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The success level of hypospadias repair in adults still needs to be established on a more extensive scaled study. Therefore, we conducted this study to document the success level of hypospadias repair in adults. This study presents the results of 620 adult distal hypospadias patients treated with TIPU operation. A retrospective study was performed for adult patients who underwent TIPU operations from February 2016 to September 2020. Patients who had distal hypospadias after the age of 16 were included in our study. The average operation time was between 35 and 65 min (50 min.). Complications developed in 79 (12.7%) patients: 37 urethral fistulas, 24 meatal stenosis, 11 anastomotic stenosis and 7 had a complete failure. In conclusion, primary adult distal hypospadias surgery is safe and easy. The complication rates are similar when compared to the paediatric group. As the surgical experience advances, the success of the operation increases in direct proportion.

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INTRODUCTION AND HYPOTHESIS: We aimed to compare labial and buccal mucosa graft methods in female urethroplasty. METHODS: Female urethroplasty surgeries performed between March 2016 and October 2020 were retrospectively reviewed. Labial and buccal mucosa graft surgeries were listed. RESULTS: Between March 2016 and October 2020, a total of 28 patients had graft urethroplasty surgery in our center. Fourteen had labial, 14 had buccal onlay graft urethroplasty. The pre-treatment Qmax values were 13 ml/s in the labia major onlay graft (LMOG) group and 12.5 ml/s in the buccal mucosa onlay graft (BMOG) group. The Qmax values after the treatment were remeasured at the 1st, 3rd, and 12th months. They were 20 ml/s, 24 ml/s, and 24 ml/s in the LMOG group and 23 ml/s, 25 ml/s, and 28 ml/s in the BMOG group. The operation times were 65 min (55-90) in the LMOG group; in the BMOG group, it was 70.35 min (65-90). CONCLUSIONS: In female urethral strictures, especially in long segments and recurrent strictures, graft urethroplasty is a successful and safe method. Dorsal buccal onlay mucosal graft and labia major grafts show similar results in the early period to complications and success. In the long term, buccal onlay mucosal graft gives better results.

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INTRODUCTION: The question of whether sexual intercourse can harm athletic performance is a long-debated topic since first sport competitions were invented. Therefore, due to the lack of solid evidence, we aimed to evaluate the effects of sexual intercourse on muscle training performance. MATERIALS AND METHODS: Physically and sexually active, 50 men (age=29.3±1.14 years) were enrolled in the study. Participants completed three weight training sessions and all sessions were at the same time of the day. The maximum weight was adjusted in the first session. In the second and third sessions, they performed five repetitions of the squat with their maximum weight for each set with a total of five sets after participating in and abstaining from sexual intercourse the night before, respectively. The duration of sexual intercourse was measured with a stopwatch. RESULTS: The mean duration of sex was measured to be 13.8±3.61 min. Furthermore, the mean lifted weight before sex was calculated to be 109.4±11.41 kg and the mean lifted weight after sex was calculated to be 107±11.05 kg. According to obtained data, sexual intercourse has a significant detrimental effect on maximum weight in squat training (p=0001). CONCLUSION: Results demonstrate that sexual intercourse within 24 hours before exercise have detrimental effect on lower extremity muscle force, which suggests that restricting sexual activity before a short-term activity may be necessary.

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PURPOSE: To investigate the relationship between failure to insert a ureteral access sheath (UAS) with inflammation and other clinical parameters in patients treated with flexible ureteroscopy for renal stones. METHODS: This study included patients who underwent flexible ureteroscopy for the treatment of renal stones in our centre between 2015 and 2020. Patients who underwent any surgical procedure on the ipsilateral ureter and had a history of spontaneous stone passage were excluded. Patients were divided into two groups based on UAS insertion success (group 1) or failure (group 2). Both groups were compared with a view to clinical characteristics, preoperative neutrophil, lymphocyte, monocyte and platelet counts and ratios of these counts, all being considered inflammatory markers. A multivariate logistic regression analysis was performed to determine the independent variables affecting UAS insertion success. RESULTS: There were 113 (59.1%) patients in group 1, while group 2 consisted of 78 (40.9%) patients. The rates of male gender, coronary artery disease and preoperative ipsilateral hydronephrosis were significantly higher in group 2, while platelet counts and platelet-lymphocyte ratios were significantly lower. Our analysis revealed four independent predictors for UAS insertion failure: female gender (odds ratio [OR]=2.1) increased the rate of UAS insertion success, while hydronephrosis (OR=1.6), low platelet counts and PLR increased the rate of UAS insertion failure (OR=0.99, OR=0.98, respectively). CONCLUSION: Our results suggest that male gender and ipsilateral hydronephrosis are associated with increased UAS insertion failure. Although we found a relationship between relatively low platelet levels and UAS insertion failure, we think that further studies are needed to investigate this matter.

