INTRODUCTION:Leiomyomas of the genitourinary tract are rare and their manifestation in the ureter is even rarer. To our knowledge, only 14 cases of leiomyoma of the ureter have been reported worldwide since 1955, therefore this case will be 15th.CASE PRESENTATION:We present a rare case of primary leiomyoma of the right ureter. Ureteroscopy did not show any abnormal findings in the ureteral mucosa. The primary leiomyoma was resected with distal ureterectomy and partial cystectomy that was followed with ureteroneocystostomy due to extraluminal mass that caused hydronephrosis and back pain.CONCLUSION:Although rare, we believe that leiomyoma should be considered in the differential diagnoses of well-circumscribed ureteral masses and kidney-sparing surgery should be performed.

OBJECTIVE:After radical prostatectomy, prostate-specific antigen(PSA) value measuring ≥0.1 ng/mL is defined as persistent PSA(pPSA) and in many studies, it was found to be associated with aggressive disease and poor prognosis. Our aim in this study is to point out the pathological and clinical factors affecting pPSA among the patients who underwent robot-assisted radical prostatectomy(RARP) in an experienced academic centre and to make a useful risk grouping algorithm that can predict pPSA value based on operative data.METHODS:We examined records of 1273 patients who underwent RARP retrospectively. Preoperative, operative and postoperative data were collected. Based on the PSA values (ng/mL) measured after 4-to-8 weeks of RARP, patients were divided into two groups as pPSA group (Group1)(n = 97) with PSA values ≥0.1 ng/mL and undetectable PSA group (Group2)(n = 778) with PSA values <0.1 ng/mL. Later on, Group1 was further divided into Group1a (PSA:0.1-0.2 ng/mL) and Group 1b (PSA≥0.2 ng/mL) to evaluate biochemical recurrence(BCR).RESULTS:Multivariate logistic regression analyses of the collected data revealed that preoperative PSA≥20 ng/mL, operation time, a postoperative international society of urological pathology (ISUP) grade of ≥4, pT 3-4 and pN were independently associated with pPSA. Based on these results, a risk grouping algorithm predicting pPSA was developed. By looking at the risk grouping algorithm pPSA was found in 98.9% of the cases with a preoperative PSA value of ≥20 ng/mL, an operation time of 150 min, a postoperative ISUP grade of 4-5, a positive lymphovascular invasion (LVI) status, pT3-T4, and pN+; while pPSA was found in 25.5% of the cases with a preoperative PSA value of <20 ng/mL, an operation time of 100 min, a postoperative ISUP grade of <4-5, a negative LVI status, pT<3-4 and pN-. The estimated BCR-free survival time was 16.3 months in Group 1a and 57.0 months in Group2 (P < .001). Adjuvant treatment ratio was 64.9% in Group1 and 7.1% in Group2 (P < .001).CONCLUSION:For the patients who underwent RARP, factors associated with aggressive disease can predict the PSA persistence. To plan our treatment modalities accurately, an applicable risk grouping algorithm in daily practice would be useful.

Objective:After radical prostatectomy,prostate-specific antigen(PSA) value measuring ≥0.1ng/ml is defined as persistent PSA(pPSA) and in many studies,it was found to be associated with aggressive disease and poor prognosis.Our aim in this study is to point out the pathological and clinical factors affecting pPSA among the patients who underwent robot-assisted radical prostatectomy(RARP) in an experienced academic center and to make a nomogram,predicting pPSA value based on operative data,useful. Methods:We examined records of 1273 patients who underwent RARP retrospectively. Preoperative,operative,and postoperative data were collected.Based on the PSA values (ng/ml) measured after 4-to-8 weeks of RARP,patients were divided into 2 groups as pPSA group (Group1)(n=97) with PSA values ≥0.1ng/ml and undetectable PSA group (Group2)(n=778) with PSA values <0.1ng/ml.Later on,Group1 was further divided into Group1a (PSA:0.1-0.2ng/ml) and Group 1b (PSA≥0.2ng/ml) to evaluate biochemical recurrence(BCR). Results:Multivariate logistic regression analyses of the collected data revealed that PSA>20ng/ml,operation time,a postoperative international society of urological pathology (ISUP) grade of ≥4, pT 3-4, and pN were independently associated with pPSA.According to the results, a nomogram predicting pPSA was developed(Table 4).By looking at the nomogram pPSA was found in 98.9% of the cases with a PSA value of ≥20ng/ml, an operation time of 150 minutes, a postoperative ISUP grade of 4-5, a positive lymphovascular invasion (LVI) status, pT3-T4, and pN+; while pPSA was found in 25.5% of the cases with a PSA value of <20 ng/ml, an operation time of 100 minutes, a postoperative ISUP grade of <4-5, a negative LVI status, pT<3-4, and pN-.The estimated BCR-free survival time was 16.3 months in Group 1a and 57.0 months in Group2 (p<0.001).Adjuvant treatment ratio was 64.9% in Group1 and 7.1% in Group2 (p<0.001). Conclusion:For the patients who underwent RARP,factors associated with aggressive disease can predict the PSA persistence.To plan our treatment modalities accurately,an applicable nomogram in daily practice would be useful.

