The efficacy of multiparametric prostate magnetic resonance imaging in the diagnosis and treatment of prostate cancer

Aim: To investigate the accuracy of multiparametric prostate magnetic resonance imaging (mpMRI) in determining the diagnosis and treatment options of prostate cancer (PCa), and its pathology correlation. Methods: Between October 2017 and January 2018, 73 patients were subjected to an mpMRI at our clinic. Of these patients, 11 were radical prostatectomy (RP) after treatment, and four were post- radiation therapy (RT) follow-up. The remaining 58 patients were assigned to the PSA elevation and / or positive digital rectal examination (DRE) patient group in this study and their outcomes were evaluated. Results: Of the 58 patients included in the study, 13 were found to have a PI-RADS 5 on mpMRI and in 9 (90%) of 10 patients undergoing simultaneous biopsy, PCa was detected. The biopsy results of all cases evaluated as PI-RADS 1 were benign. All of the patients who were ISUP 3 and above had a PI-RADS 5. Patients with a PI-RADS score of 4 and above being ISUP 2 and above was statistically significant (p=0.011). A case had undergone a previous radical prostatectomy assessment revealed that tPSA increased to 2 ng/ml during the follow-up, and so RT was added to the treatment; although LAP was identified in the left iliac region on an mpMRI performed upon the continued increase of tPSA. During the follow-ups of the patient who had regional RT, the tPSA dropped below 0.01 ng/ml. Conclusion: The results of our study show that mpMRI can gain a new and important place in urology due to the guidance it provides in biopsies, facilitating targeted biopsy, its effectiveness in determining treatment modalities and its importance in post-PCa treatment follow-ups

Impact of Reducing Irritative Symptoms in Non-Muscle Invasive Bladder Cancer During BCG Instillation: A Pilot Study

INTRODUCTION: We evaluated use of anticholinergics, mirabegron, and combination of anticholinergics with mirabegron during Bacillus Calmette-Guérin (BCG) instillation for reducing irritative symptoms in patients with non-muscle invasive bladder cancer (NMIBC). METHODS: Prospectively recorded data of NMIBC patients receiving BCG were retrospectively evaluated between August 2015 and April 2019. Patients with low-grade T1 solitary papillary lesions <4 cm were included in the study. Validated questionnaires (OAB-V8) for irritative symptoms adapted to Turkish language, and QoL index forms were filled out by the study participants. OAB-V8 scores of ≥8 were considered as an indication to start medical treatment for irritative symptoms. Groups were formed according to daily used anticholinergic drugs and combinations as follows: Group 1, tolterodine; Group 2, solifenacin 5mg; Group 3, mirabegron, and Group 4, mirabegron with solifenacin 5 mg. RESULTS: Mean follow- up period was 20.4+-6.8 months. There were 132 patients [110 men (83%) and 22 (17%) women] with irritative symptoms and NMIBC. Mean age of the study population was 59.7+-12.4 years. The OAB-V8 scores and QoL indexes significantly improved with all drugs. However, in subgroup analyses, Group 4 provided the most dramatic improvement in OAB-V8 and QoL index scores (P=0.02 for both). The longest in time to micturition was recorded in Group 4 (P=0.04). Tumour recurrence was similar for groups 12 months after BCG instillation (P=0.9), however the least recurrence was observed in Group 4. DISCUSSION AND CONCLUSION: Combination of solifecacin and mirabegron can reduce irritative symptoms, improve QoL, and prolong time to micturition, during BCG instillation in selected NMIBC patients. This combination may also decrease recurrence rates in this patient population

Sexual Function in Male Patients with Metabolic Syndrome and Effective Parameters on Erectile Dysfunction

Purpose: We aimed to investigate the relationship between metabolic syndrome and sexual function and effective parameters on erectile dysfunction (ED). Materials and Methods: A total of 1300 individuals were included in this study between January 2009 and July 2012. All of individuals were asked to fill in an International Index for Erectile Function (IIEF) questionnaire. The presence of metabolic syndrome was determined when any three or more of the five risk factors were present according to the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP)-III. Obese individuals were divided into six groups according to modified World Health Organization (WHO) definition. Effective parameters on erectile dysfunction were investigated in individuals with metabolic syndrome. Results: Metabolic syndrome was detected in 455 individuals (35%). Mean domain scores of IIEF for all parameters were higher in individuals without metabolic syndrome than individuals with metabolic syndrome (p < 0.05). Mean domain scores of IIEF were lower in individuals with class 3 obesity than individuals with other obese groups (p < 0.05) for erectile dysfunction. There was statistical difference in terms of mean score of IIEF-Erectile function between smoking and nonsmoking groups (p < 0.05). Seventy percent of individuals with metabolic syndrome and 45% of individuals without metabolic syndrome had ED (p < 0.001). Logistic regression analysis revealed that waist circumference (WC) was the most important criteria for ED (p < 0.05). Conclusions: Metabolic syndrome, smoking and obesity seem to be potential risk factors for ED. We recommend individuals with metabolic syndrome, smoking and obesity should be questioned about ED

