Predictive Role of the Systemic Immune Inflammation Index for Intravesical BCG Response in Intermediate- and High-Risk Non-Muscle-Invasive Bladder Cancer

INTRODUCTION

In this study, we aimed to explore using the predictive role of systemic immune inflammation index (SII) for responses of intravesical Bacillus Calmette-Guérin (BCG) therapy in patients with intermediate- and high-risk non-muscle-invasive bladder cancer (NMIBC).

METHODS

From 9 centers, we reviewed the data of patients treated for intermediate- and high-risk NMIBC between 2011 and 2021. All patients enrolled in the study presented with T1 and/or high-grade tumors on initial TURB had undergone re-TURB within 4-6 weeks after initial TURB and had received at least a 6-week course of intravesical BCG induction. SII was calculated with the formula SII = (P × N)/L, where P, N, and L refer to peripheral platelet, neutrophil, and lymphocyte counts, respectively. In patients with intermediate- and high-risk NMIBC, the clinicopathological features and follow-up data were evaluated to compare SII with other systemic inflammation-based prognostic indices. These included the neutrophil-to-lymphocyte ratio (NLR), platelet-to-neutrophil ratio (PNR), and platelet-to-lymphocyte ratio (PLR).

RESULTS

A total of 269 patients were enrolled in the study. Median follow-up time was 39 months. Disease recurrence and progression were observed in 71 (26.4%) and 19 (7.1%) patients, respectively. For groups with and without disease recurrence in terms of NLR, PLR, PNR, and SII calculated prior to intravesical BCG treatment, no statistically significant differences were observed (p = 0.470, p = 0.247, p = 0.495, and p = 0.243, respectively). Moreover, there were also no statistically significant differences between the groups with and without disease progression in terms of NLR, PLR, PNR, and SII (p = 0.504, p = 0.165, p = 0.410, and p = 0.242, respectively). SII did not show any statistically significant difference between early (<6 months) and late (≥6 months) recurrence (p = 0.492) and progression groups (p = 0.216).

CONCLUSION

For patients with intermediate- and high-risk NMIBC, serum SII levels do not present as an appropriate biomarker for the prediction of disease recurrence and progression following intravesical BCG therapy. A possible explanation for the failure of SII to predict BCG response may be found in the impact of Turkey's nationwide tuberculosis vaccination program.

Immediate post-operative intravesical instillation of a single dose chemotherapy is not superior to continuous saline irrigation

INTRODUCTION AND OBJECTIVES

To evaluate whether there is any difference between immediate postoperative instillation of intravesical chemotherapy (IPOIC) and continuous saline bladder irrigation (CSBI) in terms of bladder cancer (BC) recurrence in patients with primary low- or intermediate-risk non-muscle-invasive BC (NMIBC).

MATERIALS AND METHODS

Medical records of 1482 patients who underwent transurethral resection of bladder tumor between March 1994 and August 2020 were reviewed retrospectively. Patients were divided into two groups according to IPOIC and/or CSBI administration status [Group-1 = CSBI alone; Group-2 = CSBI following IPOIC]. Low- and intermediate-risk NMIBC patients were also divided into subgroups according to IPOIC and/or CSBI administration status.

RESULTS

A total of 594 patients with primary NMIBC were included. Of the patients, 86 (14.5%) were female and 508 (85.5%) were male with a median age of 69 (60-78) years. The frequency of patients in Group-1 and Group-2 were 361 (60.8%) and 233 (39.2%), respectively. Recurrent disease was observed in 213 (35.9%) patients. There was no difference between the groups when they were compared for recurrent disease frequency, median time to first recurrence and frequency of recurrence within first 12 months (P = .064, P = .671, and P = .145, respectively). Disease recurrence rates in low-risk NMIBC patients was lower when they were treated with "CSBI following IPOIC" when compared to "CSBI alone" (P = .042). However, no difference was observed in low-risk NMIBC subgroups when they were compared for pathological features of recurrent tumors such as number, size, grade, stage, and presence of carcinoma in situ (P > .05, for each).

CONCLUSIONS

"CSBI following IPOIC" combination was not superior to "CSBI alone" for preventing adverse pathological outcomes in recurrent low- and intermediate-risk NMIBC.

