Our Surgical Approach and Management Results in Renal Tumors

Objective:Surgery is the gold standard therapy method in renal tumors. Renal tumor surgery can be performed as open radical nephrectomy, open partial nephrectomy, laparoscopic radical nephrectomy or laparoscopic partial nephrectomy.Each technique has its own advantages and disadvantages. In this research, it was aimed to evaluate the renal tumor surgery techniques in our clinic and the oncologic data obtained from the patients.Material and Method:A total of 92 patients with a radiologically proven renal mass were underwent surgery between July 2011 and January 2018. The clinical, oncological and pathological results of these patients are evaluated according to their surgical approach retrospectively. The obtained data were evaluated according to the surgical technique.Results:The patients who have renal mass underwent partial nephrectomy (n:39), radical nephrectomy (n:38), laparoscopic radical nephrectomy (n:14) and laparoscopic partial nephrectomy( n:1). The most common pathologic tumor type is clear cell carcinoma (n: 56), the most common T stage is T1b (n: 39) and the most common tumor grade is Fuhrman grade 2 (n:34). Average tumor mass size of open partial nephrectomy patients are 3,3±1,8 cm, significantly smaller than the radical surgeries (p0,05).Conclusion:Surgery is still the best type of oncological treatment in renal tumors. Partial and laparoscopic radical nephrectomy has similar oncologic results with open radical nephrectomy in selected cases. Kidney tumor surgery results in our clinic have similar characteristics with the literature

The Results of Urodynamics and Pressure Flow Study of Patients with Neurological Disease in a Single Center for 12 Years: Neurogenic Bladder Etiology

Aim:Generally, urodynamic-pressure flow study (U-PFS) is performed on patients with lower urinary tract symptoms (LUTS) for verifying the diagnosis and evaluating the rate of response for treatment. The aim of the study was to assess the results of the U-PFS of patients according to the etiology of neurological disorders.Materials and Methods:The data of 2,489 patients who underwent U-PFS in our clinic between 2010-2022 were analyzed retrospectively. A total of 535 patients with LUTS and neurogenic disorder were included in the study. Patients were divided into subgroups according to their diagnosis. The patient’s age, gender, and U-PFS data (sensation of first urine, maximum cystometric capacity (MSC), maximum detrusor pressures in the filling phase, presence of urgency, and bladder compliance status) were evaluated and compared according to neurological disorders.Results:Cervical and lumbar disc disorder was found in 204 (38.1%) patients, multiple sclerosis (MS) in 103 (19.2%), and cerebrovascular incidents in 74 (13.8%) patients (SVI), spinal cord injury in 48 (8.9%), polyneuropathy in 43 (8.0%), Parkinson’s disease (PD) in 30 (5.6%), diabetic neuropathy in 18 (3.4%), and operated spine bifida (oSB) in 15 (2.8%) was detected. Detrusor pressures in the filling phase were compared according to neurological disorders, and detrusor pressures were statistically significantly higher in patients with oSB and PD (52.66±40.78 mmHg; 45.30±34.43 mmHg, respectively; p<0.001). When the MSCs were compared, it was observed that the bladder capacity was significantly lower in PD and ASD patients, whereas bladder capacity was relatively increased in lomber and servical disc disorder, spinal cord injury and polyneuropathy patients (respectively 308.71±190.25 mL, 264.81±140.25 mL, 491.90±167.49, 474.52±182.92, 447.67±168.03, p<0.001).Conclusion:These specific patient groups (oSB and spinal cord injury) are hazardous groups for the development of end-stage kidney failure. Clinicians should take into consideration that patients and their relatives have to be informed about possible long-term complications

