Impact of Prostate Needle Biopsy on Erectile Function

Aim:To evaluate the impact of transrectal ultrasonography-guided prostate needle biopsy (TRUS-Bx) on erectile function.Methods:Patients who underwent TRUS-Bx were prospectively examined. The indications for prostate biopsy were elevated prostatespecific antigen (PSA) level and/or abnormal digital rectal examination. All patients were evaluated with the 5-item version of the International Index of Erectile Function (IIEF-5) before TRUS-Bx and at one, three and six months after TRUS-Bx. Severity of erectile dysfunction (ED) was classified into five categories according to IIEF-5 scores.Results:Eighty patients were included in the study. The mean age of the patients was 64.7 years and the mean serum PSA level was 10.2 ng/mL. The mean IIEF-5 score was 16.5 prior to TRUS-Bx. Before TRUSBx, ED was reported in 61 patients and mild, mild to moderate, and moderate ED in 23 (28.8%), 21 (26.2%), and 17 (21.2%) patients, respectively. Six months after TRUS-Bx, ED was reported as mild, mild to moderate, moderate and severe in 23 (28.8%), 21 (26.3%), 16 (20%) and one (1.3%) patients, respectively. The differences between before and after prostate biopsy were statistically insignificant (p>0.05).Conclusion:TRUS-Bx does not have a permanent effect on erectile function. It seemed to be a trend toward increasing ED at 1 month and longer follow-up showed that these changes resolved back to baseline

Efficiency and Reliability of Laparoscopic Partial Nephrectomy for Renal Tumors Larger than 4 cm

Aim: To evaluate safety and efficiency of laparoscopic partial nephrectomy for renal tumors larger than 4 cm. Methods: We retrospectivelly evaluated the medical records of 65 patients who underwent laparascopic partial nephrectomy between May 2009 and June 2013 in our clinic. The patients were divided into two groups according to tumor size. Patients with a tumor 4 cm were included in group 1 (n=45) and group 2 (n=20), respectively. Demographic, perioperative and postoperative parameters were compared between the groups. Histopathological examination and surgical margin status were also evaluated. Results: The mean age of the patients was 59.2±10.9 (range: 26- 81) years. The mean tumor size and the mean RENAL nephrometry score were significantly higher in group 2 than in group 1. The mean operation time and warm ischemia time were similar between groups but estimated blood loss and transfusion requirement were significantly higher in group 2. Convertion to open surgery was seen two patients in group 2 and one patient in group 1. Only one patient underwent radical nephrectomy for uncontrolled bleeding in group 2. There was no difference in preoperative and 3-month postoperative serum creatinine levels between the groups. The incidence of positive surgical margin was 0% and 5% in group 1 and group 2, respectively. Conclusion: Laparoscopic partial nephrectomy for renal tumors is an effective and feasible procedure with acceptable oncologic results. However, tranfusion rate and requiremet of pelvicaliceal system repair were more common in patients with tumor >4 cm. (The Medical Bulletin of Haseki 2015; 53:30-5

Robotic Surgery: Technological Developments and the Position in Urological Surgery

In this study, we discuss the place of robotic surgery in urology in the light of the current technological developments. Within the past 15 years, unprecedented advances have been experienced in robotic surgery. Urology has been played an active role in these developments. Owing to innovations of robotic surgery, some technical limitations of conventional laparoscopy have been overcome. Especially, some technical limitations of conventional laparoscopic surgery requiring reconstruction and operational challenges have significantly been solved. Despite these superior advantages, high cost of the method is the most important disadvantage. In the literature, the cost-effectiveness is the main point of discussions about robotic surgery. In the future, if the cost problem is resolved, robotic surgery will be the gold standard of treatment for the operations, such as partial nephrectomy, pyeloplasty, radical prostatectomy and radical cystectomy, which require more complex reconstruction

Is There a Concordance Between the Gleason Scores of Needle Biopsy and Radical Prostatectomy Specimens in Prostatic Carsinoma?

