An evaluation of factors affecting pain during transrectal ultrasonographic prostate biopsy: a real-life scenario in a retrospective cohort study

Background Periprostatic infiltration anesthesia (PPIA) and intrarectal topical anesthesia (IRTA) are recommended methods to control pain in transrectal ultrasonographic prostate biopsy (TRUS-Bx). This study evaluates the factors affecting pain during TRUS-Bx, considering the pathologies involved in anorectal pain etiology and comparing the effectiveness of local anesthesia techniques in providing patient comfort. Material and Methods We retrospectively evaluated 477 consecutive patients with TRUS-Bx for elevated Prostate Specific Antigen (PSA), abnormal rectal examination findings, or both. Patients were grouped as local anesthesia methods for pain control during TRUS-Bx. Both groups were compared in terms of age, body mass index, clinical T stage, PSA, prostate volume, number of biopsy cores, type of anesthesia, previous biopsy history, and presence of prostate cancer. We used a visual analog pain scale (VAS) to evaluate the patient’s pain status; pre-procedure (VAS-0), during probe insertion (VAS-I), administration of anesthetic (VAS-A), and simultaneous with the biopsy procedure itself (VAS-Bx). For PPIA and IRTA, 4 ml lidocaine 20 mg/ml injection and 5 g 5% prilocaine-5% lidocaine cream was used, respectively. Results The PPIA was used 74.2% (n = 354) and IRTA was used for 25.8% (n = 123) patients. VAS-0, VAS-I, and VAS-A scores are similar between groups. VAS-Bx was significantly higher in the IRTA than in the PPIA (3.37 ± 0.18 vs. 2.36 ± 0.12 p > 0.001). Clinical T stage (OR: 0.59), number of biopsy cores (OR: 1.80), and type of anesthesia application (OR: 2.65) were independent variables on TRUS-Bx for pain. Conclusion Three factors play roles as independent variables associated with the pain in TRUS-Bx; abnormal rectal examination findings, collection of more than twelve core samples during the biopsy, and the type of anesthesia used. Compared with PPIA, IRTA does not improve pain related to probe insertion, and using IRTA results in higher pain scores for biopsy-related pain. Thus, we recommend a PPIA to lower biopsy-related pain

Comparison between retroperitoneal and transperitoneal approaches in the laparoscopic treatment of Bosniak type I renal cysts: A retrospective study

Purpose: We retrospectively compared laparoscopic transperitoneal and retroperitoneal approaches for the decortication of simple renal cysts with respect to safety, postoperative pain, and clinical results. Materials and Methods: The study included 40 patients (28 males and 12 females) with symptomatic simple renal cysts and who underwent laparoscopic cyst decortication, and they were evaluated retrospectively. Patients' age, gender, disease-specific history, comorbid disease and family history, in general and urological and physical examination findings were recorded. Patients prior to surgery were evaluated by urinalysis, serum creatinine level, blood count, urinary tract ultrasonography, and unenhanced and contrast-enhanced abdominal computed tomography. Patients were informed about laparoscopic surgery and their written informed consent was taken. For those who preferred the laparoscopic approach, the placement of the cyst, history of prior surgery and obesity were evaluated. All patients filled out the visual analog scale (VAS) to evaluate postoperative pain. Results: The mean age of the patients were 54.65 ± 5.26 years in the retroperitoneal group and 56.0 ± 4.66 years in the transperitoneal group. For all patients the indication for surgery included right or left flank pain. The mean operative time for the transperitoneal approach was 51.5 min, and that for the retroperitoneal approach was 44.75 min. This difference was statistically significant between the two groups (P <.05). According to VAS scale, the retroperitoneal scoring method was found to be lower than the transperitoneal scoring method. All patients were discharged on the first postoperative day, and the drains were taken out. None of the patients had complications. At the end of six months, no clinical and radiological recurrence was detected in any patient. Conclusion: We consider the retroperitoneal approach to be the first-choice because of its shorter operation time and particularly low level of postoperative pain

