RESUMEN

INTRODUCTION: Office-based flexible cystoscopy is a common outpatient procedure in daily urology practice. Sometimes, cystoscopy procedures are performed on the initial day or scheduled on the following days. We designed this study to compare immediate versus scheduled cystoscopy in terms of anxiety and pain. METHODS: In this study, 160 patients were prospectively randomized to undergo office-based flexible cystoscopy by the same urologist between November 2017 and January 2018. Participants were grouped as scheduled for a cystoscopy on the third day of their application (group 1) and immediate cystoscopy on the same day of the application (group 2). A visual analog scale (VAS), State-Trait Anxiety Inventory (STAI) and Beck Anxiety Inventory (BAI) were completed by the patients. RESULTS: Among men, immediate cystoscopy group experienced an increased state anxiety score compared to scheduled group (51.21 ± 8.108 vs 35.29 ± 10.553; p < 0.001). BAI scores were 16.51 ± 8.078 for group1 vs 31.92 ± 8.403 for group2 (p < 0.001). The mean VAS score was 3 ± 1.183 and 4.55 ± 1.155 in group1 and group2, respectively (p < 0.001). Among women, both the trait anxiety score and state anxiety score were found significantly low in scheduled group (mean trait anxiety scores 44.71 ± 6.051 and 49.3 ± 6.670, mean state anxiety scores were 33.71 ± 8.776 and 44.15 ± 7 in group1 and 2, respectively; p < 0.0001). BAI scores were also low in scheduled group (19.02 ± 7.786 vs 34.13 ± 8.367). Additionally, the mean VAS score was significantly high in immediate cystoscopy group compared to scheduled cystoscopy group (3.50 ± 0.784 vs 2.61 ± 0.919; p < 0.001). CONCLUSION: To reduce anxiety and pain, informing patients properly about the cystoscopy and scheduling the procedure would be helpful for a better cooperation of the patient.

Asunto(s)

RESUMEN

The aim of this study was to evaluate the effect of inflammation on the success of varicocelectomy by using some inflammatory markers. Adult male patients aged ≥18 years who were evaluated for infertility, had abnormal parameters in at least two preoperative semen analyses and underwent subinguinal microscopic varicocelectomy were retrospectively evaluated. The patients were divided into two groups; those showing improvement in semen parameters were determined as Group A and those without improvement as Group B and compared with each other. A total of 102 patients were included in this study. Group A contained 32 (31.4%) patients while Group B had 70 (68.6%) patients. Monocyte/lymphocyte ratio (MLR) and neutrophil/lymphocyte ratio (NLR) were found to be statistically significantly higher in Group B (p = 0.014 and p = 0.028 respectively). Although preoperative sperm concentration and total motile sperm count were higher in Group B, postoperative all semen parameters were significantly higher in Group A. The cutoff points that were determined using the Youden test were <2.02 for NLR (AUC = 0.636, CI = 0.519-0.754; p = 0.028) and <0.22 for MLR (AUC = 0.652, CI = 0.531-0.773; p = 0.014). Pre-varicocelectomy low NLR and MLR values were found to be significant parameters in predicting the success of the surgery.

Asunto(s)

RESUMEN

The aim of this study was to investigate whether the time interval between ejaculation and scrotal Doppler ultrasonography affects the results of the varicose vein diameter and reflux time. Age, medication use, operation history, physical examination and semen analysis findings, varicose vein diameters and the presence of reflux and reflux time were evaluated prospectively in the patients older than 18 years of age who presented to the urology outpatient clinic with infertility and underwent scrotal Doppler ultrasonography and semen analysis. The time interval between the two scrotal Doppler ultrasonography for semen analysis was noted, the two results were compared. The patients were divided into four groups according to the time interval between ejaculation and scrotal Doppler ultrasonography. The study included 81 varicocele cases, with 57 left-sided and 12 bilateral varicocele. The varicose vein diameters were significantly larger after ejaculation than before ejaculation (p < .001). Similarly, the reflux time after ejaculation in all patients was significantly higher in scrotal Doppler ultrasonography performed before and after ejaculation at rest and during Valsalva manoeuvre (p < .001). In conclusion, the results of the present study suggest that a waiting time of at least 90 min must be allowed between ejaculation and scrotal Doppler ultrasonography.

