Late Diagnosis of Bladder Injury During Cesarean Section

Intraoperative bladder injury in cesarean deliveries is an important complication that causes maternal morbidity. Bladder adhesions resulting from previous abdominal operations, cesarean section under emergency conditions, cesarean section after prolonged labor or in the second stage of labor are predisposing factors for bladder injury. In order to prevent bladder injury, it is important to be aware of bladder injury during peritoneal incision in risky cases, delivery of the baby, and hysterotomy and fascia closure. In this article, we present the diagnosis and treatment of a patient who was diagnosed with intraperitoneal bladder perforation, intra-abdominal abscess and peritonitis one week after cesarean section, in the light of current literature. In our case, intraoperative diagnosis could not be made, postoperative active hematuria was not observed, the focus was on the diagnosis of postoperative ileus, and intra-abdominal abscesses developed. A multidisciplinary team ensured success in the treatment

Comparison of before and after COVID-19 urology practices of a pandemic hospital

Objective: The aim of this study is to compare the effects of COVID-19 on urology practice using pre- and post-pandemic data of a pandemic hospital.Material and methods: March 11 is considered as the beginning of COVID-19 and, changes in the number of the outpatient clinic examinations, non-surgical procedures, and surgery in the 8-week period before and during the pandemic were evaluated by weeks. Age, gender, and comorbid diseases of the operated patients were compared statistically. The symptoms, complaints, mortality, and morbidity conditions of the patients were recorded by contacting them. Descriptive data and chi-square test were used.Results: The number of COVID-19 cases has been reported as 8,916 for the hospital, 88,412 for the city and 150,593 for the country. The mean age of the operated patients before and after 11 March was 51 and 47, and comorbidities were 79 and 40, respectively, and there was no statistically significant difference(p<0.05). The number of patients examined was 2,309 and 868, the number of operated patients 173 and 94, the number of patients undergoing non-surgical procedures were 371 and 174, respectively. The names and numbers of surgical and non-surgical procedures are listed according to European Association of Urology (EAU) priority classification. In follow-up, no complication because of COVID-19 was observed in any patient.Conclusion: Our study showed that, although the numbers have decreased, similar operations can be performed in daily urology practice without any contamination and mortality during the pandemic compared to the prepandemic period, by taking precautions and following the algorithms

Analysis of patients undergoing urological intervention amid the COVID-19: Experience from the pandemic hospital

Purpose It is reported that surgical procedures performed during the COVID-19 pandemic are accompanied by high complications and risks. In this study, the urological interventions applied with appropriate infrastructure and protocols during the pandemic in the pandemic hospital that is carrying out the COVID-19 struggle are analyzed. Methods Urological interventions were reviewed in the 5-week period between March 11 and April 16. The distribution of outpatient and interventional procedures was determined by weeks concurrently along with the COVID-19 patient workload, and data in the country, subgroups were further analyzed. Patients intervened were divided into four groups as Emergency, High, Intermediate, and Low Priority cases according to the EAU recommendations. The COVID-19-related findings were recorded; staff and patient effects were reported. Results Of the 160 interventions, 65 were minimally invasive or open surgical intervention, 95 were non-surgical outpatient intervention, and the outpatient admission was 777. According to the priority level, 33 cases had emergency and high priority, 32 intermediate and low priority. COVID-19 quarantine and follow-up were performed at least 1 week in 22 (33.8%) operated patients at the last week, 43 (66.2%) patients who were operated in the previous 4 weeks followed up at least 2 weeks. No postoperative complications were encountered in any patient due to COVID-19 during the postoperative period. Conclusion In the COVID-19 pandemic, precautions, isolation, and algorithms are required to avoid disruption in the intervention and follow-up of urology patients; priority urological interventions should not be disrupted in the presence of necessary experience and infrastructure

A whole-slide image grading benchmark and tissue classification for cervical cancer precursor lesions with inter-observer variability

he cervical cancer developing from the precancerous lesions caused by the human papillomavirus (HPV) has been one of the preventable cancers with the help of periodic screening. Cervical intraepithelial neoplasia (CIN) and squamous intraepithelial lesion (SIL) are two types of grading conventions widely accepted by pathologists. On the other hand, inter-observer variability is an important issue for final diagnosis. In this paper, a whole-slide image grading benchmark for cervical cancer precursor lesions is created and the “Uterine Cervical Cancer Database” introduced in this article is the first publicly available cervical tissue microscopy image dataset. In addition, a morphological feature representing the angle between the basal membrane (BM) and the major axis of each nucleus in the tissue is proposed. The presence of papillae of the cervical epithelium and overlapping cell problems are also discussed. Besides that, the inter-observer variability is also evaluated by thorough comparisons among decisions of pathologists, as well as the final diagnosis. [Figure not available: see fulltext.].Istanbul Technical University ; Yildiz Technical Universit

Preservation of antegrade ejaculation after surgical relief of benign prostatic obstruction is a valid endpoint