ÖZET Amaç: Çalışmamızda radikal prostatektomi (RP) yapılmış, metastatik olmayan prostat kanseri hastalarında ileri yaşın onkolojik sonuçlara etkisini araştırmak amaçlanmıştır

OBJECTIVES:To assess the relationship between prostate cancer and thiol/disulphide homeostasisas an important indicator of oxidative stress.METHODS:After ethics committee approval (546/2015); 388 patients aged between 46-75 years who underwent transrectal ultrasound guided prostatebiopsy in three different centers between July 2015-2016 owing to serum prostate specific antigen (PSA) levels ≥2.5 ng/ml and/or abnormal digital rectal examination were involved in this study. The plasma levels of thiol/disulphide homeostasis parameters were compared in patients with and without prostate cancer.RESULTS:The mean age of the patients was 62.9±7 years. In patients with prostate cancer (n=130, 33.5% ) the mean plasma levels of native thiol and total thiol were lower (332.9 vs 362.1 μmol/L and 363 vs 392.6 μmol/L, p=0.001). Plasma disulphide levels were not statistically different between the groups (15 vs 15.3 μmol/L, p=0.936). In prostate cancer group; patients with Gleason score ≥7 had lower plasma native thiol levels than patients with Gleason score<7 (321.3  vs 342.6 μmol/L, p=0.029) while there were no significant differences in total thiol and disulphide levels (352.3 vs 371.9 μmol/L, ptotal Thiol =0.064 and 15.5 vs 14.6 μmol/L, pdisulphide =0.933).CONCLUSIONS:Lower plasma levels of thiol in patients with prostate cancer and high Gleason score is an oteworthy result. We believe that our results should be supported by further studies.

