Factors associated with urinoma accompanied by ureteral calculi

Objective: Urinoma is a rare entity and mainly occurs due to acute obstruction such as ureteral stone. We aimed to demonstrate factors associated with urinoma accompanied by ureteral calculi. Material and methods: Data of 550 patients who were diagnosed with ureteral stone by computed tomography (CT) were analyzed retrospectively. In 20 patients perirenal urinoma was associated with ureteral calculi (group I), whereas in other 530 patients no urinoma was detected (group II). Gender, age, size, side and localization of the stone, hydronephrosis, fever, sepsis, urinary tract infections (UTIs), hematuria, serum creatinine, blood urea nitrogen (BUN), white blood cell (WBC), C-reactive protein (CRP), presence of diabetes mellitus (DM), hypertension (HT) and cronic kidney disease (CKD) of the two groups were compared. Results: The average age of the patients were 46.2 (20-71) and 44.9 (10-82) years in group I and group II, respectively (p > 0.05). According to our results leukocytosis, microscopic and macroscopic hematuria, UTIs, increase of serum creatinine, BUN and CRP, diagnosis of DM and HT were significantly associated with urinoma (p < 0.05). In addition, patients with distal ureteral stones are more prone to urinoma (p = 0.001). An interesting finding of the study was that the stone size in group I (median 5 mm [range 3-8]) was significantly smaller than in group II (9.3 mm [4-25]; p = 0.001). Conclusions: Small stone size, distal localisation of the stone in ureter, leukocytosis, hematuria, UTIs, increase of serum creatinine, BUN and CRP, presence of DM and HT are associated with perirenal urinoma

Prospective assessment of VI-RADS score in multiparametric MRI in bladder cancer: accuracy and the factors affecting the results

PURPOSEWe aimed to investigate the accuracy of Vesical Imaging - Reporting and Data System (VI-RADS) in the detection of muscle-invasive bladder cancer (MIBC) and to determine which factors affect the results of this scoring system.METHODSA prospective data analysis of 80 patients who were detected to have bladder tumor was performed between March 2019 and October 2020. VI-RADS scoring was used to determine the probability of muscle invasion. The scores were compared with pathological results to evaluate the accuracy of the VI-RADS scoring system. Interobserver agreement was assessed by VI-RADS scoring of 20 randomly chosen patients by a different experienced radiologist.RESULTSUsing the VI-RADS scoring system, the sensitivity, specificity, positive predictive value, and negative predictive value of multiparametric magnetic resonance imaging (mpMRI) were 87.5%, 87.5%, 63.6%, and 96.6%, respectively. The interobserver agreement expressed as the interclass correlation coefficient (ICC) was 0.72 (95% CI: 0.44-0.84, P < .001). In addition, the flat appearance of the tumor was an important factor affecting the accuracy of the VI-RADS score (odds ratio: 5.3 [95% CI: 1.1-27.0] and relative risk: 1.87 [95% CI: 1.24-2.82]).CONCLUSIONThe mpMRI, used in conjunction with VI-RADS, has proven to be an effective imaging method for detecting muscle invasion in cases of bladder cancer. VI-RADS scoring system can distinguish whether there is a muscle-invasive and non-muscle invasive bladder cancer with acceptable accuracy. In addition, the flat appearance of the tumor is an important entity that can affect the accuracy of the VI-RADS scoring system

Secondary Phimosis due to Circumcision

WOS: 000478576300003INTRODUCTION: In this study we aimed to present the secondary phimosis cases after circumcision as a complication of circumcision and demographic data of the patients. METHODS: The data of 47 patients revised because of secondary phimosis developing after circumcision were analyzed retrospectively. The demographic data of the patients were evaluated. RESULTS: The mean ages of 47 patients were 2.84 years (5 months-11 years). All of the patients had been circumcised under local anesthesia by a non-physician circumciser in the home environment. 37 patients were consulted in the first six months after circumcision, and the remaining 10 patients were consulted in the later period (6 months-8 years). It was found in all patients that both penile skin and mucous was left longer than usual and fibrotic ring which grew out during the healing tightened the glans penis. All disorders were corrected surgically. None of the patients in the early and late postoperative follow-up showed any complications. DISCUSSION and CONCLUSION: Our study reveals that secondary phimosis is a complication requiring circumcision revision and may develop after circumcision made by non-physicians and out of the hospital or a health organization. Moreover, the study shows that sleeve resection technique circumcision is a safe and successful method for revision in the hospital. The limitations of our study are that it is retrospective and there is no control group