Purpose To review the current data on retrograde ejaculation (RE) and ejaculatory dysfunction (EjD) after endoscopic and minimally invasive surgical treatment of benign prostatic obstruction (BPO) and, their perceived impact in the quality of life (QoL) and sexual life of patients and their partners. Methods Narrative review of systematic reviews (SR) assessing comparative rates of RE, EjD or erectile dysfunction (EF) was carried out. Relevant articles on the prevalence of RE, EjD or EF and on their impact in the QoL or sexual life of patients and partners were manually selected based on relevance. Results Twelve SRs reporting on comparisons of different endoscopic/minimally invasive treatments of BPO were found. Data on outcomes varied widely. Overall, after conventional TURP or laser techniques 42-75% of patients present RE. Prostatic incision and ablative procedures present lowest rates of de novo RE or EjD whereas laser adenomectomy and ejaculation preservation procedures preserve antegrade ejaculation in 46-68% of patients. EjDs is associated to LUTS and present in 10% of sexualy active men before intervention. It modulates the QoL and sexual life of the couple. In spite of the scarce literature assessing patient's and partner's perception of postoperative EjD, it strongly suggests that both parties value the maintenance of the ejaculatory function. Conclusion Ejaculation-preserving techniques and minimally invasive techniques successfully prevent BPO treatment-induced RE or EjD in 70-100% of the cases. While this is appealing to patients and spouses, technique selection and treatment durability are issues to be discussed with the couple

Classification of cervical precursor lesions via local histogram and cell morphometric features

Cervical squamous intra-epithelial lesions (SIL) are precursor cancer lesions and their diagnosis is important because patients have a chance to be cured before cancer develops. In the diagnosis of the disease, pathologists decide by considering the cell distribution from the basal to the upper membrane. The idea, inspired by the pathologists' point of view, is based on the fact that cell amounts differ in the basal, central, and upper regions of tissue according to the level of Cervical Intraepithelial Neoplasia (CIN). Therefore, histogram information can be used for tissue classification so that the model can be explainable. In this study, two different classification schemes are proposed to show that the local histogram is a useful feature for the classification of cervical tissues. The first classifier is Kullback Leibler divergence-based, and the second one is the classification of the histogram by combining the embedding feature vector from morphometric features. These algorithms have been tested on a public dataset.The method we propose in the study achieved an accuracy performance of 78.69% in a data set where morphology-based methods were 69.07% and Convolutional Neural Network (CNN) patch-based algorithms were 75.77%. The proposed statistical features are robust for tackling real-life problems as they operate independently of the lesions manifold.Scientific Research Projects Coordination Department (BAP), Istanbul Technical University ; Yildiz Technical Universit

Changes in Testosterone Levels Following Surgical Sperm Retrieval in Men with Non-Obstructive Azoospermia: Systematic Review and Meta-Analysis

Purpose: Surgical sperm retrieval (SSR) is used to extract spermatozoa for use with intracytoplasmic sperm injection in men with obstructive and non-obstructive azoospermia (NOA). The procedure may lead to segmental devascularization, postoperative fibrosis, and atrophy with a subsequent decrease in testosterone. The aim of the study is to investigate the impact of SSR on serum levels of total testosterone (TT), follicle-stimulating hormone (FSH), luteinizing hormone (LH) testicular volume, and sexual function in infertile azoospermic men. Materials and Methods: In this systematic review and meta-analysis (SRMA), we searched articles in PubMed and Scopus exploring the impact of SSR on TT, FSH, LH, and testicular volume. The full-text articles were screened to assess eligibility before data extraction, quality assessment, and meta-analysis. Results: Seventeen studies meeting the inclusion criteria were finally analyzed and included 1,685 infertile, azoospermic men. Patients underwent SSR and were followed in the postoperative period (one week to 32 months). The analysis showed a significant reduction in TT (mean difference [MD] 3.81 nmol/L, 95% confidence interval [CI] 0.55:7.06; p=0.02) compared to pre-SSR values. We also observed insignificant differences in serum FSH (MD 5.08 IU/L, 95% CI-5.6:15.8; p=0.35), LH (MD-2.96 IU/L, 95% CI-6.31:0.39; p=0.08), and no change in testicular volume (MD 0.07 mL, 95% CI-1.92:2.07; p=0.94) after SSR. Sexual dysfunction was associated with hypogonadism, depression, and anxiety, especially in men with unsuccessful SSR and Klinefelter syndrome. Conclusions: The results of this SRMA indicate a significant reduction in TT after SSR. Sexual dysfunction after testicular sperm extraction and the potential negative impact of future SSR repeat should be considered during preoperative counseling

Segmentation of precursor lesions in cervical cancer using convolutional neural networks

Ülkemizde ve dünyada en sık görülen kanser tiplerinden olan rahim ağzı (serviks) kanseri, kanser öncüsü lezyonlarından gelişmektedir. Kanser öncüsü bu lezyonların saptanması, hastanın kanser olmadan tedavi olmasına olanak sağladığiçin önemlidir ve analizleri yapan patologlar tarafından tanısı konmaktadır. Bu çalışmada evrişimsel sinir ağları (ESA) yöntemi kullanılarak kanser öncüsü lezyonların otomatik tespitini gerçekletiren bir sistem tasarlanmıştır. Eğitim aşamasında sistemin görüntülerden lezyonları tanıma başarımı %92 olarak elde edilmektedir. Eğitim aşamasından sonra bütün görüntüler 60×60 boyutlarında bir pencere ile evriştirilerek bölütlenmektedir. İlgili lezyonların Dice katsayısına göre %81.71 başarı ile bölütlendiği bir model oluşturulmuştur.Cervical carcinoma is one of the frequently seen cancers in the world and in our country, develops from precursor lesions. These precursor lesions are analyzed by pathologists so that the diagnosis of the disease can be made. In this study, a system that performs automatic detection of pre-cancerous lesions was performed using the convolutional neural networks (CNNs). In the training phase, lesion recognition performance of the proposed system has reached 92%. Thereafter, whole image was segmented by using 60 × 60 pixel tiles during the training phase. After all, the precursor lesions were segmented with 81.71% Dice coefficient