Amaç: Bu çalışmada renal hücreli karsinom (RHK) nedeniyle radikal ve parsiyel nefrektomi yapılan hastaların evrelere göre onkolojik sonuçlarının karşılaştırılması amaçlanmıştır. Bu amaçla klinikopatolojik özelliklerin rekürrenssiz sağkalım ve kansere özgü sağkalım üzerine etkileri incelendi. Materyal-Metod: 2004-2012 tarihleri arasında renal kitle nedeniyle kliniğimizde parsiyel/radikal nefrektomi uygulanan T3a ve altındaki 200 hastanın verilerini retrospektif olarak inceledik. Klinikopatolojik özelliklerin sağkalımlara üzerine istatistiksel etkileri olup olmadığı Log-Rank testi kullanılarak Kaplan Meier sağkalım analizi ile değerlendirildi. Her bir değişkene ilişkin 1- 3 ve 5 yıllık sağkalım hızları, ortalama yaşam süresi ve bu süreyle ilişkili %95 güven aralıkları hesaplandı. Bulgular: Tüm olgular içerisinde 1- 3 ve 5 yıllık rekürrenssiz sağkalım % 95.5, 90.5 ve 85.5, kansere özgü sağkalım % 98.8, 96.4 ve 92.3 olarak tespit edildi. PN grubunda RN grubuna göre rekürrenssiz sağkalım istatistiksel olarak daha yüksekti (p=0,014) ama kansere özgü sağkalımda fark gözlenmedi. Evrelere göre T1a, T1b ve T3a’ da rekürrrenssiz sağkalım ve kansere özgü sağkalım T2a ve T2b’ den daha yüksekti (p=0,023 ve p lt;0,001). T1a ve T1b evrelerinde 1- 3 ve 5 yıllık rekürrenssiz sağkalım ve kansere özgü sağkalım benzer olarak bulundu ve klinikopatolojik özelliklerle istatistiksel olarak ilişki tespit edilmedi. Tüm olgular içerisinde patolojik tümör boyutu (p=0,026) ve diğer (Toplayıcı kanal karsinomu) histolojinin (p lt;0,001) rekürrenssiz sağkalımı etkilediği görüldü. Tüm olgular içerisinde multivariate analizlerde yaş (p=0,010) ve patolojik tümör boyutunun (p=0,018) kansere özgü sağkalımı etkilediği görüldü. Sonuç: T1a ve T1b böbrek tümörlerinde parsiyel nefrektomi ve radikal nefrektomi yapılan hastalar arasında rekürrenssiz ve kansere özgü sağkalımların benzer olduğu gözlendi ve prognozunun herhangi bir klinikopatolojik özellikten etkilenmediği gözlendi. Klinikopatolojik ve demografik özelliklerin ileri evrelerde sağkalımla ilişkili olabileceği düşünüldü.

OBJECTIVE:We evaluated the effect of diabetes mellitus (DM) on urinary continence after robotic radical prostatectomy (RARP). PATIENTS AND METHODS:Overall, 99 patients with DM and 213 patients without DM who underwent RARP with at least 2-year follow-up were included. The preoperative prostate biopsy Gleason scores and clinical stages of the groups were similar. The patients who were dry or used one safety pad per day were regarded as continent. Early (0-3 months), mid-term (4-12 months), and late-term (>12 months) continence rates were evaluated. RESULTS:In diabetic and nondiabetic groups, mean age was 63.3 ± 6.5 and 61.3 ± 6.8 years, respectively (p = 0.015). On the day of the removal of the urethral catheter, 61.6% (n = 61) of the diabetic patients and 99.1% (n = 211) of the nondiabetic patients were continent (p = 0.000). At third-month follow-up, 80.8% (n = 80) of the diabetic patients and 99.1% (n = 211) of the nondiabetic patients were continent (p = 0.000). At sixth-month follow-up, 89.9% (n = 89) of the diabetic patients and 99.1% (n = 211) of the nondiabetic patients were continent (p = 0.000). At first-year follow-up, 93.9% (n = 93) of the diabetic patients and 100% (n = 213) of the nondiabetic patients were continent (p = 0.001). At 18th-month follow-up, 96.0% (n = 95) of the diabetic patients and 100% (n = 213) of the nondiabetic patients were continent (p = 0.013). At second-year follow-up, 98.0% (n = 97) of the diabetic patients and 100% (n = 213) of the nondiabetic patients were continent (p = 0.115). Multivariate analysis showed that age and body mass index had no impact on urinary continence (p > 0.05). Presence of diabetes (p = 0.008) and duration (≥5 years) of diabetes (p = 0.004) were independent factors that had a significant negative impact on urinary continence. CONCLUSIONS:Diabetes seems to be a significant disadvantage in gaining urinary continence compared with nondiabetic patients particularly in the first 18 months after RARP. Diabetic patients should be informed about possible late recovery of postoperative urinary continence compared with nondiabetic patients after RARP.

