Effect Of RENAL Nephrometry Score On the outcome Of Laparoscopic Partial Nephrectomy In Urologists At The Beginning Of the Learning Curve

INTRODUCTION: Surgical experience and tumor characteristics are extremely important in laparocopic partial nephrectomy surgery (LPN). Most of the studies examining the relation of R.E.N.A.L.nephrometry score to surgical success have examined the results of experienced surgeons. In this study, we investigated the effectiveness of R.E.N.A.L. nephrometry score (RNS) in predicting complications and success for urologists who are at the beginning of the learning curve for laparoscopic partial nephrectomy. METHODS: The first 30 cases of LPN performed by a single surgeon were evaluated, retrospectively. The patients were grouped according to the RNS as low-risk and medium-high risk. Operation time, warm ischemia time and were recorded. Postoperative blood transfusion rate, hospital stay, hemogram levels and pathology results (surgical margin and tumor type) were evaluated. The comparison of perioperative values of the two groups was done by Mann-Whitney U test. RESULTS: There was no statistically significant difference between operation time, warm ischemia time, hospital stay time, and intra-operative bleeding amount (p> 0.05) between the low risk group and medium-high risk group patients. The total complication rate was 33.3%. The compliction rate for the low risk group was 27% (n = 5) (major complication 5.5% (n = 1)) and 41.6% (n = 5) for the medium-high group (major complication 8.3% (n = 1)). In comparing the two groups for complications, no significant difference was found (p = 0.46). DISCUSSION AND CONCLUSION: The R.E.N.A.L.nephrometry score does not affect the success and complication rates of urologists at the beginning of the learning curve in LPN surgery

Acute prostatitis after prostate biopsy under ciprofloxacin prophylaxis with or without ornidazole and pre-biopsy enema: analysis of 3.479 prostate biopsy cases

Objectives: To investigate the characteristics of cases of NIH category I acute prostatitis developed after transrectal prostate biopsy and clarifiy the risk factors and preventive factors. Materials and Methods: We retrospectively reviewed the medical records of 3.479 cases of transrectal ultrasound-guided needle biopsies performed with different prophylactic antibiotherapy regimens at two different institutions between January 2011 and February 2016. The patients of Group I have received ciprofloxacin (n=1.523, 500mg twice daily) and the patients of Group II have received ciprofloxacin plus ornidazole (n=1.956, 500mg twice daily) and cleansing enema combination as prophylactic antibiotherapy. The incidence, clinical features and other related microbiological and clinical data, were evaluated. Results: Mean age was 62.38 +/- 7.30 (47-75), and the mean prostate volume was 43.17 +/- 15.20 (21-100) mL. Of the 3.479 patients, 39 (1.1%) developed acute prostatitis after the prostate biopsy procedure. Of the 39 cases of acute prostatitis, 28/3.042 occurred after the first biopsy and 11/437 occurred after repeat biopsy (p=0.038). In Group I, 22 of 1.523 (1.4%) patients developed acute prostatitis. In Group II, 17 of 1.959 (0.8%) patients developed acute prostatitis. There was no statistical difference between the two groups according to acute prostatitis rates (X2=2.56, P=0.11). Further, hypertension or DM were not related to the development of acute prostatitis (P=0.76, X2=0.096 and P=0.83, X2=0.046, respectively). Conclusions: Repeat biopsy seems to increase the risk of acute prostatitis, while the use of antibiotics effective for anaerobic pathogens seems not to be essential yet

Evaluation of various active surveillance protocols in prostate cancer

Objective: This study aims to investigate whether pathology results obtained by radical retropubic prostatectomy (RRP) were correlated with active surveillance (AS) criteria defined by Klotz, Soloway and D’Amico. Materials and Methods: In our clinic we evaluated 211 patients with diagnosis of localized prostate cancer who underwent RRP between 2007 and 2012. AS criteria defined by Soloway (cT ≤ T2, PSA ≤ 15 ng/dl, Gleason ≤ 6), Klotz (cT1c-T2a; if age ≥ 70 PSA ≤ 15 ng/dl, if age < 70 PSA ≤ 10 ng/dl; if age ≥ 70 Gleason ≤ 7(3+4), if age < 70 Gleason ≤ 6) and D’Amico (cT1c-T2a, PSA ≤ 10 ng/dl, Gleason ≤ 6) were used in our study. Pathological stages and Gleason scores were evaluated with coherence to AS protocols, mis-staging rates, biochemical recurrence (BC) of the mis-staged patients and death due to prostate cancer Data was analyzed using NCSS 2007 & PASS 2008 Statistical Software (Utah, USA). Chi square test and Mann-Whitney U test were applied for analyzing qualitative data. Significance was determined as p < 0.05. Results: 137 (64.9%) patients were coherent with Soloway AS criteria, 118 (55.9%) with Klotz AS criteria and 108 (51.1%) with D’Amico AS criteria. Histopathological results of the patients grouped according to Soloway, Klotz and D’Amico AS protocols showed high stage prostate cancer in 40 (29.2%), 32 (27%) and 27 (24.9%) patients, respectively. High grade prostate cancer rates in Soloway, Klotz, D’Amico groups were 55 (40.2%), 46 (38%) and 39 (36.1%); respectively. Misstaging rates of Soloway, Klotz and D’Amico AS protocols were determined as 65 (47.4%), 54 (45.5%) and 46 (42.5%), respectively. In the Soloway group BC rate was 21.9% in those with high stages. Relation between BC and high stage was found to be statistically significant (p < 0.05). Conclusion: Misstaging rates were relatively high in the three groups and there was no difference between the three groups in BC rates. Randomized studies with adequate follow up are needed

Adenocarcinoma in Orthotopic Neobladder 19 Years After Radical Cystoprostatectomy

Radical cystectomy and orthotopic neobladder are the most preferred surgical approaches for the treatment of invasive bladder cancer. Secondary tumour of ileum on neobladder is very rare. We report a 67-year man complaining of hematuria with the history of ileal neobladder for 19 years. An ileal adenocarcinoma of neobladder was detected with transurethral resection. He also had a non-functioning right kidney. A neobladderectomy. with right nephroureterectomy and ureterocutaneostomy was performed. An adenocarcinoma invading subserosal layer was reported. At six months postoperatively, patient was free of recurrence and progression. Seconder tumour of neobladder is a very rare condition. Early diagnosis and excision of neobladder may provide cure.WOS:0006485800000202-s2.0-85107082819PubMed: 3402787