Aim: To evaluate the concordance between the Gleason Scores (GS) of prostate biopsy and radical prostatectomy specimens. Methods: Prostate biopsy was performed in 1135 patients with the suspicion of prostate cancer in our clinic between 2008 and 2012. A total of 366 patients were diagnosed with prostate cancer. Radical prostatectomy was performed in 73 of these patients and GS of pathology specimens were included in this study for comparison. The patients were divided into three groups (low intermediate- and high-risk patients) according to the D’amico risk classification for prostate cancer. Results: The median age of the patients was 64.2±6.1 years (54- 73). The mean prostate specific antigen level was 20.34 ng/mL and the mean biopsy core number was 12±0.58. A statistically significant concordance was detected between the GS of biopsy specimens and radical prostatectomy materials in 65.7% of patients (p<0.01). There were 40 patients in the low-risk group, however, 8 (20%) of them were identified to be intermediate-risk patients and one (2.5%) was found to be a high-risk patient after radical prostatectomy. Conclusion: Concordance between the GS of prostate biopsy and radical prostatectomy materials are important for selection of the appropriate treatmen

Applicability of Distal Hypospadias Surgery in State Hospitals: Retrospective Analysis of 48 Cases

Aim: Hypospadias is one of the most common malformations in the male genital tract and distal hypospadias is the most frequent type. In this study, we aimed to retrospectively analyze medical records of patients who have undergone distal hypospadias surgery between April 2011 and April 2013 in a state hospital. Methods: We retrospectively evaluated hospital records of 48 patients who have been operated for distal hypospadias between April 2011 and April 2013. All patients were operated by a single surgeon (AŞ). Patient age, type of hypospadias, the presence of chordee and history of circumcision were evaluated. In addition, duration of surgery, duration of catheterization, length of hospital stay, and short-term and long-term complications were recorded. Results: The mean age of the patients was 7.38±3.77years. Subcoronal hypospadias was the most frequent type and eight of patients had chordee. A total of 42 patients underwent tubularized incised plate urethroplasty (TIPU) and six patients underwent meatal advancement and glanduloplasty (MAGPI). The mean duration of surgery was 83.41±25.65 minutes. None of the patients had a short-term complication; meatus stenosis developed during long-term follow-up in three patients who were treated by dilatation. Additionally, TIPU was performed in three patients in whom fistulas developed. Conclusion: We aimed to demonstrate that distal hypospadias surgery could be performed with low complication and high success rates in state hospitals by surgeons who receive training in hypospadias surgery. (The Me­di­cal Bul­le­tin of Ha­se­ki 2014; 52: 195-8

Percutaneous Nephrolithotomy: Our Results of a Single-Centre Analysis in 2300 Cases

Aim: In this study, we evaluated the results of 2300 patients who underwent percutaneous nephrolithotomy (PNL) between March 2002 and April 2013. Methods: In our clinic, a total of 2300 PNL operations were performed between March 2002 - April 2013. Demographic characteristics (age, gender), body mass index, stone features (side, size, location), clinical characteristics of the urinary tract (renal anomaly, previous surgery, previous extracorporeal shock wave lithotripsy), operation parameters (duration of the intervention and fluoroscopy, number of access, location of access, transfusion, complications), post-operative data (length of hospital stay, transfusion, complications, stone-free) were recorded on PNL forms. The data were analyzed retrospectively. Results: Of all the PNL operations, 1225 (53.2%) were left-sided, 1074 (46.6%) were right-sided and 1 was bilateral. The mean age of the subjects was 43.5 (7-83) years and the mean body mass index was 26.6 kg/m2 (12-51). A total of 46 (2%) cases had renal anomalies. There were 16 patients with horseshoe kidney. More than one accesses was performed in 18.6% of the patient and intercostal access was done in 9.8%. Perioperative and post-operative transfusion rates were 1.4% and 2.9%, respectively. The mean stone size was 7.5±4.1 cm2. Stone-free (SF) rate was 65.1% and success rate was 78.5%. Conclusion: With increasing experience and advances in endourology, PNL is being widely performed with low morbidity and high success in our country as in the world. (The Me­di­cal Bul­le­tin of Ha­se­ki 2013; 51: 19-24