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BACKGROUND: The anatomical architecture is a prominent factor in the outcomes of flexible ureteroscopy (FURS). AIMS AND OBJECTIVES: The aim to regard the success of procedures based on Pelvicalyceal body that called Sampaio classification system. MATERIALS AND METHODS: A total of 125 FURS procedures were reviewed between December 2012 and December 2016 in our department. Seven patients were excluded from the study due to the horseshoe kidney in two cases and recurrent cystine stone configuration in five patients. The patient's renal collecting system anatomy characteristics are regarded, and they are classified into four main groups based on the mid-renal-zone anatomy assessed according to Sampaio Classification. RESULTS: Total stone-free rate (SFR) during the postoperative 1st-month evaluation was noncontrast computerized tomography 75 (63.6%). The evaluation of the SFR in all subgroup of cases based on Sampaio classification noticed easily, SFR was significantly lower in subgroup A2 (30.4%) (P = 0.00), significantly higher in subgroup B2 (P = 0.008). The comparative analysis of the operative duration defined that it was the shortest (75.3 ± 18.1 min) in Type B1 subgroup cases, and the longest (84.7 ± 25.7 min) in the Type A2 subgroup cases. Even though this duration was found to be relatively higher in Type A2 subgroup cases than the others, this difference was not statistically significant (P = 0.271). Fluoroscopy time was noted to be the shortest (11.9 ± 13.4 s) in B1 subgroup and the longest in A2 subgroup with a statistically significant different (median: 21.3 ± 30.4) (P = 0.04). While 6 (5.1%) cases had Clavien 2 and 3 (2.5%) cases, demonstrated Clavien 3a complications. CONCLUSION: The calyceal structure of the kidney affects the SFR; therefore, a detailed classification of pelvicalyceal could improve the outcomes, decrease the rate of auxiliary procedures and prevent the complications.

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PURPOSE: This study aimed to investigate the rate of tunica defect detection by postoperative penile ultrasound (US) and the effect of tunica defect length (TDL) on functional outcomes. METHODS: Forty-six patients who underwent early penile fracture surgery in our hospital between July 2010 and December 2018 were included in the study. Each diagnosis was made via history, physical examination and US. Functional outcomes were assessed at 3, 6 and 12 months postoperatively. The International Index of Erectile Function-5 (IIEF-5) score was used to assess erectile function. US detection rates for tunica defects, as well as whether the rates changed according to TDL, were also analysed. The TDL cut-off value for US detection was determined to be 11 mm using the receiver operating characteristic curve. The impact of TDL on functional outcomes was also evaluated using this cut-off value. RESULTS: The main cause of fractures in 34 patients (74%) was sexual intercourse. One patient (2.2%) had penile curvature, and 16 (34.8%) had penile nodules in the follow-ups. US had a higher detection rate in the group with TDL >11mm (94% vs 25%). IIEF-5 scores at the postoperative third month were statistically lower in patients with TDL >11mm (n = 34) compared with those with ≤11 mm (n = 12). The rate of penile nodules was found to be statistically higher in the group with TDL >11mm at the end of the 1-year follow-up period (44.1% vs 8.3%). CONCLUSIONS: US is a valuable tool for the detection of tunica defects especially with >11mm length. In addition, TDL >11 mm in penile fractures is associated with lower IIEF-5 scores in the early postoperative period and higher rates of penile nodules.

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OBJECTIVE: To evaluate the factors affecting the success of semi-rigid ureteroscopy in proximal ureter stones. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of Urology, Nevsehir State Hospital, Turkey between March 2017 and October 2019. METHODOLOGY: Patients, who underwent a semi-rigid ureteroscopic lithotripsy (URSL) operation for proximal ureteral stones, were evaluated retrospectively in terms of gender, age, stone side, stone size, stone density, the type of lithotripsy, placement of the stone cone, the type of anesthesia and postoperative stone-free rates, which were recorded. The diameter of the ureter with the stones and the distances of the stones to the ureteropelvic junction (UPJ) were measured. Patients who had stone-free status after the URSL were labelled as group I. Patients whose stones were pushed back during URSL were labelled as group II. RESULTS: The distance of the stone to the UPJ was statistically significantly higher in group I (p=0.006). The rate of using stone cone in patients in group I was statistically significantly higher than in patients in group II (p=0.001). The rate of stones in the middle ureter in group I was statistically higher than group II (p<0.001). The rate of using laser lithotriptor in group I was statistically higher than group II (p=0.007). CONCLUSION: Semi-rigid URSL is a useful technique in the proximal ureter stones.  The distance of the stone to the UPJ affects the success; and using laser lithotripsy and stone cone increases the success. Key Words: Ureteral stone, Ureterorenoscopy, Laser lithotriphsy, Pnomotic lithotripsy.

