Laparoscopic simple nephrectomy patient with situs inversus totalis and left renal hypoplasia: A case report

Situs inversus totalis (SIT) is a relatively rare anatomical condition characterized by the transposition of thoracic and abdominal organs from the normal side to the opposite position. Most reports of laparoscopic procedures in patients with SIT cite technical difficulties and longer operative times due to disorientation because of the reversed abdominal organs and necessary modification of the surgeon's movements and techniques. We present a case of a patient with SIT in whom a transperitoneal laparoscopic simple nephrectomy was performed

Effects of 5 alpha-reductase inhibitor therapy with dutasteride on sexual function in patients with benign prostatic hyperplasia

Conclusion: Six-month therapy of dutasteride in men with BPH did not alter the sexual functions

Can neutrophil to lymphocyte ratio predict lamina propria invasion in patients with non muscle invasive bladder cancer?

ABSTRACT Objective Recent studies have demonstrated the role of systemic inflammation in the development and progression of cancer. In this study, we evaluated whether preoperatively measured neutrophil-to-lymphocyte ratio (NLR) can predict lamina propria invasion in patients with non-muscle-invasive bladder cancer (NMIBC). Material and Methods We reviewed the medical records of 304 consecutive and newly diagnosed patients with bladder cancer who had been treated with transurethral resection between January 2008 and June 2014. In total, 271 patients were included in the study and the patients were divided into two groups according to the pathological stage (Group 1: Ta, Group 2: T1). NLR was calculated by dividing the absolute neutrophil count (N) by the absolute lymphocyte count (L). Results In total, 271 patients (27 women and 244 men) were enrolled. Mean age was higher in Group 2 than in Group 1 (67.3±10.8 vs. 62.9±10.8, p<0.001). Furthermore, the presence of high grade tumors and tumors ≥3cm in size was statistically higher in Group 2 than in Group 1 (70.9% vs. 9.9%, p=0.0001; 71.8% vs. 36%, p=0.0001, respectively). While the mean white blood cell (WBC) and N counts were statistically insignificant (7.63±1.87 vs. 7.69±1.93, p=0.780; 4.72±1.54 vs. 4.46±1.38, p=0.140; respectively), L was significantly lower and NLR was significantly higher in Group 2 than in Group 1 (2.07±0.75 vs. 2.4±0.87, p=0.001; 2.62±1.5 vs. 2.19±1.62, p=0.029; respectively). Conclusion Our data indicate that high NLR and low L are statistically associated with T1 stage, whereas low L are able to predict lamina propria invasion in patients with NMIBC. These findings suggest that pretreatment measurement of NLR may provide valuable information for the clinical management of patients with NMIBC. Prospective studies are now required to further validate the role of NLR as a risk factor in NMIBC

The comparison of percutaneous and transurethral cystolithotripsy methods simultaneously performed with Transurethral Resection of Prostate in patients with BPH and bladder stone

OBJECTIVE: To compare the efficiency of percutaneous (PCL) and transurethral (TCL) cystolithotripsy simultaneous with transurethral prostatectomy (TUR-P)

Comparison of stapler and handsewn anastomosis techniques in creating an ileal conduit following radical cystectomy

Background and objective: Ileal conduit for urinary diversion can be completed using either end-to-end handsewn or stapled anastomosis. This study aimed to compare stepled and handsewn anastomosis methods in terms of complications, hospitalization and cost. Materials and methods: Forty-three patients were included in the hand-sewn and 44 patients in the stapler group. After creating an ileal conduit, continuity of the loop was achieved either with handsewn or stapler method. Patients’ demographic data, time to onset of bowel movement, time to transit to oral intake, time to removal of the drain, perioperative and postoperative complications, mortality and total costs were retrospectively recorded and compared between the two groups. Results: There was no statistically significant difference between the groups in terms of the mean to the onset of bowel movements (p = 0.51) and the mean time to transit to oral intake (p = 0.23). The mean time to removal of the drain was significantly lower in the stapler group (p = 0.023). Perioperative complications were seen in eight patients in the handsewn group, while none of the patients in the stapler group developed perioperative complication (p = 0.003). Postoperative complications were similar between both groups (p = 0.75). The duration of hospitalization was statistically significantly lower in the stapler group (p = 0.004) and the mean total cost was statistically significantly more advantageous (p < 0.001). Conclusion: No significant difference was found between stapler and handsewn anastomosis techniques in terms of postoperative complications. On the other hand, hospitalization and total cost were in favour of stapler technique, showing that this technique can be used safely

Neuroendocrine Tumour of the Prostate: A Rare Variant

About 95% of prostate cancers are adenocarcinomas. Neuroendocrine differentiation (NED) is seen in virtually all cases of prostatic carcinoma, mostly in a focal pattern. Extensive NED is associated to aggressive disease with a poor prognosis and most cases are diagnosed in advanced stages.We present a 79-year- old male who was admitted to our department with severe lower urinary tract obstructive symptoms and weight loss. On digital rectal examination, the prostate was fixed to the rectum with irregular margins. Serum prostate-specific antigen (PSA) level was 1.9 ng/ml.Transrectal ultrasound-guided prostate biopsies revealed small-cell carcinoma of the prostate. Multiple metastatic lesions in vertebral bones and iliac lymph nodes were detected by nuclear bone scan and abdominal computerised tomography CT. Thereafter, the patient was treated with cisplatin-based chemotherapy and palliative radiotherapy