ABSTRACT Introduction: The success of the robot assisted radical prostatectomy (RARP) procedures depend on a successful team, however the literature focuses on the performance of a console surgeon. The aim of this study was to evaluate surgical outcomes of the surgeons during the learning curve in relation to the bedside assistant's experience level during RARP. Materials and Methods: We retrospectively reviewed two non - laparoscopic, beginner robotic surgeon's cases, and we divided the patients into two groups. The first surgeon completed the operations on 20 patients with a beginner bedside assistant in February - May 2009 (Group-1). The second surgeon completed operations on 16 patients with an experienced (at least 150 cases) bedside assistant in February 2015 - December 2015 (Group-2). The collected data included age, prostate volume, prostate specific antigen (PSA), estimated blood loss, complications and percent of positive surgical margins. In addition, the elapsed time for trocar insertion, robot docking, console surgery, specimen extraction and total anesthesia time were measured separately. Results: There were no significant differences between the groups in terms of age, comorbidity, prostate volume, PSA value, preoperative Gleason score, number of positive cores, postoperative Gleason score, pathological grade, protection rate of neurovascular bundles, surgical margin positivity, postoperative complications, length of hospital stay, or estimated blood loss. The robot docking, trocar placement, console surgery, anesthesia and specimen extraction times were significantly shorter in group 2 than they were in group 1 (17.75 ± 3.53 min vs. 30.20 ± 7.54 min, p ≤ 0.001; 9.63 ± 2.71 min vs. 14.40 ± 4.52 min, p = 0.001; 189.06 ± 27.70 min vs. 244.95 ± 80.58 min, p = 0.01; 230.94 ± 30.83 min vs. 306.75 ± 87.96 min, p = 0.002; 10.19 ± 2.54 min vs. 17.55 ± 8.79 min, p = 0.002; respectively). Conclusion: Although the bedside assistant's experience in RARP does not appear to influence the robotic surgeon's oncological outcomes during the learning curve, it may reduce the potential complications by shortening the total operation time.

The elderly population is increasing in Turkey and across the world. With the frequent use of imaging modalities, the detection rate of coincidental small renal mass has also increased. Since small renal masses are generally not malignant, most of them can be followed up by active surveillance. In the current study, we examined the treatment options that can be offered to elderly patients with small renal masses. The optimum treatment method for patients of advanced age presenting with renal masses should be determined based on the presence of comorbidities such as age, renal function, and tumor characteristics.

Many techniques have been described for robotic assisted laparoscopic radical prostatectomy. Retizus sparing robotic radical prostatectomy is a technique which we believe that structures can be preserved good in order to have better fuctional ouıtcomes. Although the technique seems to be harder to perform, experience will make it easier and will help to reduce the opertaion time and complications.

The aim of this study was to investigate the protective effects of trimetazidine (TMZ), as an antioxidant agent, on streptozotocin (STZ)-induced diabetic rats. A total of 50 male Sprague Dawley rats were randomly classified into five groups as follows: Group 1 (control), Group 2 (STZ-induced diabetic rats), Group 3 (STZ-induced diabetic rats treated orally with 1 cc/day isotonic saline), Group 4 (diabetic rats treated orally with 10 mg/kg/day TMZ) and Group 5 (diabetic rats treated orally with 20 mg/kg/day TMZ). After 8 weeks, orchiectomy was carried out. Histopathological and electron microscopic examinations were performed in all groups. In groups 1 and 5, the structural and ultra-structural findings of the testicular tissue and spermatogenesis were found normal. In groups 2, 3 and 4, similar results were obtained in terms of the impaired testicular architecture and degeneration of spermatogenesis. The administration of an optimal dose of TMZ protects against the harmful effects of diabetes mellitus on spermatogenesis in rats. TMZ therapy can be used to maintain normal spermatogenesis in diabetic rats.

Introduction Urinary stone disease is a major urological condition.Endourologic techniques have influenced the clinical approach and outcomes.Open surgery holds a historic importance in the management of most conditions.However, complex kidney stone burden may be amenable to successful results with open stone surgery.In this article, we report our eighteen cases of complex urinary stone disease who underwent open stone removal.Material and methods A total of 1701 patients have undergone surgical treatment for urinary stone disease in our clinic between July 2012 and July 2016, comprising eighteen patients who underwent open stone surgery.Patients' demographic data, stone analysis results, postoperative clinical data, and stone status were evaluated retrospectively.The choice of surgical approach is mostly dependent on the surgeon's preference.In two patients, open surgery was undertaken because of perioperative complications. ResultsWe did not observe any Clavien-Dindo grade 4 or 5 complications.Three patients were managed with a course of antibiotics due to postoperative fever.One patient had postoperative pleurisy, one patient had urinoma, and two patients had postoperative ileus.Mean operation time was 84 (57-124) minutes and mean hospitalization time was 5.5 (3-8) days.Stone-free status was achieved in 15 patients (83.3%).Conclusions Endourologic approaches are the first options for treatment of urinary stone disease.However, open stone surgery holds its indispensable position in complicated cases and in complex stone burden.Open stone surgery is also a valid alternative to endourologic techniques in all situations.

