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

Effect of the COVID-19 Pandemic on Radical Prostatectomy: A Turkish Multicenter Study

Objective: The present study examines the effects of the coronavirus disease 2019 pandemic on radical prostatectomy performed as part of localized prostate cancer treatment in Turkey. Material and methods: A retrospective analysis was made of the data of 176 patients from 8 centers in Turkey who underwent radical prostatectomy due to localized prostate cancer over the 2 years spanning March 1, 2019, to February 28, 2021. Within this timeframe, March 1, 2019, to February 28, 2020, was denoted the 1-year pre-coronavirus disease 2019 period, while March 1, 2020, to February 28, 2021, was denoted the 1-year coronavirus disease 2019 period. An analysis was made of whether there was a difference in the number of radical prostatectomies performed for prostate cancer, the time from biopsy to operation, and the biopsy and radical prostatectomy pathology between the 2 periods. Results: It was found that the number of radical prostatectomies performed for localized prostate cancer during the coronavirus disease 2019 pandemic was statistically and highly significantly fewer than in the pre-coronavirus disease 2019 period (P < .001). The patients diagnosed with Gleason 3 + 3 (low risk) prostate cancer were statistically significantly fewer in number in the coronavirus disease 2019 period (P < .001). The pathological Gleason score was upgrading than the biopsy Gleason score in all patients who underwent in both periods (P < .001). When the periods were compared, the pathological involvement determined by lymph node dissection performed during radical prostatectomy was found to be decreased in the coronavirus disease 2019 period, although the difference was not statistically significant (P = .051). Conclusion: As with many diseases, the diagnosis and treatment of prostate cancer have been adversely affected by the coronavirus disease 2019 pandemic. © 2022, AVES. All rights reserved

Effect of Modification of Lifestyle on Reproductive Potential Yașam Tarzı Değișikliğinin Üreme Potansiyeline Etkisi

ABSTRAC

Efficacy of Percutaneous Nephrolithotomy in Patients with Neurogenic Bladder Dysfunction

Aim: Patients with neurogenic bladder dysfunction (NBD) are at increased risk of urolithiasis. We review our experience with percutaneous nephrolithotomy (PCNL) on this group of patients with special attention paid to the risks of surgical complications. Methods: A total of 18 cases with NBD underwent PCNL at our institution. Neurogenous lesions included traumatic spinal cord injuries in 8 cases, sequel of cerebrovascular accident in 2, meningitis in 2, polio in 4 and kyphoscoliosis in 2. Percutaneous access was achieved under fluoroscopic guidance with a patient in the prone position and tract was formed using balloon dilation system. Stone disintegration was accomplished with a pneumatic lithotripter. Results: There were 8 staghorn stones, 6 pelvi-calyceal stones, and 4 isolated renal pelvic stones. The mean operation time was 97.5±18.7 (range: 80-120) minutes and the mean hospitalization time was 3 (range: 2-5) days. Stone-free status was achieved in 13 (72.2%) renal units. 4 (22%) patients with 2 staghorn stones and 2 pelvi-calyceal stones had clinically insignificant residual fragments (CIRF). Hydropneumothorax was encountered in 1 case with kyphoscoliosis, in whom an intercostal access was necessary. Conclusion: PCNL in patients with NBD is safe and effective, with outcomes comparable to that of patients without such a disorder. (The Medical Bulletin of Haseki 2010; 48: 76-9

Abdominal or Transrectal Ultrasonographic Prostate Volume and Cystoscopic Prostatic Urethral Length Measurements to Determine the Surgical Technique for Prostatectomy in Patients with Benign Prostate Hyperplasia