Radikal prostatektomi spesmenlerinde yüksek tersiyer gleason patern bulunmasının histopatolojik sonuçlar ve biyokimyasal başarısızlık üzerine etkisi

Objective: The aim of this study was to analyze the effect of a high-grade tertiary pattern in radical prostatectomy (RP) specimens on the histopathological results and PSA progression. Material and methods: In this study, specimens from 71 patients with clinically localized prostate cancer who underwent RP between January 2007 and January 2011 in our department, who regularly attended their follow-up visits and who had a Gleason score of 5-8 (5 and 8 included) were reanalyzed by a single pathologist. The patients were evaluated for the presence of a high-grade tertiary Gleason pattern (Gleason 4 or 5). We investigated the effect of the tertiary pattern on the histopathological results and PSA progression. The patients were followed with testing for the free and total levels of PSA and given a digital rectal examination quarterly for the first two years, semiannually for the next 2 years, and annually for the remaining period. An increase in the serum total PSA count of 0.2 ng/mL or more was considered to represent PSA progression. The statistical analysis in this study was performed with SPSS for Windows Version 15.0 (Inc., Chicago, IL). p<0.05 was accepted as significant. Results: The incidence of a high-grade tertiary pattern in RP specimens was found to be 15.4%. The patients were categorized into groups that were positive or negative for a tertiary pattern. When compared with the other group, the tertiary pattern positive group had higher preoperative PSA levels (p=0.469), more frequent extracapsular extension (p=0.031), more frequent lymph node (p=0.05) and seminal vesicle invasion (p=0.022) and more advanced disease in terms of the pathological stage (p=0.005). The patients were followed up for an average of 36,3 months postoperatively. PSA recurrence was found to be significantly higher in the tertiary pattern positive group (p=0.001), and the PSA progression time was shorter (p=0.001). There was no statistically significant difference between the two groups in terms of preoperative age, clinical stage, Gleason score and surgical margin positivity. When we investigated the effects of a high-grade tertiary pattern, extracapsular extension, seminal vesicle invasion, surgical margin positivity and Gleason scores on PSA recurrence according to the multivariate Cox regression analysis, only the presence of a highgrade tertiary pattern had a significant effect on PSA recurrence (p=0.034). Conclusion: The presence of a high-grade tertiary pattern in the Gleason scores of RP specimens is associated with poor histopathological results and with postoperative biochemical failure. We believe that prospective studies with a higher number of patients and longer follow-up periods will more distinctly reveal the prognostic value of the tertiary pattern

Relationship between Response to PDE5 Inhibitors and Penile Duplex Doppler Ultrasound in Erectile Dysfunction

The relationship between the results of penile duplex Doppler ultrasound (PDDU) and response to vardenafil was investigated in patients diagnosed with erectile dysfunction (ED). Data from 148 patients with ED were analyzed retrospectively. Patients who did not respond to therapy were classified in to Group I (n = 32), those who responded partially were classified into Group II (n = 40), and complete responders were classified into Group III (n = 76). Age, comorbidities, and vascular and penile pathologies were compared among the three groups. While diabetes mellitus (DM) and dyslipidemia positivity adversely affected the response to treatment, the presence of hypertension (HT), Peyronie’s disease and priapism increased the therapeutic response to the treatment (p &lt; 0.05). Arterial insufficiency was present in 20 (30.3%), 25 (37.9%) and 21 (31.8%) of the patients in Group I, Group II and Group III, respectively (p = 0.001). Venous insufficiency was observed in three (14.3%) patients in Group I and in eight (85.7%) patients in Group III (p = 0.001). Arterial/venous insufficiency was seen in 9 (30%), 14 (46.7%) and 7 (23.3%) of the patients in Group I, Group II and Group III, respectively (p = 0.001). The response rate to treatment was highest in normal patients according to PDDU, followed by patients with venous insufficiency. In addition, it was found that DM decreased the response to treatment, whereas the response increased in cases with HT, priapism and Peyronie’s disease