Internal urethrotomy versus plasmakinetic energy for surgical treatment of urethral stricture

Purpose: we aimed to compare the longterm outcome of surgical treatment of urethral stricture with the internal urethrotomy and plasmakinetic energy. Material and Methods: 60 patients, who have been operated due to urethral stricture were enrolled in our clinic. None of the patients had a medical history of urethral stricture. The urethral strictures were diagnosed by clinical history, uroflowmetry, ultrasonography and urethrography. The patients were divided two groups. Group 1 consisted of 30 patients treated with plasmakinetic urethrotomy and group 2 comprised 30 men treated with cold knife urethrotomy. Results: There were no statistically significant differences between two groups in terms of patient age, maximum flow rate (Qmax) and quality of life score (Qol) value. A statistical difference between the two groups was observed when we compared the 3rd-month uroflowmetry results. Group 1 patients had a mean postoperative Qmax value of 16,1 ± 2,3 ml/s, whereas group 2 had a mean postoperative Qmax value of 15,1 ± 2,2 ml/s (p &lt; 0.05). In the cold knife group, 3 of 11 (27,7%) recurrences appeared within the first 3 months, whereas in the plasmakinetic group zero recurrences appeared within the first 3 months in our study. The urethral stricture recurrence rate up to the 12 month period was statistically significant for group 1 (n = 7, 23%) compared with group 2 (n = 11, 37%) (p &lt; 0.05). Conclusion: We believe that plasmakinetic surgery is better method than the cold knife technique for the treatment of urethral stricture

RETROGRAD İNTRARENAL CERRAHİ OPERASYONUNDA TAŞSIZLIK VE KOMPLİKASYONU ÖNGÖRMEDE MAKİNE ÖĞRENMESİ ALGORİTMALARI KULLANIMI

Amaç: Son yıllarda tıbbın her alanında olduğu gibi ürolojide deyapay zekanın alt kümesi olan makine öğrenmesinin kullanıldığı çalışmalar yaygınlaşmaktadır. Ancak literatürde retrograd intrarenal cerrahi (RIRS) yapılan böbrek taşı hastalarında taşsızlık şansı ve komplikasyon ihtimalini öngörmede makine öğrenmesi kullanılarak analizyapılan sadece birkaç çalışma bulunmaktadır. Biz de RIRS yapılanhastalarda taşsızlık şansı ve komplikasyon ihtimalini öngörebilmek içinmakine öğrenmesi metodları kullanarak analiz yapmayı amaçladık.Metod: Prospektif olarak oluşturulmuş Minimal İnvaziv ÜrolojiDerneği Taş Çalışma Grubu Veri Tabanı incelemeye alındı. (Minimal İnvaziv Üroloji Derneği Taş Çalışma Grubu Veri Toplama Projesiisimli, Ondokuz Mayıs Üniversitesi, Klinik Araştırmalar Etik Kurulu,2023/144 karar numaralı, B.30.2.ODM.0.20.08/223-276 sayılı gözlem nitelikli araştırma projesi) Veritabanından RIRS yapılmış hastalar seçildi. Veri setimizde yer alan hastaların R.I.R.S skorlama sistemi skorları, Seoul Üniversitesi böbrek taşı skorları ve Resorlu Unsalböbrek taşı skorları yer almaktaydı. Bu skorlar ve veri setimizde yeralan değişkenler kullanılarak oluşturulan tahmin modeli ayrı ayrı veçeşitli şekillerde kombine edilerek analiz yapıldı. Kullanılan makineöğrenmesi metodları; Lojistik Regresyon (LR), Radial Basis FunctionSupport Vector Machine (RBF-SVM) ve Random Forest (RF) idi.Sonuçlar: Şubat 2022 – Ocak 2023 arasında RIRS yapılmış 355hastadan eksik verileri olan 56 hasta çıkarıldıktan sonra 299 hastaçalışmaya dahil edildi. Taşsızlık 207/299 (%69,2) hastada elde edilmişken, 37/299 (%12,3) hastada komplikasyon görüldü. Taşsızlık vekomplikasyonu öngörmede 4 farklı skorlama sistemi için ayrı ayrı,bütün skorlama sistemleri birarada kullanılarak, bizim değişkenlerimizle oluşturduğumuz model kullanılarak ve bizim değişkenlerimizintüm skorlama sistemleriyle kombine edildiği model kullanılarak analizyapıldı. Her bir analizde LR, RBF-SVM ve RF algoritmaları ayrı ayrıçalışıldı. Bizim modelimizin AUC değeri; hem komplikasyonu (AUC: 0,86, RF-filtre) hem de taşsızlığı (AUC : 0,81, RF) öngörmede dörtfarklı skorlama sisteminin ayrı ayrı tek başlarına kullanıldığı analizlerden daha yüksek çıktı. Ayrıca bizim modelimizin hem komplikasyonuhem de taşsızlığı öngörmede AUC değeri en yüksekti. Detaylar Tabloolarak ekte verilmiştir.Tartışma: Bizim bilgimize göre literatürde RIRS yapılan hastalardataşsızlığı öngörmede makine öğrenmesi kullanımına dayanan sadecebirkaç adet çalışma bulunmaktadır. Ayrıca literatürdeki bu çalışmalarda skorlama sistemleri ile karşılaştırmalı değerlendirme yapılmamıştır. Bizim çalışmamızın özgün yanı, R.I.R.S. skorlama sistemi, SeoulÜniversitesi böbrek taşı skoru, Resorlu-Unsal taş skoru olmak üzere3 farklı skorlama sistemi ile karşılaştırmalı analiz yapmış olmamızdır.Komplikasyon ihtimalini ve taşsızlık şansını öngörmede bizim modelimizin prediktif değeri en yüksek bulundu. Bu çalışma ön sonuçlarıiçermektedir. Minimal İnvaziv Üroloji Derneği Taş Çalışma Grubu VeriTabanı’na prospektif olarak veri girişi devam etmektedir</p