Nation-wide analysis of the impact of Covid-19 pandemic on daily urology practice in Turkey

OBJECTIVE

To present a nation-wide analysis of the workload of urology departments in Turkey week-by-week during Covid-19 pandemic.

METHODOLOGY

The centres participating in the study were divided into three groups as tertiary referral centres, state hospitals and private practice hospitals. The number of outpatients, inpatients, daily interventions and urological surgeries were recorded prospectively between 9-March-2020 and 31-May-2020. All these variables were recorded for the same time interval of 2019 as well. The weekly change of the workload of urology during pandemic period was evaluated, also the workload of urology and the distributions of certain urological surgeries were compared between the pandemic period and the same time interval of the year 2019.

RESULTS

A total of 51 centres participated in the study. The number of outpatients, inpatients, urological surgeries and daily interventions were found to be dramatically decreased by the 3rd week of pandemics in state hospitals and tertiary referral centres; however, the daily urological practice were similar in private practice hospitals throughout the pandemic period. When the workload of urology in pandemic period and the same time interval of the year 2019 were compared, a huge decrease was observed in all variables during pandemic period. However, temporary measures like ureteral stenting, nephrostomy placement and percutaneous cystostomy have been found to increase during Covid-19 pandemic compared with normal life.

CONCLUSIONS

Covid-19 pandemic significantly affected the routine daily urological practice likewise other subspecialties and priority was given to emergent and non-deferrable surgeries by urologists in concordance with published clinical guidelines.

Identifying the predictors of estimated glomerular filtration rate after partial nephrectomy with a nonlinear regression model

PURPOSE

To evaluate the effect of partial nephrectomy on renal function and to identify predictors of estimated glomerular filtration rate (eGFR) at 6 months after partial nephrectomy.

METHODS

Medical data of 154 consecutive patients who underwent partial nephrectomy for a renal mass between January 2015 and March 2020 were retrospectively analysed. The primary outcome measure was eGFR at 6 months postoperatively. An ordinary least regression analysis using a restricted cubic spline for continuous variables was performed to examine the association between primary outcome measure and candidate predictors.

RESULTS

Of the patients, 66 (42.9%) were females and 88 (57.1%) were males with a median age of 60 (range, 50 to 67) years. The median baseline eGFR was 90.40 (range, 74.96 to 102.97) mL/min/1.73 m² , while the median eGFR at 6 months was 77.12 (range, 61.06 to 91.93) mL/min/1.73 m² (P < .001). Baseline eGFR (regression coefficient (β) = 22.7, 95%CI: 18.8 to 26.5, P < .001) was found to be most significant predictor with the postoperative eGFR levels at 6 months. In addition, advanced tumour size (β = -3.17, 95%CI: -5.33 to -1.01, P < .001) and presence of hypertension (β = -3.48, 95%CI: -6.96 to -0.003, P = .049) were also found to be inversely associated with the postoperative eGFR levels at 6 months.

CONCLUSION

Baseline eGFR values, tumour size, and presence of hypertension are significant predictors of eGFR values in the mid-term in patients undergoing partial nephrectomy.

The prostatic adenocarcinoma with mucinous features: A review of the literature with three case reports

Mucinous adenocarcinoma of the prostate is one of the rare variants of the prostatic carcinoma, and its incidence among all prostatic carcinomas is reported to be 0.3% in the literature. If the tumor variant containing extracellular mucin in <25% of the resected tumor mass, the histology is defined as adenocarcinoma with mucinous features. The mucinous adenocarcinoma of the prostate displays similar prognostic features with the classic adenocarcinoma. In this study, the treatment and surveillance processes of our three patients with prostatic adenocarcinoma with mucinous features were presented along with a literature review.

Evaluation of the Sexual Functioning of Individuals Living in Turkey During the COVID-19 Pandemic: An Internet-Based Nationwide Survey Study

Introduction

Although many countries in the world prioritize self-isolation measures during the corona virus disease 2019 (COVID-19) pandemic period, the effects of this process on sexual functioning are not yet known.

Aim

To evaluate the effects of the COVID-19 pandemic on the sexual functioning of individuals who declared no medical history of the COVID-19 disease.

Methods

A total of 1,356 participants filled out an Internet-based survey between June 1 and June 20, 2020. The data from these participants were analyzed to determine sexual functioning in terms of sexual intercourse frequency and sexual desire during the COVID-19 pandemic. Subgroups analyses were also performed, wherein the subgroups were developed according to the population density of the cities in which the participants lived to examine whether population density has any effect on the sexual functions of the participants during the COVID-19 pandemic.