Asunto(s)

RESUMEN

ABSTRACT Purpose: To evaluate whether components of Testicular Dysgenesis Syndrome (TDS) affect testicular germ cell tumor (TGCT) prognosis and oncological outcomes. According to the hypothesis called TDS; undescended testis, hypospadias, testicular cancer and spermatogenic disorders share the same risk factors and have a combined fetal origin. Materials and Methods: We retrospectively evaluated the stages and oncological outcomes of 69 patients who underwent radical orchiectomy between January 2010 and December 2014 due to TGCT in our department. The presence of undescended testis, hypospadias and semen parameters disorders were recorded according to anamnesis of patients. Results: Among 69 patients with TGCT, only 16 (23.1%) had TDS. Significantly higher rate of TDS (36.1% vs. 9.1%) was observed at the advanced stages of TGCT(p=0.008). In the TDS group, the rates of local recurrence (50% vs. 11.3%, p<0.001), distant metastasis (93.6% vs. 3.8%, p<0.001) and cancer-spesific mortality (87.5% vs. 3.8%, p<0.001) were found significantly higher than those without TDS. The predicted time for recurrence-free survival (13.70±5.13 vs. 100.96±2.83 months, p<0.001) metastasis-free survival (13.12±4.21 vs. 102.79±2.21 months, p <0.001) and cancer-specific survival (13.68±5.38 vs. 102.80±2.19 months, p<0.001) were also statistically lower in this group. Conclusions: According to our preliminary results, there is an apparent relationship between TDS and tumor prognosis. Even if the components of TDS alone did not contain poor prognostic features for TGCT, the presence of TDS was found as the most important independent predictive factor for oncological outcomes in both seminomas and nonseminomas as well as all patients with TGCT.

Asunto(s)

RESUMEN

PURPOSE: To evaluate whether components of Testicular Dysgenesis Syndrome (TDS) affect testicular germ cell tumor (TGCT) prognosis and oncological outcomes. According to the hypothesis called TDS; undescended testis, hypospadias, testicular cancer and spermatogenic disorders share the same risk factors and have a combined fetal origin. MATERIALS AND METHODS: We retrospectively evaluated the stages and oncological outcomes of 69 patients who underwent radical orchiectomy between January 2010 and December 2014 due to TGCT in our department. The presence of undescended testis, hypospadias and semen parameters disorders were recorded according to anamnesis of patients. RESULTS: Among 69 patients with TGCT, only 16 (23.1%) had TDS. Significantly higher rate of TDS (36.1% vs. 9.1%) was observed at the advanced stages of TGCT(p=0.008). In the TDS group, the rates of local recurrence (50% vs. 11.3%, p< 0.001), distant metastasis (93.6% vs. 3.8%, p< 0.001) and cancer-spesific mortality (87.5% vs. 3.8%, p< 0.001) were found significantly higher than those without TDS. The predicted time for recurrence-free survival (13.70±5.13 vs. 100.96±2.83 months, p< 0.001) metastasis-free survival (13.12±4.21 vs. 102.79±2.21 months, p< 0.001) and cancer-specific survival (13.68±5.38 vs. 102.80±2.19 months, p< 0.001) were also statistically lower in this group. CONCLUSIONS: According to our preliminary results, there is an apparent relationship between TDS and tumor prognosis. Even if the components of TDS alone did not contain poor prognostic features for TGCT, the presence of TDS was found as the most important independent predictive factor for oncological outcomes in both seminomas and nonseminomas as well as all patients with TGCT.

Asunto(s)