Urodynamic Evaluation of Female Patients with Metabolic Syndrome

Objective: In this study, our main objective is to show the connection between metabolic syndrome (MetS) and bladder functions by using urodynamic evaluation in female MetS patients.Materials and Methods: 131 female patients referred to our clinic for urodynamic evaluation from April 2014 to December 2014 were included in our study. 85 of these patients were diagnosed with MetS (study group) meanwhile 46 patients did not meet MetS criteria (control group). MetS definitions were taken from National Cholesterol Education Program’s Third Adult Treatment Panel criteria. SPSS 17.0 was used for statistical analysis of data and p&lt;0.05 values were deemed as statistically significant.Results: Urodynamic results of 131 patients were analyzed and patients were divided into study and control groups in accordance with their MetS profile. 85 patients were included in the study group and rest 46 were used as the controls. A statistically significant difference was detected when IPSS results were separated into low, intermediate and severe between study and controls (p=0.007). Moreover, urge-type incontinence was more frequent in MetS patients when compared with control group (p&lt;0.001). However, there was no significant difference between groups in terms of SEAPI scores and IPSS. Patients with MetS had significantly higher detrusor, vesical and abdominal pressure in comparison with control group (p&lt;0.001). No significant difference was found in uninhibited contractions, first urinary sense, strong desire to urinate, Valsalva leak-point pressure (VLPP) and abdominal leak-point pressure (ALPP) parameters between the groupsConclusion: Our results showed that MetS and its components can be associated with neurogenic bladder symptoms due to peripheral neuropathy and urge incontinence. Female patients with MetS have significantly higher post-voiding residue and intravesical pressure in comparison with control group. Further clinical studies with longer and controlled series are necessary for clarification of the metabolic syndrome’s effect on bladder dysfunction on a molecular level

Can preoperative neutrophil lymphocyte ratio predict malignancy in patients undergoing partial nephrectomy because of renal mass?

ABSTRACT Purpose: To evaluate the importance of preoperative neutrophil lymphocyte ratio (NLR) predicting malignancy in patients who undergo partial nephrectomy due to renal mass. Materials and Methods: Seventy nine patients who underwent open partial nephrectomy for renal masses were included in this retrospective study. In preoperative routine blood tests, renal ultrasonography and contrast-enhanced computed tomography were performed for all patients. Preoperative neutrophil lymphocyte ratio were compared in patients with clear cell renal cell carcinoma (Group1, 65 patients) and benign lesions (Group 2, 14 patients). The predictive ability of NLR was analyzed by ROC curves and Youden Index method was used to identify the cut-off value for NLR. Results: The mean age of patients was 59.8±11.7 years in Group1 and 57.4±12.6 years in Group 2 (p=0.493). The mean tumor size was 3.8±1.2 cm in Group 1 and 3.3±1.0 cm in Group 2 (p=0.07). The median NLR was 2.48 (1.04) in Group 1 and 1.63 (0.96) in Group 2 (p<0.001). The area under a ROC curve was 0.799 (p<0.001). Conclusions: Preoperative neutrophil lymphocyte ratio may predict renal masses that can not be distinguished radiologically. Our results must be confirmed by large and properly designed prospective, randomized trials

The Effect of Combined Therapy with Tamsulosin Hydrochloride and Meloxicam in Patients with Benign Prostatic Hyperplasia Symptoms and Impact on Nocturia and Sleep Quality

