Urodynamic findings of multiple sclerosis patients at a single institution

Aim: Multiple sclerosis (MS) is a chronic and progressive disease of the central nervous system (CNS). The destructive effect of MS on the urogenital system has been demonstrated in many studies especially in young adults. Urodynamic evaluation is recommended in the diagnosis of urogenital system pathologies for MS patients. Unfortunately, there are not enough studies evaluating the urodynamic examinations of MS patients in our country. In this study, urodynamic findings of patients with MS were evaluated. Material and Method: A total of 58 patients (39 female and 19 male) were included in the study. The urodynamic findings of the patients in the same center between January 2011 and October 2017 were evaluated retrospectively. Urodynamic evaluation was performed with 20 ml of infusion per minute according to the International Continence Society standards. Results: The mean age of the patients was 47.4 +/- 8.8 years. The mean duration of multiple sclerosis was 11.8 +/- 7.4 years. When the features of multiple sclerosis were evaluated, 13 (22.4%) patients had a progressive type, 20 (34.5%) had a secondary progressive type, and 25 (43.1%) had relapsing-remitting (with relapses and remissions). The urodynamic findings of the patients are shown in Table 1. Urodynamic evaluations of patients with urinary incontinence are reported as 'Urge type urinary incontinence' was observed in 30 (83.3%), 'stress type urinary incontinence' in 5 (13.9%) and 'mixed type urinary incontinence' in 1 (2.8%) patient. Discussion: Multiple sclerosis is a common neurological pathology which has different urinary system findings. Detrusor overactivity is the most common urinary manifestation, and patients may also have impaired contractility, detrusor sphincter dyssynergia, urodynamic stress incontinence, and bladder outlet obstruction

The role of human resources in the efficiency of innovation strategies

Küreselleşmenin sonuçlarından kaynaklanan ve organizasyonları adeta amansız bir rekabet ortamına sürükleyen günümüz ekonomik yapılarında, organizasyonlar varlıklarını sürdürebilmek için stratejiler oluşturmak ve bunları doğru bir şekilde uygulamak durumundadır. Bu stratejilerden en önemlileri arasında inovasyon stratejilerini saymak mümkündür. İnovasyon ve bu doğrultuda ortaya konacak stratejilerin temelinde insan faktörü yer almaktadır. Bu nedenden dolayı, literatür taramasına dayandırılarak ortaya çıkartılmış olan bu çalışmada; organizasyonlar için hayati faaliyetleri arasında sayılabilecek olan insan kaynakları faaliyetlerinin, inovasyon stratejilerinin verimliliğindeki rolü incelenmiştir.Çalışmada ilk olarak; çeşitli insan kaynakları faaliyetleri incelenmiş ve bu incelemeyi inovasyon ve inovasyon stratejileri takip etmiştir. Son bölümde ise; incelenmiş olan insan kaynakları faaliyetlei ile inovasyon stratejileri birlikte değerlendirilmiştir As a result of the effects of the globalization and current economic structure drive organizations to a relentless competitive environment, organizations create strategies to sustain their existence and must practice them correctly. Among the most important of these strategies are possible to count innovation strategies. Innovation and innovation strategies base on human factor. For this reason, this study, which is based on literature review, examines the role of human resource activities, which can count very vital activities, in the efficiency of innovation strategies.Firstly, in this study was worked on different human resources activities and then, innovation and innovation strategies were followed the first chapter. In the last chapter, the human resources activities and the innovation strategies, which were worked previous chapters, were evaluated together

Bilateral same-session flexible ureterorenoscopy for renal and/or ureteric stone disease treatment