Objective We aimed to determine the most suitable technique for prostate volume (PV) measurement to decide for the most appropriate surgical approach - endoscopic or open - by establishing the relationship between imaging techniques and the resected tissue weight (RTW). Materials and Methods Sixty men aged 49-95 years with lower urinary tract symptoms, who were scheduled for transurethral resection, were enrolled. The relationship of RTW with PV determined by preoperative abdominal ultrasonography as well as transrectal ultrasonography (TRUS) performed at the table just before surgery, and prostatic urethral length (PUL) measured at the time of cystoscopy was analyzed. Two groups were established with respect to PV, (less than or equal to 75 cc and greater than 75 cc, respectively), and according to PUL (less than or equal to 2.5 cm and longer than 2.5 cm, respectively). Statistical analyses were performed between the groups to identify the best correlation between resected tissue weight and pre-surgical volume determination methods. Results The strongest correlation between RTW and prostatic volume measurements was established for the TRUS measurements (r=0.79; p<0.001). The coefficients of the abdominal and transrectal ultrasonographic volume and PUL were 0.127, 0.287 and 0.219, respectively. Conclusion Determination of PV by TRUS was found to be more accurate than abdominal ultrasonographic and cystoscopic measurements. Therefore, TRUS measurement of volume on the table at the time of surgery appears to be more suitable than other methods for the selection of the most suitable surgical technique especially in case of pre-operative difficulty for deciding the most appropriate surgical approach

Pain Control and Its Relationship with Histopathological Outcome in TRUS-Guided Prostate Needle Biopsy: A Prospective Non-Randomized Trial

Objective Transrectal ultrasound-guided prostate biopsy (TRUS-Bx) is a standard diagnostic modality for detecting prostate cancer (PCa). Pain during biopsy is the most important problem that still needs a solution. The purpose of this study was to compare 3 pain control techniques and to investigate the relationship between the level of pain and histopathological findings. Materials and Methods 139 patients underwent prostate biopsy utilizing 3 analgesic techniques; 1- using lidocain gel (group 1), 2- pethidine+diazepam (group 2) and 3- periprostatic nerve block (group 3). Pain level, the tolerability and repetition of the procedure were questioned. The pathological findings were recorded. Results There was a statistically significant difference between group 1 and the others with regard to tolerability and repeating the procedure. The pain score during biopsy in group 1 was greater than in the other groups and those in group 2 was higher than in group 3. The mean pain score during probe insertion in group 2 was lower than in groups 1 and 3. The mean pain score taken during the biopsy was higher than that during probe insertion in group 2. However, the mean pain score during probeinsertion in group 3 was not different from that in group 1. There was no significant difference in pathological results between group 1 and groups 2 and 3. Pain scores in patients with chronic prostatitis were statistically higher than those in patients with benign prostatic hyperplasia (BPH) and Pca in groups 2 and 3 (p<0.05). Conclusion Periprostatic nerve block is superior to the others. However, it is not better than pethidine plus diazepam during rectal probe insertion. In the presence of chronic prostatitis, pain scores can increase regardless of the pain control method

Endometriosis presenting with right side hydroureteronephrosis only: a case report.

İstanbul Bilim Üniversitesi, Tıp Fakültesi.INTRODUCTION: Endometriosis can be defined as the presence of endometrial glandular and stromal tissue outside the uterus. Affected sites of endometriosis can even be the urinary tract. Here, we present the case of a 30-year-old woman with right ureteral endometriosis. This case was important due to the unusual localization and no signs of the disease except for hydroureteronephrosis. CASE PRESENTATION: A 30-year-old Caucasian woman with para 2 was admitted to our department for right side flank pain, dysuria and suprapubic pain. She had no complaints of vaginal discharge, bleeding or painful menstruation. Her menstrual cycles were normal and lasting for three to four days. She did not have a history of any surgical interventions. A physical examination revealed a right side costovertebral angle and suprapubic tenderness. Laboratory test results including a complete blood count, serum biochemical analysis, urine analysis and urine culture were normal. Urinary ultrasonography showed right side hydroureteronephrosis with renal cortical thinning. We suspected a right ureteral stone obstructing the ureter and a computed tomography scan was performed. The computed tomography scan revealed similar right side hydroureteronephrosis with obstruction of the ureter. No signs of stone were observed on the scan. Retrograde pyelography and diagnostic ureterorenoscopy were performed and they showed a focal stricture with a length of approximately 3 cm at the distal ureteral part and secondary hydroureteronephrosis. Open partial ureterectomy and ureteroneocystostomy with Boari flap were performed. The pathologic specimen of her ureter demonstrated intrinsic endometriosis of the right ureter with endometrial glandular cells and stromal tissue