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This study aims to determine the histological data such as microvessel density, nerve density, and the androgen, oestrogen and progesterone receptor density in the prepuce of primary distal hypospadias cases in adulthood, compared to that of healthy individuals in the same age group. Between 2014 and 2019, we prospectively evaluated adult hypospadias and adult circumcision patients. A total of 28 patients were included: Group 1 (18 patients) primary distal hypospadias and Group 2 (10 patients-control group) healthy individuals who had a previous circumcision request for social/religious reasons. The prepuce of healthy individuals that were excised after the circumcision and the excised parts excluded from the prepuce that was used in reconstruction during the repair of hypospadias, were shaped and stored to be able to perform a study by the pathology clinic. Histopathological findings on adult distal hypospadias cases showed that the microvascular density and inflammation in the prepuce with hypospadias were found to be increased compared to the healthy prepuce and the density of androgen and oestrogen receptors was similar in both groups. Unlike childhood studies, in this study with adults, the progesterone receptor was detected in both groups and found to be significantly lower in the hypospadias group.

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PURPOSE: To evaluate the prognostic factors affecting the surgical margin and recurrence in patients who underwent partial nephrectomy (PN) for renal masses. MATERIALS AND METHODS: Data of 125 patients who underwent open or laparoscopic PN because of renal mass between January 2006 and January 2019 were analysed retrospectively. Demographic data, habits, additional diseases, clinical and laboratory findings, operational data, the morphology of the tumour in computerised tomography or magnetic-resonance imaging and follow-up data were scanned and acquired via our hospital's system and archive. RESULTS: Average age was 54.4, male-female ratio was 1.55 and average tumour size was 3.31 cm. One hundred and four patients had malignant pathology and 21 were benign. Positive surgical margin (PSM) rate was 5.6% and recurrence rate was 3.2%. Average follow-up was 47.4 months. Pathological size of the tumour was larger (P = .006), warm-ischemia period was lower (P = .003) and PADUA score was higher (P = .015) in open technique. Tumour size and tumour stage were statistically higher in patients with recurrence (P = .009, P < .001, respectively). There was a significantly higher PSM ratio in mandatory indication group than elective indication group (P = .025). No statistically significant difference was observed between surgical margin positivity and tumour size, Fuhrman grades, PADUA scores, RENAL scores and C-index. (P > .05). CONCLUSION: Surgical margin positivity after PN is not significantly associated with tumour characteristics and anatomical scoring systems. Surgical indication for PN has a direct influence on PSM rates. Tumour size and stage after PN are valuable parameters in evaluating the recurrence risk.

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Renal transplantation is the optimal treatment for patients with end-stage renal disease. However, the incidence of malignancies, especially urological malignancies, increases after renal transplantation due to long-term immunosuppressive treatments. We report a case of radical cystectomy and ileal conduit diversion in a 39-year-old female patient who developed invasive bladder carcinoma with extravesical extension three years after renal transplantation. Radical cystectomy and ileal conduit diversion surgery are feasible options for patients who developed invasive bladder cancer after renal transplantation and are effective methods for the protection of renal functions in the short-term follow-up period.

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OBJECTIVES: The aim of this retrospective study is to describe the importance of serum creatinine levels for the long-term renal outcome in cases of posterior urethral valve. METHODS: Records of 94 patients who underwent cystoscopic valve ablation were evaluated retrospectively. Demographic variables, radiologic findings, and serum creatinine levels were recorded. Patients were grouped according to the serum creatinine levels in the first month of life. Twenty-four patients' serum creatinine levels were found to be above 1 mg/dL in group 1 and ≤1 mg/dL in 70 patients in group 2. RESULTS: The initial findings of 74 patients were as follows: pyelonephritis in 24 (32.43%) patients, hydronephrosis in 20 (27.02%), and inability to urinate in 18 (24.32%). Prenatal hydronephrosis was present in 36 cases (38.29%). Of the 92 voiding cystograms, 53.26% had findings that included vesicoureteral reflux. The mean serum creatinine levels of the patients in group 1 increased above 1 mg/dL in the 2nd year, the significant difference between the two groups lasted up to 7 years of age, and no significant difference was observed at the age of 7. The mean serum creatinine levels of the patients in group 2 were observed to increase above 1 mg/dL by the 10th year. CONCLUSIONS: In patients with posterior urethral valves, nadir creatinine, especially higher than 1 mg/dL, should be considered as high risk for end-stage renal disease. Therefore, clinicians should improve awareness about early detection and treatment of posterior urethral valves, and these patients should be monitored as early as possible for the risk of chronic kidney disease.