RESUMEN

OBJECTIVES: To determine the prevalence of sexual dysfunction in male partners of infertile couples and evaluate the effect of childlessness on erectile dysfunction (ED) and sexual relationship stress. MATERIALS AND METHODS: We collected datas of couples who attended our clinics for infertility between 2009 and 2016. Erectile dysfunction was investigated with the Questionnaires of International Index of Erectile Function-15 (IIEF-15) whereas premature ejaculation (PE) status with the Premature Ejaculation Diagnostic Tool (PEDT). The stress status of the childlessness in terms of sexual intercourse was scored by the Visual analogue scale (VAS) questionnaire. These scores were measured before and after a successful assisted reproductive treatment with the birth of the child. RESULTS: The median age of the 193 male patients was 31 years (range 23-48). Erectile dysfunction was found in 68 (35.2%) and PE in 42 (21.7%) subjects. One hundred and forty-one couples were treated with assisted reproductive treatments. Forty eight couples had successful pregnancy. The IIEF-15 test was repeated after the birth of the child to the male partners of these couples. We observed that the IIEF-15 scores increased from 16 to 21 (p = 0.014). However there were no significant improvement on their ejaculation status (p > 0.05). The mean VAS scores of male partners was 5.2 (3-10) in the treatment period while it decreased to 4.1 (0-8) after the birth of the chils (p = 0.02). Statistically analysis showed a correlation between VAS and infertility as did IIEF-15. CONCLUSIONS: We observed that having children has a reducing effect on sexual relationship stress. Infertility is absolutely blamed on the women and men. This condition may have negative effects on male sexual performance and it is closely related with some emerging female sexual disorders. It should be taken into consideration that infertile couples may have sexual dysfunction.

Asunto(s)

RESUMEN

OBJECTIVE: Obturator nerve injuries may be seen during pelvic lymph node dissection in oncological surgery and although not common it is an important complication. According to the shape and location of the injury, tingling and loss of sensation may develop on the inner surface of the leg, together with loss of motor function of the adductor muscles. In this study an evaluation was made of these complications encountered in our clinic and the management strategies applied to these patients. MATERIAL AND METHODS: The data were retrospectively reviewed of 843 patients who underwent open radical retropubic prostatectomy between January 2002 and May 2016. To confirm obturator nerve palsy, electrophysiological investigation (ENG-EMG) was performed immediately postoperatively and 3 weeks later. RESULTS: A total of 6 obturator nerve injuries occurred during pelvic lymphadenectomy (0.7%). Reapproximation end to end with sutures was applied in 3 case and sural nerve graft in 1. In the other 2 patients, just clips were placed and these were removed early during the operation. After the treatment period, neurotropic medications or physiotherapy were given in some cases according to the neurological examinations. CONCLUSION: Obturator nerve injury can be prevented by having a comprehensive knowledge of pelvic anatomy, and avoiding the use of electrocautery during lymph node dissection. The repair should be performed as soon as possible, with a tension-free reapproximation of the ends, using electrophysiological tests with a multidisciplinary approach and benefit should be taken from physiotherapy and medical treatment when needed.

RESUMEN

AIM: The complaints of lower urinary tract symptoms (LUTS) in cases with Prostate carcinoma (Pca) depend on coexisting benign prostate hyperplasia (BPH) or aging bladder. We aimed to investigate and compare the effect of goserelin acetate with leuprolide acetate on total prostate volume (TPV), post voiding residue (PVR), International Prostate Symptom Score (IPSS) and maximum flow rate (Qmax) reduction on cases of advanced Pca. METHODS: Patients with advanced Pca were treated with goserelin acetate (10.8 mg/3 months) or leuprolide acetate (22.5 mg/3 months) for 6 months. Changes in Prostate specific antigen (PSA), testesterone level, TPV, IPSS, PVR, and Qmax were assessed every 3 months. RESULTS: Fifty-one patients analyzed in this study. Mean percent decrease in PSA and testesterone from baseline to 6th month was not significantly difference between two groups (respectively; p = 0.9, p = 0.15) but TPV was reduced by -20.2 % ± 4.8 and -15.6 % ± 1.04,  the median total IPSS score was decreased by -34.77 % ± 8.8 and -19.77 % ± 6.1, median Qmax increased by 45.34 % ± 10.16 and 23.21 % ± 6.93, median PVR decreased by -31.54 % ± 8.4 and -19.23 % ± 5.5, respectively for two groups (all parameters (p < 0.05))Conclusion. In this study, we observed that the improvement of voiding parameters goserelin acetate was beter than leuprolide acetate. Especially it was detected the superiority of goserelin acetate group on the reduction of TPV, PVR and IPSS. Oncological outcomes were not different in both groups.