The impact of ureteral Double-J stent insertion following ureterorenoscopy in patients with ureteral stones accompanied by perirenal fat stranding

WOS: 000440545900004PubMed: 29633793Objective: To evaluate the impact of ureteral stent insertion following semirigid ureterorenoscopy (URS) in patients with perirenal fat stranding (PFS) due to ureteral stones. Material and methods: Data of 600 patients who underwent URS were analyzed retrospectively. Seventy-two patients detected to have PFS accompanying ureteral stone were included. Patients who did not undergo double J (DJ) stent insertion following semirigid URS were classified as Group I (n: 52), while those who underwent stent insertion were classified as Group II (n: 20). Side distribution; localization of the stones, stone size, presence of fever, urinary tract infection (UTIs) and urosepsis rates were compared in the two groups. Results: The average age of the patients was 44.4 (20-71) years. Male/female ratio and side of the stone location showed similar distribution in both groups (p > 0.05). Fever occurred in 23 cases (44.2%) in Group I and in 15 cases (75%) in Group II (p = 0.038). UTIs occurred in 15 cases (28.9%) in Group I and in 12 cases (60%) in Group II (p = 0.03). Urosepsis presented in 3 (5.8%) and 5 (25%) of the patients in Group I and II, respectively (p = 0.033). Conclusions: According to our results, ureteral DJ stent insertion following URS in patients with PFS due to ureteral stone caused an increase on postoperative infection related complications

Early ureteroscopic lithotripsy in acute renal colic caused by ureteral calculi

WOS: 000519233300001PubMed: 31586281Purpose We aimed at comparing the success and complications of early semirigid ureteroscopy (URS) and elective URS in ureteral calculi with renal colic that do not respond to analgesics. Methods We retrospectively analyzed the data of 690 patients with obstructive ureteral stones who underwent URS with stone retrieval. 247 patients who underwent early URS within the first 12 h were classified as group I and 443 patients who underwent elective URS as group II. Both groups were compared in terms of age, sex, creatinine, eGFR, stone size, laterality, location and number of stones, type of lithotriptor, presence of hydronephrosis and success and complication rates. Results The mean age of the patients was 50.4 (18-89 years) (p > 0.05). There was no statistically significant difference between the groups in terms of age, eGFR, side, presence of hydronephrosis, fever, mucosal damage, stone migration, perforated ureter, ureteral avulsion, ureteral stent insertion at the end of the surgery and sepsis (p > 0.05). Both groups had male dominance (p > 0.05). Creatinine was significantly lower in Group I (p < 0.05). The mean stone size was also significantly lower in Group I ( p < 0.05). Middle and proximal ureteral calculi were more common in Group II (p < 0.05). Multiple stones were higher in Group II (p < 0.05). The dominant type of lithotriptor used was pneumatic in Group I and laser in Group II (p < 0.05). Stone-free rates (SFRs) were higher in Group I (98% vs 90% in the first month) (p < 0.05). Postoperative hematuria and infection were more common in Group II (p < 0.05). Conclusions In selected cases, early ureteroscopy is an effective and safe method for distal ureteral calculi smaller than 10 mm that are painful and resistant to analgesic treatment

The impact of extracorporeal shock wave therapy for the treatment of young patients with vasculogenic mild erectile dysfunction: A prospective randomized single-blind, sham controlled study