Main Outcome Measure

The study outcomes were obtained using a study-specific questionnaire to assess the changes in people's sexual functioning.

Results

The mean age of the participants was 33.16 ± 8.31 years. There was a statistically significant difference between the participants according to the decrease in the number of weekly sexual intercourses when they were compared in terms of smoking status, alcohol consumption, marital and parental status, being a health-care worker, having a regular sexual partner, and the working status during the COVID-19 pandemic (P < .05, for each). In the subgroup analyses, it was observed that there was a statistically significant difference between the groups for change in the number of sexual intercourses, the number of masturbations, and sexual desire during the COVID-19 pandemic (P < .05, for each).

Conclusion

A decline in sexual functioning was observed during the COVID-19 pandemic period. Living in a metropolitan area was associated with a decline in both sexual intercourse frequency and sexual desire during the COVID-19 pandemic.

Karsiyakali N, Sahin Y, Ates HA, et al. Evaluation of the Sexual Functioning of Individuals Living in Turkey During the COVID-19 Pandemic: An Internet-Based Nationwide Survey Study. Sex Med 2021;9:100279.

Open radical cystectomy is a reliable surgery with acceptable complication rates in elderly male patients: a retrospective, tertiary hospital-based study

Objective: This study aims to evaluate safety of radical cystectomy (RS)+pelvic lymph node dissection (PLND)+ileal conduit urinary diversion (ICUD) in male patients aged >65 years versus ≤65 years.Materials and Methods: Eighty-five male patients who underwent RS + PLND + ICUD for bladder cancer were retrospectively analyzed. The patients were divided into two groups according to age: ≤65 years (Group 1, n = 40) versus >65 years (Group 2, n = 45). Data including baseline demographic and clinical characteristics of the patients, length of hospital stay, and complications within 90 days of surgery, and Grade ≤ II and Grade ≥ III complications according to the Clavien-Dindo (C-D) classification were recorded. Groups were compared in terms of demographic features and development of complications within 90 day after surgery statistically.Results: The median length of hospital stay was statistically significantly longer in Group 2 than Group 1 [10 (7-17) days vs. 9 (6-14) days, respectively; p < .05]. There was no statistically significant difference in the rehospitalization rate within 90 days of surgery between the groups (p > .05).Conclusion: Our study results suggest that RS + PLND + ICUD is a safe procedure in male patients aged ≥65 years.

Clinical features and outcomes of COVID-19 patients with benign prostatic hyperplasia in ageing male: A retrospective study of 18 cases

AIM

A worldwide pandemic of coronavirus disease 2019 (COVID-19) which emerged in China in December 2019 affects the world very seriously. We aimed to evaluate the benign prostatic hyperplasia (BPH) patients who were admitted and treated to our hospital due to COVID-19.

METHODS

Between March 18, 2020 and April 5, 2020, 18 patients admitted with COVID-19 who has BPH and are using medication for this were included in the study and analysed retrospectively. Diagnosis was confirmed by COVID-19 nucleic acid test by sampling sputum or nasopharyngeal swab. Standard COVID-19 treatment protocol determined by our Ministry of Health was applied to all patients according to their risk groups. Epidemiological, clinical, radiological features, additional diseases, laboratory tests, complications and outcome data of all patients were recorded.

RESULTS

Mean age of patients was 59.6 (range: 56-73). As the mode of transmission, 10 (55.5%) of patients were infected in hospital, 5 (27.7%) patients had a relative with COVID-19 and three (16.6%) was unknown. During follow-up, 2 (11.1%) patients were transferred to intensive care unit (ICU). One of these patients dramatically progressed and died. Patients who survived and were not transferred to ICU had lesser comorbidities and were relatively young. Mean duration of hospitalisation was 14.2 days (range 12-19).

CONCLUSION

We think that COVID-19 patients with BPH had a low mortality rate and did not have a poor prognosis in this patient group. It is crucial to take comprehensive preventive measures to control COVID-19 transmission via hospital route.