Nation-wide analysis of the impact of Covid-19 pandemic on daily urology practice in Turkey

Ozkent, Mehmet Serkan/0000-0002-6613-0671; Mercimek, Mehmet Necmettin/0000-0002-0680-4451; karabay, emre/0000-0003-1654-8524; Sen, Volkan/0000-0003-2832-0682; Ceyhan, Erman/0000-0001-8223-6399; Irer, Bora/0000-0002-7719-9033; deger, dogan/0000-0002-5095-7770WOS: 000584084200001PubMed: 32996259Objective To present a nation-wide analysis of the workload of urology departments in Turkey week-by-week during Covid-19 pandemic. Methodology the centres participating in the study were divided into three groups as tertiary referral centres, state hospitals and private practice hospitals. the number of outpatients, inpatients, daily interventions and urological surgeries were recorded prospectively between 9-March-2020 and 31-May-2020. All these variables were recorded for the same time interval of 2019 as well. the weekly change of the workload of urology during pandemic period was evaluated, also the workload of urology and the distributions of certain urological surgeries were compared between the pandemic period and the same time interval of the year 2019. Results A total of 51 centres participated in the study. the number of outpatients, inpatients, urological surgeries and daily interventions were found to be dramatically decreased by the 3rd week of pandemics in state hospitals and tertiary referral centres; however, the daily urological practice were similar in private practice hospitals throughout the pandemic period. When the workload of urology in pandemic period and the same time interval of the year 2019 were compared, a huge decrease was observed in all variables during pandemic period. However, temporary measures like ureteral stenting, nephrostomy placement and percutaneous cystostomy have been found to increase during Covid-19 pandemic compared with normal life. Conclusions Covid-19 pandemic significantly affected the routine daily urological practice likewise other subspecialties and priority was given to emergent and non-deferrable surgeries by urologists in concordance with published clinical guidelines