Asunto(s)

RESUMEN

PURPOSE: To evaluate the effect of corticosteroid (CS) on early postoperative pain, renal colic and total analgesic consumption after uncomplicated and unstented ureteroscopy (URS). METHODS: Data of 397 patients who underwent URS and stone fragmentation for symptomatic distal ureteral stone (≤ 15 mm) were retrospectively evaluated. After exclusion, 72 patients who received methylprednisolone (Group I) after non-stenting uncomplicated URS were matched with another 72 patients who did not receive CS (Group II). Cases were matched 1:1 ratio and the matched-pair criteria were age, stone diameter, and duration of surgery. RESULTS: Both groups were statistically similar in terms of mean age, operative time, stone size and preoperative pain score. However, the mean postoperative pain score was statistically significantly lower in group I than group II on the day of surgery (3.3 ± 1.7 vs. 3.9 ± 1.3, p = 0.012) and postoperative day 1 (2.8 ± 1.8 vs. 3.4 ± 1.3, p = 0.02), respectively. Renal colic episode development rate (4.2 vs. 13.2%, p = 0.036), parenteral analgesic requirement rate (18.1 vs. 33.3%, p = 0.001) and total parenteral analgesic consumption per patient (18 vs. 36mg, p = 0.009) were statistically lower in group I than group II on the day of surgery; however, there were no statistically significant differences on postoperative day 1. There were no statistically significant differences between groups in terms of ureteral stenting requirement and late unplanned urgent room visit rates. CONCLUSIONS: Corticosteroid after uncomplicated URS can be offered to reduce early postoperative pain, renal colic episode and total analgesic consumption.

Asunto(s)

RESUMEN

Objective. The cancer of the prostate risk assessment (CAPRA-S) postsurgical score predicts recurrence, metastasis, and cancer-specific survival after radical prostatectomy (RP). We evaluated the relation between CAPRA-S score and biochemical recurrence (BCR) in prostate cancer after RP in our clinic. Materials and Methods. This study was performed on 203 patients with prostate carcinoma who underwent open RP and regional lymph node dissection in our clinic between 2008 and 2013. We calculated the CAPRA-S scores including prostate-specific antigen (PSA) at diagnosis, pathology Gleason score, surgical margin, seminal vesicle invasion, extracapsular extension, and lymph node involvement. The patients were divided into 3 risk groups (low, intermediate, and high risk) according to risk scores. Results. Recurrence occurred in 17.8% of the patients (36 patients out of 203 patients) with a median of 11.7-month follow-up. The average recurrence-free survival time is 44.6 months. Surgical margin invasion and seminal vesicle invasion significantly correlated with BCR especially in high risk group (11 and 13 of 15 patients, p < 0.05, resp.). Conclusion. CAPRA-S score can be easily calculated and it is useful in clinical practice in order to timely propose adjuvant therapies after surgery.

RESUMEN

PURPOSE: To investigate the role of CD44, cytokeratin 20 (CK20) and survivin for the detection and prognosis of patients with urothelial carcinoma of the bladder. MATERIALS AND METHODS: The study included 82 patients who underwent transurethral resection of bladder tumors between 2009 and 2014. The patient and tumor characteristics with relevance to age, tumor size and focality, grade and stage, recurrence and progression were noted. Patients with carcinoma in situ, those who had at more than 3 sites of lesions and greater than 3 cm tumors were excluded. All cases were ex-smokers. All histological samples stained with hematoxylin and eosin were re-evaluated according to the 2004 World Health Organization/International Society of Urological Pathology (WHO/ISUP) classification system and immunohistochemically stained for CD44, CK20 and survivin. RESULTS: The study group comprised 57 (69.5%) males and 25 (30.5%) females with a mean age of 60 years (range, 26-87 years). All were newly-diagnosed patients with bladder tumors. Immunohistochemical evaluation revealed that there was a statistically significant correlation between the grade and stage of the tumor with CK20 and survivin positivity (P < .05). As the grade and stage increased CD44 immunoreactivity significantly decreased (P = .002, P = .0001, respectively). However, relationship of protein expressions with recurrence and progression remained insignificant (P > .05). CONCLUSION: In cases of bladder urothelial carcinoma positivity for CD44, CK20, and survivin has significant relation with the tumor grade and stage while no significant relationship was determined in terms of recurrence and progression .