Arda, Ersan (Trakya author)Objective: To evaluate the effectiveness and safety of bilateral same-session flexible ureterorenoscopy (f-URS) in the treatment of bilateral renal and/ or ureteric stone disease. Patients and methods: From October 2007 to December 2015, 62 patients who had undergone bilateral, same-session f-URS were included in the study. The procedures were performed under general anaesthesia, in lithotomy, and initiated on the side in which the patient was clinically symptomatic or on the side in which the stone was smaller. Plain abdominal radiography, intravenous urography, renal ultrasonography and/or non-contrast computed tomography scans were conducted in all patients. The success rate was defined as, patients who were stone-free or only had residual fragments of < 3 mm. Results: A total of 62 patients (43 male, 19 female), with a mean (SD) age of 39 (15.1) years, were included. The mean (SD) stone size was 23.2 (6.11) mm with a mean (SD) operative time of 58.8 (16.24) min. The stone-free rates were 90.3% and 100% after the first and second procedures, respectively. The mean (SD) hospital stay was 1.58 (0.72) days. There were minor complications (Clavien-Dindo grade I-II) in 10 (16%) patients and major complications (Clavien-Dindo III-IV), e.g. distal ureter laceration and laser injury of the ureter, in two patients. Conclusion: Same session bilateral f-URS is a successful and safe method for bilateral renal and/or ureteric stones. (C) 2018 Production and hosting by Elsevier B.V. on behalf of Arab Association of Urology

The clinical significance of abnormal ejaculation by silodosin. Is it important?

We aimed to evaluate the effect of the abnormal ejaculation (AEj) on patients using silodosin in terms of drug cessation. We also analysed the possible factors that may affect the decisions of patients with AEj to proceed or change their medication. The patients (n = 118) treated with silodosin 8 mg daily were prospectively analysed. In order to evaluate the erectile function, ejaculatory function, depression and sexual satisfaction; IIEF, MSHQ-EjD, Beck's depression and Golombok-Rust questionnaires were given to patients respectively. Patients were re-evaluated at the 3rd month of their treatment. The rate of AEj was 52.5%. Nearly 42% of the patients with AEj desired to stop their medication whereas it was 7.1% at patients without AEj (p <.001). The pre-treatment International Prostate Symptom Score (IPSS) and the decrease in IPSS score were significantly lower in patients who demand to stop their treatment (p <.05). AEj was significantly higher in patients who wanted to stop their medication (p <.001). Even if they had an AEj, patients who were happy with the clinical efficacy of silodosin did not want to change their drug. In addition to this, pre-treatment ejaculatory status was an important indicator for patients to decide drug cessation due to AEj side effect of silodosin. © 2021 Wiley-VCH GmbH

Tekirdağ İlindeki Ürologlar Üriner Sistem Taş Hastalığında Taş Analizi, Metabolik Değerlendirme ve Metafilaksi Yapabiliyor mu?

Objective: As the urolithiasis is an endemic situation in our country, the urologists are well-experienced about this situation. The prevention of urolithiasis recurrence is as important as the surgical treatment. For this reason metabolic evaluation and medical treatment of stone disease is extremely important. This study aimed to evaluate urological specialists' views of metabolic evaluation and medical treatment of urolithiasis. Thus, the main problems and the probable solutions about medical treatment and metabolic evaluation of urinary system stone disease can be evaluated. Methods: The urologists working at Tekirdag were invited to the study. A face-to-face questionnaire, which was composed of three parts, was performed to the participants. In the first section, the demographic characteristics of the participants were evaluated. In the second and third sections, the approach of participants to metabolic evaluation and medical treatment in urolithiasis were investigated, respectively. Results: A total of 29 urologist who routinely performed endourological surgery were included to the study. When we evaluated their endourological practice, 65.5% of the participants were performing 10-25 endourological surgery per month. When we asked the approach of participants about the metabolic evaluation, 34.5% reported that they did not perform metabolic evaluation to their adult patients and 65.5% did not perform to the children with urolithiasis. All participants believed the efficacy of medical treatment however, 66% of the participants were performing at less than half of their patients in clinical practice. Conclusions: The clinical practice about metabolic evaluation, stone analysis and metaphylaxis were lower than expected. Most of the participants were not able to make metabolic evaluation and stone analysis. Further studies are needed to resolve the problems associated with metabolic evaluation and metaphylaxis administration.Giriş: Üriner sistem taş hastalığı coğrafyamız açısından endemik bir durum olup, ülkemizdeki üroloji uzmanlarının üriner sistem taş hastalığı ile ilgili tecrübeleri oldukça yüksektir. Üriner sistem taş hastalığının cerrahisi kadar bu hastalığın nüksünü engellemek de bir o kadar önemlidir. Bu bağlamda, taş hastalığının metabolik değerlendirmesi ve medikal tedavisi son derece önem taşımaktadır. Bu çalışmada, Tekirdağ ilinde çalışan üroloji uzmanlarının, üriner sistem taş hastalığında metabolik değerlendirme ve medikal tedaviye bakış açılarının değerlendirmesi amaçlanmıştır. Yöntemler: Çalışmaya Tekirdağ ilindeki hastanelerde çalışan üroloji uzmanları davet edildi. Katılımcılara, toplam üç bölümden oluşan anket yüz-yüze uygulandı. Anketin ilk bölümde katılımcıların demografik özellikleri değerlendirildi. Anketin ikinci ve üçüncü bölümlerde ise sırasıyla üriner sistem taş hastalığında metabolik değerlendirme ve medikal tedaviye yönelik katılımcıların yaklaşımları incelendi. Bulgular: Klinik pratiğinde rutin endoürolojik cerrahi uygulayan toplam 29 üroloji uzmanı çalışmaya dahil edildi. Katılımcıların %65,5’i ayda ortalama 10-25 endoürolojik cerrahi uygulamaktaydı. Metabolik değerlendirme ile ilgili görüşleri sorgulandığında katılımcıların %34,5’i erişkinlerde ve %65,5’i çocuk taş hastalarında metabolik değerlendirme uygulamadığını belirtti. Tüm katılımcılar üriner sistem taş hastalığında medikal tedavinin etkinliğine inanmaktaydı. Ancak katılımcıların %66 ’sı klinik pratikte medikal tedaviyi hastaların yarısından azında uygulamaktaydı. Bunun sebebi sorulduğunda katılımcıların yarısına yakını, metabolik değerlendirme için olanaklarının olmadığını belirtti. Tartışma: Çalışmamızda, katılımcıların metabolik değerlendirme, taş analizi ve metafilaksi konusundaki uygulamalarının beklenilenden daha düşük olduğu görüldü. Katılımcıların çoğu metabolik değerlendirme ve taş analizi yapamadıklarını belirtti. Metabolik değerlendirme ve metafilaksi uygulanması ile ilgili problemlerin çözülmesine yönelik daha fazla çalışmaya ihtiyaç vardır