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Kidney anomalies are always a challenge even for the most experienced vascular and urologic surgeons in the reconstruction of the abdominal aortic segment. In the literature, the most common anomalies of the kidney are the horseshoe kidney. THE CASE: A 77-year-old male headed to the emergency department with complaints of acute abdominal pain and sudden onset of fatigue. The enhanced CT-scan performed and the horseshoe kidney with the ruptured aortic aneurysm seen. The cardiovascular and transplantation surgery team decided to perform explorative surgery.

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46-year-old wife (donor) and 52-year-old husband (recipient) admitted to our clinic for kidney transplantation. CT angiography of the donor showed us there were bilateral renal double artery and a tortuous aorta that is deviated to the left side. The main artery cannot be reached by laparoscopy because of the upper level of renal artery and deviation of the aorta and an open conversion was performed. Presence of tortuous aorta with multiple renal arteries makes laparoscopic donor nephrectomy a challenging procedure even preformed by an experienced surgeon. The possibility of open conversion should always be kept in mind in these cases.

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In this paper, we presented a patient, who applied to our clinic because of infertility. After an intensive investigation, we diagnosed systemic sarcoidosis with testicular involvement. Urogenital sarcoidosis is a rare and insidious condition, however, it can lead to infertility. Therefore, following the diagnosis, we applied systemic steroid therapy to the patient. Within one year, the patient had a child without assisted reproductive techniques. According to our experience, in this case, we concluded that infertility without an etiology should be investigated elaborately. Furthermore, urogenital sarcoidosis should keep in mind as a rare etiology.

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INTRODUCTION: The inflatable penile prosthesis (IPP) is the last step in drug-resistant erectile dysfunction treatment. IPP implantation can be challenging, especially following a cystoprostatectomy with an orthotopic neobladder. There is no consensus about surgical techniques for placement of an IPP reservoir in such patients. In this paper, we present a case of an IPP and reservoir placement with a single penoscrotal incision. CASE: A 55-year-old patient, who underwent radical cysto-prostatectomy with an orthotopic neobladder seven years ago, presented with severe erectile dysfunction. His oncologic status was stable, and he was in remission. He also had high blood pressure and took medication for it. He previously used different medical treatments, such as oral phosphodiesterase-5 inhibitors (PDE5i), intraurethral prostaglandin E2 (PGE2) installations, and Trimix injections. As far as we know, he had no benefit from these treatments. A three-piece IPP was recom- mended. After a discussion of surgical techniques, we chose the penoscrotal approach, and the ectopic reservoir was placed through the inguinal canal, guided by a forefinger. RESULTS: The total operative time was 60 minutes, and the estimated blood loss was minimal. There were no perioperative complications. The patient was discharged on postoperative day one. He could start to use the IPP in the first month. His sexual and urinary functions were normal, and there was no abdominal bulging from the ectopic reservoir at the three-month follow-up. CONCLUSIONS: In conclusion, ectopic placement of the reservoir through a single penoscrotal incision appears to be a safe and acceptable surgical technique for postoperative ED following a radical cystoprostatectomy with an orthotopic neobladder.

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BACKGROUND: The diagnostic benefit of prostate specific antigen (PSA) is limited, owing to its lack of specificity, particularly in men with PSA levels of 4.0 to 10.0 ng/mL. Therefore, there is a need for more specific and sensitive biomarkers to improve diagnostic accuracy and to predict prostate cancer (PCa) progression. Assessing the expression levels of specific microRNAs (miRNAs) in patients with PCa may be helpful in detecting cancer and predicting the cancer prognosis and its evolution, and may serve as markers to decide the treatment. We examined the expression levels of five miRNAs (let-7c, miR-21, miR-145, miR-185, and miR-221) on patients with low-risk PCa who had been eligible for active surveillance but underwent radical prostatectomy. We investigated the correlation between the relative expression of miRNAs and clinicopathologic parameters to evaluate their clinical significance. MATERIALS AND METHODS: Total RNA was isolated from the tumor and the corresponding non-neoplastic prostate tissue of 45 patients who underwent radical prostatectomy. Quantitative reverse transcriptase-polymerase chain reaction was used to measure the levels of let-7c, miR-21, miR-145, miR-185, miR-221, and RNU6B expression, using TaqMan MicroRNA Assays. miRNA expression was examined in low-risk PCa, and miRNAs' association with Gleason upgraded (GU) and biochemical recurrent (BR) patients was evaluated. RESULTS: We observed that miR-21 and miR-182 were overexpressed; conversely, let-7c, miR-145, and miR-221 were underexpressed in patients with low-risk PCa. GU patients (n = 16) and non-upgraded patients (n = 28) were compared. miR-145 was downregulated significantly in the GU group (P = 0.03). Similarly, miR-221 was downregulated significantly in patients with BR (n = 14) compared with non-recurrent patients (n = 30) (P = 0.04). Receiver operator characteristics (ROC) curve analysis revealed that miR-221 levels were significantly associated with BR in patients with a cut-off <-1.666, a value at which sensitivity was 70% and specificity 71% (area under curve [AUC] = 0.705, P = 0.030). CONCLUSIONS: There is still a need for a tumor marker with higher sensitivity and specificity than that of PSA. Among the five miRNAs examined, miR-221 was most associated with biochemical recurrence in low-risk PCa.