Renal pelvis urine Gram stain as a traditional, but new marker in predicting postoperative fever and stone culture positivity in percutaneous nephrolithotomy: an observational, prospective, non-randomized cohort study

PURPOSE

The aim of this study was to evaluate the diagnostic value of renal pelvis urine Gram staining (RPUGS) in predicting postoperative fever and renal stone culture (RSC) positivity in percutaneous nephrolithotomy (PCNL).

METHODS

Totally 141 consecutive patients undergoing PCNL for renal stone were included between January 2018 and December 2019. The RPUGS and renal pelvis urine culture (RPUC) were performed using urine sample from renal collecting system, while RSC was performed using stone fragments. Patients were divided into two groups as Group 1 (n = 119) without postoperative fever (< 38 °C) and Group 2 (n = 22) with postoperative fever (≥ 38 °C). Stone culture and Gram staining models were created for predicting postoperative fever using constant covariates of the presence of residual stone, hydronephrosis, and stone burden.

RESULTS

A significantly higher number of patients in Group 2 had RPUGS, RSC, and RPUC positivity (p < 0.001, for each). The sensitivity, specificity, positive predictive value, and negative predictive value of RPUGS in predicting postoperative fever were 72.7%, 89.9%, 57.1%, and 94.7%, respectively. It was observed that both models had similar predictive values and diagnostic performances. Although RSC and RPUGS had a similar diagnostic value in predicting postoperative fever in univariable analysis, both were found to be independent predictors in multivariable analysis (OR: 10.6, 95% CI 4.07-27.9, p < 0.001 and OR: 15.0, 95% CI 5.4-41.2, p < 0.001, respectively).

CONCLUSIONS

In conclusion, RPUGS is as effective as RSC in predicting fever after PCNL. We recommend RPUGS during PCNL to manage post-PCNL infectious complications.

Neutrophil gelatinase-associated lipocalin is an early marker of renal damage in lower urinary tract obstruction in rats

To compare the urinary NGAL levels with serum creatinine levels as an early biomarker for renal injury in rats with bladder outlet obstruction (BOO). METHODS: Twenty male Wistar Albino rats dividedin to 4 groups. In each group basal serum creatinine and urinary NGAL levels were evaluated. In Group 1 (Sham/Control group) only laparotomy was performed.In Group 2 (14th day partial BOO) and Group 3 (28th day partial BOO) partial obstruction and in Group 4(Complete BOO) complete obstruction was performed. Serum creatinine levels and urinary NGAL levels were evaluated in Group 4 on the third day of the study, in Group 2 on the 14th day and in Group 3 and Group 1 on the 28th day. Urethra, ureters and kidneys were excracted by laparotomy and evaluated for histopathologic examination. RESULTS: The increase in plasma creatinine levels after obstruction was statistically significant in Group 4 ( p <0.005). There was significant difference between the groups in urinary NGAL levels after obstruction (p<0.005). Post-obstruction urinary NGAL level was highest in Group 4 and it was statistically significant when compared to beginning levels (p<0.005). In Group 3, increase in urinary NGAL levels were higher (p<0.005) with no increase in plasma creatinine level after obstruction. CONCLUSIONS: It can be concluded that urinary NGAL levels might be an early biomarker for renal dysfunction in partial bladder outlet obstruction which may cause renal impairment through upper urinary tract injury.Therefore, urinary NGAL may play role during the treatment choice and follow-up in BOO patients.

Penile verrucous squamous cell carcinoma: A rare case report

Penile cancer is a rare type of urological cancer. Predisposing factors include phimosis, poor hygiene, and smoking. Circumcision in early childhood has been shown to be protective against penile cancer. About 95% of penile cancers are squamous cell carcinomas, while verrucous type is a rare variant with frequent recurrences, but with a favorable prognosis. The majority of patients are asymptomatic; however, patients may present with pain, discharge, and bad odor depending on the severity of the disease. Although hospital admission is often late due to psychosocial factors, cancer is often localized. Herein, we report a 61-year-old circumcised patient presenting with painful penile mass who was diagnosed with a penile verrucous squamous cell carcinoma in the light of literature data.

Evaluation of Nephrolithometric Scoring Systems to Predict Outcomes of Retrograde Intrarenal Surgery

PURPOSE

The aim of the study was to evaluate the predictive value of nephrolithometric scoring systems used to predict the complexity of renal stones for the outcomes of retrograde intrarenal surgery (RIRS).