Predictive and prognostic impact of preoperative complete blood count based systemic inflammatory markers in testicular cancer

Purpose: To determine the utility of preoperative complete blood count (CBC) based systemic inflammatory markers in the prediction of testicular cancer and its prognosis. Material and Methods: Between 2008-2017 the data of all testicular tumor patients undergoing radical orchiectomy were retrospectively analyzed. Patient baseseline characteristics (age, tumor stage, tumor markers, etc.) and results of routine preoperative blood tests including mean platelet volume (MPV), red cell distribution width (RDW), lymphocyte ratio (LR) and neutrophil ratio (NR) were retrieved. In addition, neutrophil to lymphocyte ratio (NLR) was calculated. Results: Mean age of the tumor and control group was 36.0 +/- 15 and 30.50 +/- 11 years, respectively. Mean RDW, NR and NLR were significantly higher in the tumor group with p values<0.001; whereas LR and MPV were significantly higher in the control group (p<0.001). Receiver Operating Characteristic (ROC) analyses of LR, NR, RDW, MPV, and NLR are shown in Table-3. The cut off values for RDW and NR were found as 13,7 (Area under the curve (AUC): 0.687, sensitivity = 42.2%, specificity = 84.8%) and 55.3 (AUC:0.693, sensitivity 72.2%, specificity 62%), respectively. Area under the curve for NLR in tumor group was 0.711, with a threshold value of 1.78 and sensitivity=81.8% and specificity= 55.4% (AUC:0.711/sig<0.001) that together with RDW exhibited the best differential diagnosis potential which could be used as an adjuvant tool in the prediction of testicular tumor and its prognosis. Conclusion: Several systemic inflammatory markers, which are obtained by routinely performed cost-effective blood tests, could demonstrate incremental predictive and prognostic information adjuvant to preoperativly achieved testiscular tumor markers

Chronic Bacterial Prostatitis in a Turkish Population: The Microbiological Etiology and Distribution

