of the study was to determine the life experiences and health-related quality of life (HRQOL) of patients living with a urostomy. DESIGN: Cross-sectional descriptive study. SUBJECTS AND SETTING: This prospective and descriptive study was carried out in a research and training hospital in Gaziantep, Turkey; data were collected from May 2009 to September 2011. Twenty-four participants had undergone a urostomy operation at least 4 months before study participation. METHODS: A form querying pertinent demographic and clinical information, combined with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QoL Q-C30) was used for data collection. Data collection forms were sent to the patients via mail in closed envelopes. The Mann-Whitney U, the Kruskal Wallis, and Wilcoxon signed rank tests were used for the comparative statistics; statistical significance was accepted when P values were <.05. RESULTS: The mean age of the 24 participants was 63.45 ± 6.33 years (mean ± SD; range, 49-72 years). The average time since surgery was 9.83 ± 2.34 months (range, 4-18 months). Most respondents stated that their urostomy affected their dressing habits (83.4%), sleep patterns (91.7%), family life (91.7%), participation in social activities (91.7%), and occupation (75.0%). All participants reported problems with psychological health and sexual activity following urostomy surgery. Analysis of EORTC QoLQ-C3 scores revealed that general wellness, functional condition, and symptomatic condition mean scores were lower than population-based norms associated with this instrument (54.16 ± 15.29, 44.07 ± 9.62, and 64.31 ± 12.56, respectively). CONCLUSIONS: Creation of a urostomy affected the patients' lifestyle and HRQOL negatively. Determining the patients' experiences, problems, and the change in HRQOL may provide assistance in designing appropriate nursing approaches to alleviate problems adapting to a urostomy.

1949 yılında tanımlanmış olan Anderson-Hynes açık dismembered piyeloplasti; primer üreteropelvik bileşke darlığının tedavisinde %90'lık başarı oranı ile hala altın standarttır. Üreteropelvik bileşke darlığının tedavisinde son iki dekatta minimal invaziv teknikler geliştirilmiştir. Popüler hâle gelen laparoskopik piyeloplasti ve robot yardımlı laparoskopik piyeloplastinin başarı oranları açık cerrahinin sonuçlarına yaklaşmaktadır. Transperitoneal veya retroperitoneal yaklaşımla gerçekleştirilebilmektedir. Laparoskopik piyeloplasti rekonstrüktif bir cerrahi olduğundan dolayı, anatomik yapıların dikkatli bir şekilde diseksiyonunda belirli bir eğitim ve laparoskopik vücut içi sütür ve bağlama tekniklerinde ciddi bir tecrübe gerektirmektedir. Bu çalışmada, üreteropelvik bileşkenin laparoskopik diseksiyonun takiben küçük bir flank insizyon sonrası yapılan kas ayırma tekniği ile ekstrakorporeal anastomoz yaptığımız üç Anderson-Hynes dismembered pyeloplasti olgusu sunulmuştur. Ortalama izlem süresi 36 ay idi. Cerrahi sonrası semptomlar düzeldi ve DTPA renal sintigrafi bütün olgularda üreteropelvik bileşke darlığı olmadığını doğruladı. İzlem süresinde herhangi bir komplikasyon veya nüks görülmedi. Ekstrakorporeal üreteropelvik anastomoz için laparoskopik yaklaşım ile kombine edilen kas ayırma tekniği üreteropelvik bileşke darlığı olan erişkin hastalarda güvenli, etkili ve minimal invaziv bir metottur.

Üreteropelvik bileşke darlığının tedavisinde altın standart açık dismembered piyeloplastidir. Üreteropelvik bileşke darlığının tedavisinde son iki dekadda minimal invaziv teknikler geliştirilmiştir. Popüler hâle gelen robot yardımlı laparoskopik piyeloplastinin başarı oranları açık cerrahinin sonuçlarına yaklaşmaktadır. Bu teknik, transperitoneal veya retroperitoneal yaklaşımla gerçekleştirilebilmektedir. Büyük renal pelvisi olan hastalarda; transperitoneal yaklaşım sırasında üreteropelvik bileşkeye mezokolon yoluyla direkt ulaşma kolon mobilizasyonu prosedürüne göre daha az zaman gerektirmektedir. Biz primer üreteropelvik bileşke darlığı olan 25 yaşındaki bir hastada robot yardımlı laparoskopik piyeloplasti gerçekleştirdik. Herhangi bir komplikasyon meydana gelmedi. Takip süresi 22 ay oldu. Postoperatif hastanın semptomları düzeldi ve DTPA renal sintigrafi üreteropelvik bileşke darlığı olmadığını doğruladı. Robot yardımlı laparoskopik transmezokolik piyeloplasti büyük renal pelvisi olan üreteropelvik darlıklı seçilmiş hastalarda isteğe bağlı yaklaşım olabilir.

SUMMARYThe treatment with robot-assisted Seminal vesicle cyst with ipsilateral renal and ureter agenesis is very rare condition. It can cause pain, infections and infertility also. Treatment choices are open , laparoscopic and the robot assisted laparoscopic surgery. Robotic technology offering not only a magnified 3-dimentional view and enhancing the tremor but also postoperative less analgesic reguirement improving postoperative outcomes with shorter recovery times and hospital stay. Here we reported our experience about robotic surgery for huge seminal vesicle cyst with contrast enhanged during abdominopelvic computed tomography which is accompanying ipsilateral renal agenesis.

CONTEXTO E OBJETIVO: Lasers sao amplamente utilizados no tratamento de hiperplasia benigna de prostata sintomatica. Na pratica atual, lasers de fosfato de titanilo de potassio (KTP) sao os tipos mais comuns usados dos sistemas. O objetivo foi avaliar o efeito rapido do sistema laser de alta potencia apos a aplicacao de hipericina.TIPO DE ESTUDO E LOCAL: Estudo experimental animal, realizado no Departamento de Urologia, Academia de Medicina Militar de Gulhane, Ancara, Turquia, em 2012.METODOS: 16 ratos foram divididos aleatoriamente em 4 grupos: 120W KTP laser + hipericina; 120W KTP laser somente; 80W KTP laser + hipericina; 80W KTP laser somente. Hipericina foi dada intraperitonealmente duas horas antes da aplicacao do laser. As incisoes a laser foram feitas atraves do musculo quadriceps dos ratos. A profundidade e a largura das incisoes a laser foram avaliadas histologicamente e registradas.RESULTADOS: Para padronizar o efeito do laser foi utilizada a razao entre profundidade e largura. Estes novos valores nos mostraram a profundidade da aplicacao do laser de largura por unidade. Os novos valores adquiridos foram avaliados estatisticamente. Os valores da media de profundidade/largura foram 231,6, 173,6, 214,1 e 178,9 nos grupos 1, 2, 3 e 4, respectivamente. O resultado mais notavel foi atingir altos graus de penetracao tecidual nos grupos com hipericina (P < 0,05).CONCLUSOES: Os resultados promissores do nosso estudo preliminar mostraram que hipericina pode melhorar os efeitos das aplicacoes do laser KTP.