Ronney Abaza Aly Abdel-Karim Haidar Abdul-Muhsin Mehran Abolbashari Ahmad Abolyosr Ashraf Abou-Elela Omar Aboumarzouk Jose Benito Abraham Sxenol Adanur Samiran Adhikary Ramez Adrawis Anshuman Agarwal Mayank Agarwal Madhu Agrawal Sachin Agrawal Rajesh Ahlawat Tom Ahlering Murat Akand Oktay Akca Yigit Akin Joseph Akornor Yılmaz Aksoy Abdulaziz Al Athel Turki Al Essawi Abdulla Al Naimi Samih Al-Hayek Ahmed Al-Kandari Khaled Al-Kohlany Peter Alken Nawar Alkhamesi Mohamad Allaf Stefanos Almpanis Abdulrahman Alruwaily Serkan Altinova Mario Alvarez-Maestro Sapan Ambani Alireza Aminsharifi Theodore Anagnostou Kevin Anderson Sero Andonian Hiury Andrade Guillermo Andres Jodi Antonelli Yoichi Arai Marco Arap I. Atilla Aridogan Angela Arlen Abdullah Armağan Noel Armenakas Monish Aron Sohrab Arora Nicola Arrighi Amir Arsanjani Murat Arslan Murad Asali John Asplin Dean Assimos Mohamed Atalla Hammad Ather Fatih Atug Brian Auge Riccardo Autorino Timothy Averch Emin Aydur Ali Ayyıldız Nessn H. Azawi Abdel-Rahmene Azzouzi Richard Babayan Christian Bach Alexander Bachmann William Badger Gopal Badlani Herman Bagga Badrulhisham Bahadzor Michael Bailey Mevlana Balbay Kristin Baldea D. Baldwin Yige Bao Shivadev Bapat Caner Baran John Barry Joseph Basler Zhoobin Bateni Richard Baverstock Mehmet Baykara Selahattin Bedir Dina Bedretdinova Frank Begun Darren Beiko Arie Belldegrun Jakob Ben-Chaim Brian Benway Aaron Berger Andre Berger Robert Berkenblit Norberto Bernardo Sara Best Akshay Bhandari Akshay Bhandari Mahendra Bhandari Shiv Bhanot Sam Bhayani Naeem Bhojani Giampaolo Bianchi Pierre Bigot Murat Binbay Saleh Binsaleh Vincent Bird Jay Bishoff Chandra Biyani Truls Bjerklund-Johansen Jerry Blaivas Romain Boissier Damien Bolton Hendrik Borgmann James Borin Ronald Boris Michael Borofsky Francisco Botelho David Bouchier-Hayes Pierluigi Bove Geoffrey Box Ugur Boylu Ibrahim Bozkurt Luis H.P. Braga Alberto Breda Gerry Brock Nicholas Brook Yuriy Brook Franck Bruyere Noor Buchholz Matthew Bultitude Juan Pablo Caballero Jeffrey Cadeddu Tommaso Cai Bodo Knudsen Jaime Landman Husain Alenezi Thomas Tailly Janak Desai Daniel Olvera-Posada Athanasios Papatsoris Demetrius Bagley Jens Rassweiler Roger Sur Kenneth Pace Mantu Gupta David Lee Ashok Hemal Kemal Sarica JOURNAL OF ENDOUROLOGY Volume 31, Number 4, April 2017 a Mary Ann Liebert, Inc. Pp. 422–425 DOI: 10.1089/end.2017.29026.ack