Effect of Mitomycin - C and Triamcinolone on Preventing Urethral Strictures

Urethral stricture is a common disease with high recurrence rate. Several manipulations were defined to prevent the recurrence but the results were disappointing. This study aimed to evaluate the efficacy of triamcinolone and mitomycin-C on urethral stricture formation and their effect on inhibition of urethral fibrosis. A total of 24 New Zealand rabbits were divided into 3 groups. Urethras of rabbits were traumatized with pediatric resectoscope. Resection area was irrigated with 10mL saline, swapped with a cotton wool soaked with 0.5mg/mL MMC and injected by 40mg triamcinolone in groups 1, 2 and 3 respectively. Retrograde urethrogram was performed at 28th day of procedure and the urethra was removed for histopathologic evaluation. There were significant differences in urethral diameters and in lumen reduction rate between the control and study groups (p< 0.001). Compared to control group, all treatment groups showed mild fibrosis, less collagen bundle irregularity, and lower numbers of fibroblasts (p= 0.003). The Tunnel assay showed that the number of apoptotic cells in the submucosal connective tissue was quantitatively higher in control groups (p= 0.034). In the view of efficacy and safety, MMC and triamcinolone have the potential to replace the use of stents, clean intermittent catheterization, or long term catheters following internal urethrotomy. There were no statistically significant differences between two agents in terms of preventing urethral stricture formation in the present study. Mitomycin C and triamcinolone decreased the recurrence rates of urethral stricture

Combination therapies for the management of nocturia and its comorbidities

Nocturia is the most bothersome lower urinary tract symptom. It has a multifactorial etiology. It had been thought nocturia was a nonspecific symptom of lower urinary system dysfunction, but it has been determined that many diseases, related to different organ systems, might be reasons for this nonspecific symptom. Along with the importance of systemic diseases that cause nocturia, the symptom itself has adverse effects on patients’ health and quality of life. There are several studies reporting a direct relationship between nocturia and depression, cognitive dysfunction, mood disturbances, falls, and fractures. For this reason, it is important to treat nocturia both to increase quality of life and to decrease related complications. Treatment opportunities have been under investigation for 20 years. Most of the studies in the literature have reported the results of single-drug medication on nocturia, which may be insufficient for a situation that has such a multifactorial etiology. In this review, we evaluated the success of different treatment combinations on nocturia

Lateral Transperitoneal Laparoscopic Adrenalectomy: A Single Center Experience

Objective: Laparoscopic adrenalectomy is the gold stan­dard surgical technique for benign adrenal tumors. On the other hand, most surgeons still prefer to perform open surgery for adrenal tumors. This may be related with the surgeons opinions that laparoscopic adrenalectomy is an advanced laparoscopic surgery and has a high learning curve. In this article we present the results of our initial transperitoneal laparoscopic adrenalectomy cases. Methods: Lateral transperitoneal laparoscopic adrenal­ectomy cases that were performed between 2013 and 2015, were retrospectively analyzed. Patients demo­graphics, pathological types, operation time, blood loss, hospitalization time and complications were evaluated and compared with the literature. Results: A total of 21 patients were analyzed. Twelve (57.1%) patients had right and 9(42.9%) patients had left laparoscopic adrenalectomy. Mean operation time was 130.2±39.1 min, mean blood loss was 197.6±72.4 ml and mean hospitalization time was 3.09±1.57 days. Pathol­ogy reports of adrenal tumors were pheochromocytoma at 4 patients, myeloma at 1 patient and adenoma at 16 patients. Patients with tumor size > 5 cm had significantly higher blood loss, operation time and hospitalization time compared to tumors < 5 cm. (p<0.05) Conclusion: Laparoscopic adrenalectomy is a safe and feasible technique. Transperitoneal approach would be more suitable technique for initial cases. Surgeons must consider the tumor size and possible pathology of adrenal tumor to decide the surgical technique