Objective: To investigate the category 2 frequency and microorganism distribution of patients diagnosed with chronic prostatitis in a Turkish population. Methods: Data of 3200 patients diagnosed with chronic prostatitis in the urology outpatient clinic between 2009 and 2014 were retrospectively reviewed. The symptom scores were calculated considering the National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) according to pain (0-21 points), quality of life (0-12 points), and urinary (0-10 points) subdomains to a total score of 0-43 points. All patients were checked for symptoms, urinalysis, expressed prostatic secretion (EPS), or urine after prostatic massage (VB3) culture and PCR (Polymerase Chain Reaction) of EPS or VB3 for Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma hominis, Mycoplasma genitalium, and Trichomonas vaginalis. Results: The mean age of the patients was calculated as 37.7 +/- 7.4 (range 22-65) years. The average of total NIH-CPSI score was determined as 9.08 (range 1-40). In 223 of 3200 patients, positive culture and/or PCR results were observed. The results were as follows: E. coli 27 (12.1%), E. faecalis 18 (8.1%), S. epidermidis 15 (6.7%), S. haemolyticus 10 (4.5%), S. aureus 5 (2.2%), S. agalactiae 4 (1.8%), Pseudomonas 3 (1.3%), C. trachomatis 24 (10.8%), U. urealyticum 95 (42.6%), M. genitalium 6 (2.7%), M. hominis 14 (6.3%), and T. vaginalis 2 (0.9%). Conclusion: In a Turkish population, category 2 patients constitute 7% of all chronic prostatitis patients. This ratio is consistent with the NIH classification of prostatitis data, but it differs etiologically with U. urealyticum, E. coli, and C. trachomatis being the most proliferated pathogens in our study

Comparison of transurethral incision of the prostate and silodosin in patients having benign prostatic obstruction in terms of retrograde ejaculation

Background: To compare the functional outcomes and retrograde ejaculation (RE) after transurethral incision of the prostate (TUIP) or silodosin in bladder outlet obstruction (BOO) secondary to a small prostate. Methods: Prospectively collected data from December 2011 through December 2014 of 192 LUTS patients having fertility concerns with prostate volume smaller than 40 ml receiving either TUIP or silodosin treatment were prospectively reviewed. The treatment outcomes were evaluated and compared. Results: TUIP was performed in 96 cases and silodosin 8 mg was prescribed in 96 cases. At 12th months after TUIP or continuous silodosin treatment, the decrease in mean International Prostate Symptom Score (IPSS) and postvoiding residual urine (PVR) and the improvement of mean maximal flow rate (Qmax) were significant (p = 0.000). The improvement in IPPS and Qmax was significantly higher in TUIP group compared to silodosin group (p = 0.005, p = 0.000) with a lower rate of retrograde ejaculation (RE) in TUIP group. (11/96 vs 33/96) (p = 0.000) Conclusions: Both TUIP and silodosin ensures comparable improvement in PVR, IPSS and Qmax with a lower rate of RE on the TUIP group in prostates weighing less than 40 grams suggesting that TUIP is a better choice in younger patiens seeking preservation of ejaculation with fertility concerns

The value of hematological inflammatory parameters in the differential diagnosis of testicular torsion and epididymorchitis

Objective: Aim of this study is to investigate the effectiveness of mean platelet volume (MPV), neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) values, that can easily be obtained with complete blood count (CBC), in the diagnostic differentiation of testicular torsion and epididymorchitis. Method: Data of patients, who admitted to the urology or emergency departments, diagnosed with acute scrotum, between 20082017, were reviewed and retrospectively extracted. Basic characteristics (age,etc.) of patients and blood test results were retrieved. Inflammatory markers such as MPV, NLR and PLR were compared between groups. Result: After determining inclusion/exclusion criteria, a total of 111 patients were divided as testicular torsion, epididymorchitis and control group, including 37 patients each. Mean age of groups were 19.27 +/- 6.93, 26.27 +/- 6.23 and 23.24 +/- 8.49 years, respectively. Statistical significance was found in epididymorchitis and testicular torsion groups compared to the control group according to NLR (P<0.01). PLR showed a statistically significant relationship only with the epididymorchitis group and control group (P=0.46). However, according to MPV values, no statistically significance was found between the groups. Additionally, ROC analyse was performed to evaluate predictive cut-off values of NLR and PLR for the diagnostic differentiation of both groups. Conclusion: Inflammatory markers, obtained from routinely performed low-cost CBC, might be used as adjuvant parameters to differentiate acute scrotal pathologies like testicular torsion and epididymorchitis