Effects of the COVID-19 Pandemic on Bladder Cancer Diagnosis and Treatment Processes; A Turkish Multicenter Study

Objective: The coronavirus disease-2019 (COVID-19) pandemic effect diagnosis and treatment of certain conditions, including bladder cancer (BC). This study aimed to evaluate the effects of the COVID-19 pandemic on BC diagnosis and treatment.Materials and Methods: Following the approval of the ethics committee for the study, data of 869 patients who underwent surgery for BC in the 2-year period between March 1, 2019 and February 28, 2021 were analyzed retrospectively. The number of surgeries performed for BC, the time elapsed between symptoms and diagnosis, the treatments performed, and the operative pathologies were compared before and during the COVID-19 pandemic.Results: During the COVID-19 period, there was a decrease in the total number of BC surgeries compared to the pre-COVID-19 period (p=0.004). It was observed that this decrease was due to a decrease in patients newly diagnosed with BC (p=0.001) as well as the decrease in the number of primary transurethral resection for bladder tumor procedures performed. There was no difference in the tumor stages of the patients at diagnosis (p=0.9). Intracavitary Bacillus Calmette-Guerin therapy use in high-risk non-muscle invasive bladder cancers (NMIBC) patients also decreased (p=0.008) during the pandemic period. It was observed that the time between symptom and diagnosis was longer in MIBC than in NIMBC during both periods (p<0.001).Conclusion: Diagnosis and treatment of BC have been adversely affected by the ongoing COVID-19 pandemic. The decrease in the number of new diagnoses may not reflect a true decrease in BC incidence, meaning that BC cases that arose during the pandemic are likely to be diagnosed at a more advanced stage

Comparison of Penile Block and Caudal Block Applications in Patients Undergoing Circumcision Surgery

Objective: To evaluate the effectiveness of caudal block and penile block methods, in patients who underwent circumcision surgery in preventing postoperative pain. Materials and Methods: Patients who underwent elective circumcision surgery between January 2019 and May 2022 were retrospectively evaluated. After the exclusion criteria, 56 patients were included in the study. They were divided into two groups as penile block (group P, n=31) and caudal block (group C, n=25). Anesthesia technique applied, anesthesia duration, postoperative first micturition time, postoperative complications, time of first analgesia, analgesia need in the first six hours, observer pain score and Modified Pediatric Objective Pain Scale scores (MPOPS) were scanned. Results: When the first micturition time in the postoperative period was compared, it was found that group P took a significantly shorter time than group C (p=0.001). It was determined that group C needed analgesia in a shorter time than group P (p=0.028). When the MPOPS at 30th min (p=0.031), 90th min (p=0.043) and 6th hour (p=0.016) were compared, group C higher scores than group P. Conclusion: As a result, both methods can be used effectively and safely for appropriate pain control in patients who will undergo circumcision surgery. Both methods have advantages and disadvantages over each other. The choice of methods may vary with the experience of the surgeon and anesthetist

Management of Priapism: Results of a Nationwide Survey and Comparison with International Guidelines

Objective: The aim of this study is to evaluate current urologic practice regarding the management of priapism in Turkey and compare with international guidelines. Methods: Urologists and urology residents were invited to an online survey consisting of 30 multiple-choice questions on priapism-related clinical practices that were considered most important and relevant to practices by using Google Forms. Results: Total number of responses was 340. Respondents reported that they recorded a detailed patient’s medical history and physical examination findings (n = 340, 100%) and laboratory testing, which includes corporal blood gas analysis (n = 323, 95%). Participants announced that they performed Doppler ultrasound for 1/4 cases (n = 106, 31%), but 22% of the participants (n = 75) replied that they performed in >75% of cases. Participants (n = 311, 91%) responded that the first-line treatment of ischemic priapism is decompression of the corpus cavernosum. Moreover, most respondents (n = 320, 94%) stated that sympathomimetic injection drugs should be applied as the second step. About three-quarters of respondents (n = 247, 73%) indicated adrenaline as their drug of choice. Phosphodiesterase type 5 inhibitors seems to be the most preferred drug for stuttering priapism (n = 141, 41%). Participants (n = 284, 84%) replied that corpora-glanular shunts should be preferred as the first. A large number of participants (n = 239, 70%) declared that magnetic resonance imaging can be performed in cases with delayed (>24 hours) priapism to diagnose corporal necrosis. Most of the participants (84%) responded that penile prosthesis should be preferred to shunts in cases with delayed (>48 hours) priapism. Conclusion: It would be appropriate to improve the training offered by professional associations and to give more training time to the management of priapism during residency