Reliability and accuracy of varicocele videos in YouTube

Objectives: To evaluate the scientific impact of videos about varicocele on YouTube. Method: A cross-sectional study was conducted at Turkey in September 2020, and comprised YouTube videos related to varicocele. The videos were divided into 2 groups according to their reliability and accuracy using the European Association of Urology Sexual and Reproductive Guidelines 2020. A 5-point modified reliability (DISCERN) tool, Global Quality Score, and Journal of the American Medical Association scores of each video were calculated. The user’s engagements by total views, video-related comments, and “likes” and “dislikes” to the videos were compared. Data was analysed using SPSS 23. Results: Of the 151 videos assessed, 73(48.34%) were included; 36(49.3%) reliable and 37(50.7%) unreliable. All scores were significantly higher for reliable videos (p<0.05). The mean number of views was 108448±90567 for reliable and 392626±895897 for unreliable videos (p=0.044). The rates of “likes” and “dislikes” were similar between the groups, whereas the comment rate was significantly higher for reliable videos (p<0.05).  Most of the videos 40(54.8%) were uploaded by medical advertisements or for-profit companies, while those uploaded by universities or professional organisations were 19(26%). Conclusion: Nearly half of the varicocele-related videos on YouTube were unreliable, and the reliability of videos was not directly related to their popularity. Key Words: Social media, Ethics, Misinformation, Varicocele, Internet

Active Follow-Up Decision In Prostate Cancer; How Safe is The Biopsy Gleason Score?

Aim:With the invention of prostate specific antigen, incidental prostate cancer rates increased significantly and the patients had to be exposed to unnecessary treatments. For those patients with incidental prostate cancer, active surveillance was introduced in the guidelines and has been applied to the patients. But, the pathological mismatch between the transrectal ultrasonography guided biopsy and the radical prostatectomy specimens may risk the patients who need curative treatment. In this study, we aimed to compare the Gleason scores between radical prostatectomy specimens and transrectal ultrasonography guided biopsy.Material-Methods:The data of the patients, who had radical prostatectomy in our clinic between March 2011 and June 2016, had been retrospectively evaluated. The PSA value before transrectal ultrasonography guided biopsy, biopsy core numbers, cancer positive biopsy core numbers, cancer percentage and Gleason scores at biopsy have been noted, and compared with the Gleason score after radical prostatectomy, tissue cancer ratio in prostatectomy specimen, surgical margins and pathologic stage.Results:The data of 44 patients were evaluated. The Gleason score was 7 at 1 (16,6%) patient in both transrectal ultrasonography guided biopsy and radical prostatectomy.Conclusion:There are differences between transrectal ultrasonography guided biopsy Gleason scores and the radical prostatectomy Gleason scores. This differences especially are obvious in patients with Gleason score <7. The reliability of gleason scores reported by the pathologists might be questionable so, in order to decide active surveillance for patients, other variables (core-tumor ratio, tumor core number, PSA) must also be considered

The shrinkage effect of formalin on renal cell carcinoma: Does it change the stages?

Objective: To determine the shrinkage effect of formalin on renal cell carcinoma. Method: The retrospective study was conducted from October to November 2020 at Tekirdag Namil kemal University, Turkey and comprised all radical and partial nephrectomy cases performed by a single surgeon in a single clinic between January 2014 and August 2020. Preoperative images and postoperative pathology were reviewed by the same clinician. Preoperative longest tumour diameter of radiological images and pathological specimens measured after formalin fixation shrinkage were compared, and the effect of the difference between the two measurements on the circumference of the tumour was examined. The formalin related shrinkage rates of renal tumours according to the tumour size and the tumour types were also analysed. Data was analysed using SPSS 20. Results: Of the 101 cases, 58(57.4%) were of radical and 43(42.6%) of partial nephrectomy. Also, there were 77(76.2%) renal cell carcinoma cases, 22(21.8%) benign renal tumours and 2(1.9%) had other malignant tumours. There were 59(58.4%) males and 42(41.6%) females with an overall mean age of 58.1±12,2 years (range: 30-82 years). The mean radiological size of the renal tumours was 55.3±30.4mm and it was 52.9±31.6mm at pathological examination (p>0.05). Conclusion: Formalin fixation of tissues post-surgery caused a difference between the radiological and pathological dimensions. Though the difference was no significant, under-staging due to the shrinkage post-surgery should be considered. Key Words: Renal tumours, Tissue shrinkage, Formalin, radiological dimension, Pathological dimension. ---Continu