Effects of 5α-reductase inhibitor therapy with dutasteride on bone metabolism in patients with benign prostatic hyperplasia

Objectives: The aim of this study was to investigate the effect of dutasteride on bone metabolism in patients with benign prostate hyperplasia (BPH). Design: Prospective study Setting: Sakarya University Sakarya Training and Research Hospital Subjects: Fifty patients were administered 0.5 mg dutasteride daily for treatment of BPH. Interventions: All patients were evaluated prior and six months after the treatment for bone metabolism. Main outcome measure: Standard parameters of bone metabolism and serum osteoprotogerin (OPG) levels, which is an important regulator for bone metabolism, were evaluated. Results: Seven of the 50 patients were lost to follow up and the remaining 43 patients were included in the study. Mean age of patients was 60.3±5.5 (range: 48-74) years. Dutasteride significantly increased serum testosterone and estradiol levels compared to pretreatment values. Mean OPG level increased from 198.3±40.5 pg/ml to 240±90.1 pg/ml (P=.019). Except T score of femur neck, there was an increase of T-Z scores in the lumbar spine and in the femur neck (P >.05). There was an increase in bone mineral density levels of the body, but only the increase in L4 vertebral value was statistically significant (P <.008). The treatment with dutasteride also caused significant decrease in prostate specific antigen levels and prostate volume as expected. Conclusions: It seems that, in addition to the benefits on prostatism symptoms, the short-term results of 5ARI on bone metabolism are promising

Does the experience of the bedside assistant effect the results of robotic surgeons in the learning curve of robot assisted radical prostatectomy?

ABSTRACT Introduction: The success of the robot assisted radical prostatectomy (RARP) procedures depend on a successful team, however the literature focuses on the performance of a console surgeon. The aim of this study was to evaluate surgical outcomes of the surgeons during the learning curve in relation to the bedside assistant's experience level during RARP. Materials and Methods: We retrospectively reviewed two non - laparoscopic, beginner robotic surgeon's cases, and we divided the patients into two groups. The first surgeon completed the operations on 20 patients with a beginner bedside assistant in February - May 2009 (Group-1). The second surgeon completed operations on 16 patients with an experienced (at least 150 cases) bedside assistant in February 2015 - December 2015 (Group-2). The collected data included age, prostate volume, prostate specific antigen (PSA), estimated blood loss, complications and percent of positive surgical margins. In addition, the elapsed time for trocar insertion, robot docking, console surgery, specimen extraction and total anesthesia time were measured separately. Results: There were no significant differences between the groups in terms of age, comorbidity, prostate volume, PSA value, preoperative Gleason score, number of positive cores, postoperative Gleason score, pathological grade, protection rate of neurovascular bundles, surgical margin positivity, postoperative complications, length of hospital stay, or estimated blood loss. The robot docking, trocar placement, console surgery, anesthesia and specimen extraction times were significantly shorter in group 2 than they were in group 1 (17.75 ± 3.53 min vs. 30.20 ± 7.54 min, p ≤ 0.001; 9.63 ± 2.71 min vs. 14.40 ± 4.52 min, p = 0.001; 189.06 ± 27.70 min vs. 244.95 ± 80.58 min, p = 0.01; 230.94 ± 30.83 min vs. 306.75 ± 87.96 min, p = 0.002; 10.19 ± 2.54 min vs. 17.55 ± 8.79 min, p = 0.002; respectively). Conclusion: Although the bedside assistant's experience in RARP does not appear to influence the robotic surgeon's oncological outcomes during the learning curve, it may reduce the potential complications by shortening the total operation time

De Novo or Increasing Lower Urinary Tract Symptoms during COVID-19 Infection: Long-term Results

Background: How COVID-19 affects lower urinary tract symptoms (LUTS) in men has not been demonstrated by published research. This study examined the de novo development of LUTS and the change in the severity of pre-existing LUTS in men hospitalized with COVID-19. A follow-up period of 12 months after COVID-19 infection provided data on the long-term effect of COVID-19 vs. LUTS. Methods: Data were collected from 70 male patients diagnosed with COVID-19 via nasopharyngeal swab RT-PCR technology between June 2020 and April 2021. The patient’s age, comorbidities, date of COVID-19 diagnosis, date of LUTS, International Prostate Symptom Score (IPSS), prostate-specific antigen (PSA), creatinine, and D-dimer levels, urinalysis, urine culture and duration of hospital stay were recorded. Statistical analyses were conducted to compare between pre-COVID and post-COVID IPSS and other data. Results: 42 patients were included in this study with a, mean age of patients were 54.76 ± 11.95 years. In 8 patients there was no change in IPSS pre- vs. post-COVID. In the remaining 34 patients (80.9%), the median IPSS increased from a pre-COVID value of 2 to 10 during COVID (p < 0.001). In the subgroup analysis based on age <50 years vs. ≥50 years, statistically significant increase in IPSS were found in both age groups pre- and post-COVID. Conclusions: In male patients of all ages, COVID-19 results in the de novo occurrence of LUTS and an increase in pre-existing LUTS in approximately 80% of patients. These symptoms were found to persist at a 12-months follow-up