Asunto(s)

RESUMEN

PURPOSE: To compare the effectiveness and reliability of retrograde intrarenal surgery (RIRS) and micro-percutaneous nephrolithotomy (micro-perc) for the management of kidney stones in pediatric patients. MATERIALS AND METHODS: A retrospective analysis was made of pediatric patients aged <18 years with kidney stones that ranged from 10 to 20 mm in size, who underwent RIRS (n = 36) or micro-perc (n = 45) in referral centers. RESULTS: In the RIRS group, the mean age of patients was 8.39 ± 4.72 years and in the micro-perc group, it was 5.62 ± 4.50 years (p = 0.01). The mean stone size was 12.80 ± 3.03 mm in the RIRS group and 13.97 ± 3.46 mm in the micro-perc group (p = 0.189). The success rate was 86.2% (n = 31) in the RIRS group and 80.0% (n = 36) in the micro-perc group (p = 0.47). The mean complication rate was 16.6% and 13.3% in the RIRS and micro-perc groups, respectively (p = 0.675). Hospital stay and radiation exposure were significantly lower in the RIRS group (all p < 0.001). The mean anesthesia session was 1.94 in the RIRS group and 1.26 in the micro-perc group (p < 0.001). The mean hemoglobin drop was 0.53 ± 0.87 g/dL in the micro-perc group, and none of the cases required blood transfusion. CONCLUSION: The results of this study suggested that micro-perc and RIRS were highly effective methods for the treatment of moderately sized renal stones in children, with comparable success and complication rates. Patients and their parents should be informed about the currently available treatment options, and of their efficacy and safety. However, further clinical trials are needed to support these results.

Asunto(s)

RESUMEN

INTRODUCTION: Several studies evaluating the tolerance of transrectal ultrasound (TRUS)-guided needle biopsies showed that moderate-to-severe pain was associated with the procedure. Additionally, prebiopsy anxiety or rebiopsy as a result of a prior biopsy procedure is mentioned as factors predisposing to higher pain intensity. Thus, in this study, we investigated the effects of hypnotherapy during transrectal ultrasound-guided prostate needle biopsy for pain and anxiety. MATERIALS AND METHODS: Sixty-four patients presenting for TRUS-guided prostate needle biopsy were randomly assigned to receive either 10-min presurgery hypnosis session (n = 32, mean age 63.5 ± 6.1, p = 0.289) or a presurgery control session (n = 32, mean age 61.8 ± 6.8, p = 0.289). The hypnosis session involved suggestions for increased relaxation and decreased anxiety. Presurgery pain and anxiety were measured using visual analog scales (VAS), Beck Anxiety Inventory (BAI), and Hamilton Anxiety Scale (HAS), respectively. In our statistics, p < 0.05 was considered statistically significant. RESULTS: Postintervention, and before surgery, patients in the hypnosis group had significantly lower mean values for presurgery VAS [mean 1 (0-8); p = 0.011], BAI (6.0 vs 2.0; p < 0.001), and HAS (11.0 vs 6.0; p < 0.001). CONCLUSION: The study results indicate that a brief presurgery hypnosis intervention can be an effective means of controlling presurgical anxiety, and therefore pain, in patients awaiting diagnostic prostate cancer surgery.

Asunto(s)

RESUMEN

OBJECTIVE: Renal neoplasms have a predilection to occur in older patients and they are often malignant. They may have different structural characteristics according to age groups. In our study, we have investigated age-related demographic characteristics of the patients who were operated because of suspected malignant renal masses. MATERIALS AND METHODS: Between 2010 and 2014, 129 patients were treated surgically for suspected malignant renal masses at our institution. These cases had undergone open radical, open partial, and laparoscopic radical nephrectomies. Patients were divided into two groups based on their ages and evaluated accordingly as Group 1 (≤50 years) and Group 2 (>50 years). Groups were compared based on their clinical and pathological features. RESULTS: Group 1 and Group 2 consisted of 29 (22.4%) and 91 (77.6%) patients, respectively. The mean age of younger patients was 43.1 years (23-49 years), with a male to female ratio of 19/10, while the average tumor size was 57.6 mm (20-120 mm). Twenty-four patients (83%) had a malignant pathology and five patients (17%) had a benign pathology. Clear cell carcinoma was diagnosed in 67% of the patients in both groups. There was no significant difference with respect to age and tumor size of male and female patients in the younger age group, while younger female adults tended to have a more benign pathology than their male counterparts (40% and 5%, respectively, p<0.05). CONCLUSION: There was no significant difference with respect to gender, tumor size, laterality, and surgical and pathologic features between younger and older patients. An organ- sparing approach should be strongly considered when treatment for renal tumors in young females is performed because of a potentially higher incidence of a benign pathology of renal masses.