Purpose To examine the effect of steep Trendelenburg position (ST) on intraocular pressure (IOP), resistive index of the central retinal artery, and venous impedance index of the central retinal vein during robotic prostatectomy and cystectomy. Methods A total of fifty-three male patients were included into the study (prostatectomy: 43, cystectomy: 10). During robotic surgery, the effect of the ST on IOP, resistive index of the central retinal artery (CRA-RI), and venous impedance index of the central retinal vein (CRV-VI) was prospectively examined. The measurement times of IOP are as follows: T1: before anesthesia while supine and awake; T2: anesthetized and supine; T3: anesthetized and ST; T4: anesthetized, ST, and intraperitoneal insufflation; T5: anesthetized in ST at the end of the procedure with CO 2 ; T6: anesthetized in ST after desufflation; and T7: anesthetized supine before awakening. Results There was no difference between the IOP values of the right and left eyes in both groups. The highest IOP values were reached at T4 and T5. CRA-RI values were different, while CRV-VI values were similar at T1 and T4. Conclusions Despite staying in the ST for a long time provided that the ophthalmologic examination was normal, ocular complication risk is low in robotic prostatectomy and cystectomy.

Our aim was to evaluate the satisfaction of the patients who were implanted different kinds of penile prosthesis for erectile dysfunction. Male sexual health questionnarie satisfaction scale (MSHQ) were applied to patients implanted three types of penile prosthesis by one surgeon due to erectile dysfunction between October 2007-August 2014. MSHQ was consisted of 6 questions with answers 1 to 5. (1 extremely unsatisfied, 5 extremely satisfied) The questionnarie forms were filled either direct interview with the patients or by phone calls. A total of 41 patients were implanted penile prosthesis whom 35 were included in the study. Group 1 included patients implanted 2 pieces penile prosthesis and group 2 included patients implanted 3 pieces penile prosthesis. Mean age for group 1 and 2 were 55.5(33-71) and 56.8(41-68) respectively. Median MSHQ scores for group 1 and 2 were 23 (12-29) and 24 (8-29), respectively. Extremely and moderately (a+b) for both gruops were 72.9% and 71.3%, respectively. Satisfaction rates for both groups were generally acceptable. Patients’ characteristics and MSHQ results are shown in table 1,2 and 3. There was no surgical complication or treatment failure.

The aim of this study was to evaluate outcomes of robotic partial nephrectomy (RAPN) procedures. At two centers, 42 patients underwent RAPN. Radius, Exo/Endophytic, Nearness, Anterior/Posterior, Location (R.E.N.A.L.) nephrometry and PADUA scores of patients were calculated by computed tomography (CT) or magnetic resonance imaging (MRI). Intra-and perioperative (0-30 days) complications were evaluated using modified Clavien classification. A four-arm da Vinci-S robotic surgical system was used and outcomes were evaluated retrospectively. Mean age of the patients was 52.3 +/- 6.5 years. Mean tumor size was 3.1 +/- 1.0 (1.4-6.6) cm. R.E.N.A.L. nephrometry and PADUA scores were 6.0 +/- 1.5 and 7.5 +/- 0.9, respectively. Mean surgical time was 127.7 +/- 18.7 minutes and estimated blood loss was 100 +/- 18.1 cc. Mean warm ischemia time was 16.0 +/- 8.9 (0-30) minutes. Intraoperative complications did not develop in any patient. Median hospital stay was 3.0 (2-6) days. Except for 17 patients, hilar clamping was performed in 25 patients. Histopathology results included 34 renal cell carcinoma (22 clear cell, 7 chromophobe cell, 4 papillary cell, and 1 clear papillary cell). Oncocytoma (n = 4), adenoma (n = 1), fibroadipose tissue (n = 1), papillary epithelial hyperplasia (n = 1), and chronic pyelonephritis (n = 1) were present. Surgical margins were negative in all patients. During a median follow-up period of 15.5 +/- 10.9 (3-46) months, neither local recurrence nor distant metastasis was detected. In conclusion, RAPN is a safe, minimally invasive surgical approach, with excellent surgical and oncological outcomes in T1 kidney tumors. Zero ischemia off-clamp RAPN is also safe in selected masses with the advantage of avoiding complete renal ischemia. Copyright (C) 2015, Kaohsiung Medical University. Published by Elsevier Taiwan LLC.