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Penile curvature deformities are often manageable with surgical reconstruction methods. We aimed to show the safety and efficacy of ventral and dorsal plication techniques without degloving in our two patients who have penile curvature. Two young adults, aged 20 and 23 years, presented to our clinic with lateral and dorsal penile curvatures. This problem has been sustaining since their teenage. Following the required preparations, two surgical techniques were used, namely Nesbit and Lue's "16-dot" technique. Patients completed a satisfaction survey at a mean of 6 months later the surgery. Although both patients reported a subjective decrease in penile length, their satisfaction rate was high. Penile plication without degloving is a safe and effective technique for correcting dorsal and lateral penile curvatures.

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INTRODUCTION: Our aim was to evaluate and share our urethrocutaneus fistula repair results in adult patients who had been operated for hypospadias in their childhood. MATERIAL AND METHODS: The data of totally 48 patients who had been treated for urethrocutaneous fistula after hypospadias surgery in our department from May 2008 to January 2015 analyzed retrospectively. Patients' age at fistula repair, age at first hypospadias surgery, fistula size, localization and number, distal urethral obstruction status and surgical outcomes of fistula repairs were recorded. All patients were controlled three months after the repair for surgical outcomes. RESULTS: Fistula repair performed in 45 patients. Mean age was 21.46 (20-26). Nineteen patients (42.2%) underwent first hypospadias surgery under the age of 7 years; 8 patients (17.7%) between 7 and 15 years, 18 patients between 15 and 20 years. Tubularized incised plate urethroplasty (TIPU) was performed in 40 patients (88.9%), extragenital tissue was used in 5 patients (11.1%). Twenty two patients (48.9%) had 1 or 2 operations, 17 patients (37.8%) had 3-5 operations and 6 patients (13.3%) had 6 or more operations. Thirteen (28.9%) coronal, 24 (53.3%) subcoronal, 6 (13.3%) penile and 2 (4.4%) penoscrotal fistulas were observed. While a single fistula was observed in 35 patients, multiple fistulas were seen in 10 patients. A fistula diameter les than 5mm was detected in 37 patients, and larger than 5mm in 8 patients. Fistula recurrence was observed in 3 patients at follow-up examinations carried out at 3 months postoperatively. The number of operations was more than 5, the fistula diameter was larger than 5mm and the fistulas were coronal in all three recurrent fistulas. CONCLUSION: According to our results fistula size, previous surgery and well-vascularised, one or two layer tissue were the important factors in the success of fistula repair after hypospadias surgery.

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The horseshoe kidney (HSK) is common and supernumerary kidney is the rarest developmental anomaly of the urogenital system. The supernumerary kidney in a HSK conjunction is extremely rare, and prevalence of it is unknown. A review of literature, there have been a few case reports about the supernumerary and HSK combination, however, none of which also had a concomitant kidney stone and obstructive pathology. Our case indicated that patient referred to flank pain and visible hematuria to our clinic, and further investigations demonstrate supernumerary kidney in a horseshoe configuration and kidney stone. Kidney stone could not be found at the first attempt because of the anatomical malformation. Retrograde pyelography showed ureteral branching and helps to define the placement of stone. This stone was fragmented with flexible ureteroscopy in the lower pole of the middle kidney in the second session. There was no stone fragments absence at the 1st-month control. This exceedingly rare type case should be evaluated meticulously on preoperative duration otherwise can be a challenge for surgeons. Visualize pelvicalyceal system under the fluoroscope is a vital step in this regard to being guidance during the procedure.