Background Low-intensity extracorporeal shock wave therapy (ESWT) for the treatment of vasculogenic erectile dysfunction (ED) has emerged as a promising method directly targeting the underlying pathophysiology of the disease. Objectives To compare outcomes in ED patients after ESWT and placebo treatment. Materials and methods Prospective randomized placebo-controlled single-blinded trial on 66 patients with mild ED. The study comprised a 4-week washout phase, a 4-week treatment phase, and a 48-week follow-up. Inclusion criteria included age between 18 and 75 years and diagnosis of mild ED (IIEF-EF score = 17-25) being made at least six months prior to study inclusion and being confirmed by Penile Doppler ultrasonography (US) at baseline examination. Efficacy endpoints were changes from baseline in patient-reported outcomes of erectile function (International Index of Erectile Function domain scores [IIEF-EF]), as well as erection hardness and duration (Sexual Encounter Profile diary [SEP] and Global Assessment Questions [GAQ]). Safety was assessed throughout the study. Results A total of 66 enrolled patients were allocated to ESWT (n = 44) or placebo (n = 22). Mean age of ESWT and placebo group was 42.32 +/- 9.88 and 39.86 +/- 11.64 (p = 0.374), respectively. Mean baseline IIEF-EF scores of ESWT group and placebo were 20.32 +/- 2.32 and 19.68 +/- 1.55 respectively (p = 0.34). At 3-months follow-up, mean IIEF-EF scores were significantly higher in ESWT patients than in placebo patients (23.10 +/- 2.82 vs. 20.95 +/- 2.19, p = 0.003), and IIEF-EF scores of ESWT patients remained high during the 6 months (22.67 +/- 3.35 vs. 19.82 +/- 1.56) follow-up. The percentage of patients reporting both successful penetration (SEP2) and intercourse (SEP3) in more than 50% of attempts was significantly higher in ESWT-treated patients than in placebo patients (p = 0.001). A minimal clinically important difference between the IIEF = EF baseline and 3-months follow-up was found in 74% of ESWT and 36% of placebo. No serious adverse events were reported. Discussion and Conclusion ESWT significantly improved the erectile function of relatively young patients with vasculogenic mild ED when compared to placebo and the beneficial effect of this treatment up to 6 months. These findings suggest that ESWT could be a useful treatment option in vasculogenic ED

Comparison of response to treatment of unilateral and bilateral varicocelectomy

WOS: 000395632600024PubMed: 28263485Background/aim: We aimed to compare the results of unilateral and bilateral varicocele surgery. Materials and methods: In two referral hospitals, the data of 180 patients who were treated with unilateral and bilateral microscopic varicocelectomy were retrospectively analyzed. Sperm parameters and spontaneous pregnancy rates were compared in patients who underwent bilateral and unilateral microscopic varicocelectomy. Results: The mean age was 29.6 (17- 46) years. While 82 patients underwent unilateral varicocelectomy (Group I), 98 patients underwent bilaterally varicocelectomy (Group II). Forty (48.8%) spontaneous pregnancies occurred in Group I and 59 (60.2%) in Group II. When we analyzed sperm parameters, the rate of increase in the number of sperm in spermiograms was 17% in Group I and 27.5% in Group II. The rate of increase in sperm mobility was 58.5% and 50% in Group I and II, respectively. The improvement rate in sperm morphology was 46.3% in Group I and 56.1% in Group II. There were no significant differences between all these parameters. Conclusion: In light of our results, although pregnancy rates seemed to be higher in patients who underwent bilateral varicocelectomy, these results were not statistically significant. Improvement rates in sperm parameters were similar between the patients who underwent unilateral and bilateral varicocelectomy

Diagnostic performance of prostate imaging reporting and data system v2.1: Single center experience

Aim: To assess the diagnostic accuracy of PI-RADS v2.1 using multi-parametric magnetic resonance imaging (mpMRI) to detectprostate cancer (pCa) and comparison with transrectal biopsy/radical prostatectomy results.Material and Methods: Between June 2017 and April 2019, 124 patients who underwent mpMRI prior to transrectal biopsy/ radicalprostatectomy were evaluated by a pathology results-blinded uroradiologist using PI-RADS v2.1 categories, retrospectively. PIRADSv2.1 category results were compared with transrectal biopsy/radical prostatectomy results. All clinical data were used in statisticalanalysis.Results: The sensitivity, specificity, positive predictive value, negative predictive value and accuracy values of mpMRI using PI-RADSv2.1 categorization were 96%, 44%, 73%, 88% and 75%, respectively. A significant correlation was observed between a high PI-RADSscore and high pathological grade (p0.001). The inter observer agreement expressed as the ICC was 0.65 (95% CI: 0.33–0.84, p 0.001).Conclusions: The mpMRI, used in conjunction with PI-RADS v2.1, is a useful and promising imaging method in detection of pCa