Purpose We aimed to compare the effect and feasibility of a combined therapy with tamsulosin hydrochloride plus meloxicam, and tamsulosin hydrochloride alone in patients with benign prostate hyperplasia symptoms and impact on nocturia and sleep quality. Materials and Methods Four hundred male patients were included in this study between 2008 and 2011. Patients were randomly divided into two groups: one received tamsulosin hydrochloride 0.4 mg (Group 1, 200 patients) and the other tamsulosin hydrochloride 0.4 mg plus meloxicam 15 mg (Group 2, 200 patients) prospectively. Patients were evaluated for benign prostate hyperplasia (BPH) symptoms according to the American Urological Association clinical guidelines and sleep quality according to Pittsburgh Sleep Quality Index (PSQI). Patients were reevaluated after three months of treatment. The International Prostatic Symptom Score (IPSS), IPSS-Quality of Life (IPSS-QoL), maximal urinary flow rates (Qmax), average urinary flow rates (AFR), post void residual urine volumes (PVR), nocturia and Pittsburgh Sleep Quality Score (PSQS) were recorded at baseline and after three months. Results Mean age was 63.3 ± 6.6 and 61.4 ± 7.5 years in groups 1 and 2, respectively (p = 0.245). There were no statistically significant differences between both groups. Also, baseline prostate specific antigen (PSA), prostate volume, creatinine, International Prostatic Symptom Score (IPSS), IPSS-Quality of Life (IPSS-QoL), maximal urinary flow rates (Qmax), average urinary flow rates (AFR), post void residual urine volumes (PVR), nocturia and Pittsburgh Sleep Quality Score (PSQS) were similar in both groups. In addition, the total IPSS, IPSS-QoL, PVR, nocturia, and PSQS were significantly lower in Group 2 compared with Group 1 after treatment (p < 0.05). Qmax and AFR were higher significantly in Group 2 compared with Group 1 after treatment (p < 0.05). Conclusions Cyclooxygenase (COX)-2 inhibitors in combination with an alpha blocker may decrease benign prostatic hyperplasia symptoms and increase sleep quality without serious side effects

Systemic immune inflammation index is a promising non-invasive marker for the prognosis of the patients with localized renal cell carcinoma

Purpose Our aim was to evaluate the prognostic implications of a preoperative novel index, systemic immune inflammation index (SII) in patients undergoing surgery due to renal cell carcinoma. Methods A retrospective analysis of 176 patients who underwent radical nephrectomy and diagnosed with RCC was carried out. Systemic immune inflammation index, which is calculated by neutrophil x platelet/lymphocyte, and other inflammation indexes such as neutrophil/lymphocyte ratio, platelet/lymphocyte were included. The Kaplan-Meier analysis was plotted, and the groups were compared using a log-rank test. The ROC curve for the aforementioned inflammation indexes was plotted. Results SII (x 109/l) for lower and higher T stage group were 743.70 +/- 587.55 and 907.06 +/- 631.96, respectively, which is statistically significant (p = 0.01). Patients with higher Fuhrman grade (G3 and G4) were found to have higher SII (p = 0.001). SII 830 was demonstrated as the best cut-off value for overall survival. The optimal cut-off point for SII was defined as 850 for disease-specific survival. High SII scores were associated with poor overall survival in RCC patients (p = 0.034). However, no significant association was found for disease-specific survival (p = 0.29). Conclusions Systemic immune inflammation index was found to be associated with increased TNM stage and poor prognosis of RCC patients udergoing radical nephrectomy

Patterns, Risks and Outcomes of Urethral Recurrence After Radical Cystectomy for Urothelial Cancer; Over 20 Year Single Center Experience

Purpose: To evaluate the factors affecting urethral recurrence after radical cystectomy for bladder cancer and relationship between urinary diversion type and urethral recurrence rates. Patients and methods: In our 504 radical cystectomy series, 287 male patients whose final pathological were urothelial carcinoma were included in the study. The relationship between urethral recurrence and pathological stage, grade, lymph node involvement and diversion type was researched in addition to risk factors for urethral recurrence. Results: A Total of 287 patients. Orthotopic continent urinary diversion (OCD) and ileal conduit (IC) was performed after radical cystectomy in 141 (49.1%) and 146 (50.9%) patients respectively. Urethral recurrence was observed in 11 (3.8%) patients and urethral recurrence rates in OCD and IC groups were 1.4% and 6.2% (p = 0.034). Pathological stages of recurrent patients were 2 pT1, 1 pT2 and 8 pT4 respectively (p < 0.001). Urethral recurrence was significantly lower in OCD group when compared to IC group (p = 0.036). When all parameters were analyzed using Cox multivariate regression analysis, the most important factor that affects urethral recurrence was pathological T stage (p < 0.001). Risk factors for urethral recurrence were present in 92 patients. Urethral recurrence rates in patients with and without risk factors were 8.69% and 1.53% (p < 0.01). Conclusions: In this study, pathological stage was found to be the most important factor affecting urethral recurrence and prostatic stromal invasion was an important prognostic factor in these cases. Although risk factors for urethral recurrence were similar in both groups, urethral recurrence rates were significantly lower in OCD group when compared to IC group. (C) 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.WoSScopu