MATERIALS AND METHODS

A total of 81 patients who underwent RIRS for nephrolithiasis between January 2013 and October 2017 were reviewed in this retrospective study. Guy's Stone Score (GSS), the S.T.O.N.E., Clinical Research Office of the Endourologic Society (CROES), and Seoul National University Renal Stone Complexity (S-ReSC) nephrolithometry scores were assessed by same researcher for each patient from preoperative non-contrast enhanced computed tomography scans. These nephrolithometric scores, stone characteristics and complications were compared in patients with/without residual stone.

RESULTS

The median (IQR) age of patients (37 female/44 male) was 45 (20) years. The median (IQR) stone burden was 139.4 (125.4) mm2 and the mean Hounsfield unit (HU) value was 1034.46 ± 239.56. The stone burden, S.T.O.N.E. and S-ReSC scores were statistically significantly higher and the CROES score was significantly lower in patients with a residual stone (p < 0.001, for all). The incidence of residual stones was statistically significantly higher in patients with Grade 3 GSS (p = 0.018). While S.T.O.N.E., S-ReSC and CROES were significantly correlated with stone-free rates, GSS failed to correlate with stone-free status. According to the receiver operating characteristic (ROC) curve analysis, the predictive value of stone burden was higher for residual stones, compared to S-ReSC scoring (p < 0.05).

CONCLUSION

Nephrolithometric scoring systems nomograms used to predict the PCNL success were not superior to stone burden in predicting the RIRS success.

Change in Frequency and Predictors of Erectile Dysfunction With Changes in the International Index of Erectile Function-Erectile Function Domain Score in Patients With ST-Elevation Myocardial Infarction: A Prospective, Longitudinal Study

BACKGROUND

Erectile dysfunction (ED) has been proposed as an early indicator for future coronary and peripheral vascular disease.

AIM

We aimed to investigate the longitudinal change in proportion and predictors for ED with changes in erectile function domain (EFD) of the International Index of Erectile Function-15 (IIEF-15) in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PPCI).

METHODS

Between December 2018 and June 2019, 286 male patients aged between 40 and 70 years who were treated with PPCI for STEMI were included. The patients were asked to complete the IIEF-EFD form 3 days after the procedure for the evaluation of baseline erectile functions. During follow-up 3 months after the index procedure, the patients were asked to refill the IIEF-EFD form. Both baseline and third-month IIEF-EFD scores were calculated, and the patients were classified into ED severity groups as per the IIEF-EFD scores. A linear mixed model was used to identify predictors of ED at 3 months.

OUTCOMES

This study identifies the prevalence and predictors of ED with STEMI who underwent PPCI.

RESULTS

The median age was 54 (range 48-61) years. The median IIEF-EFD scores at 3 days and 3 months were 25.5 (range 20.0-27.0) and 22.00 (range 18.25-25.00), respectively. Half of the patients were found to have ED with varying severity as per baseline IIEF-EFD scores. This rate increased to 79% at the 3-month follow-up visit. The IIEF-EFD scores of the patients decreased over time (P < .001). Advanced age (β = -0.603, se = 0.192, P = .002), presence of three-vessel coronary artery disease (β = -3.828, se = 0.783, P < .001), and diabetes (β = -2.934, se = 0.685, P < .001) were found to be inversely associated with the IIEF-EFD scores.

CLINICAL IMPLICATIONS

Advanced age, presence of three-vessel disease, and diabetes mellitus are the indicators of sexual rehabilitation needs in patients after STEMI.

STRENGTHS & LIMITATIONS

This is the first study investigating the predictor variables for the development of ED after coronary artery disease treatment. The limitations include the lack of evaluation of anxiety and depression and the measurements of testosterone levels.

CONCLUSION

The prevalence of ED was high among patients with coronary artery disease, and the frequency of ED increased during 3-month follow-up. Advanced age, three-vessel disease, and diabetes were significant predictors of ED with changes in IIEF-EFD score in patients with STEMI who underwent PPCI. Karabay E, Karsiyakali N, Cinier G, et al. Change in Frequency and Predictors of Erectile Dysfunction With Changes in the International Index of Erectile Function-Erectile Function Domain Score in Patients With ST-Elevation Myocardial Infarction: A Prospective, Longitudinal Study. J Sex Med 2020;17:1101-1108.

Predictive value of prognostic nutritional index on tumor stage in patients with primary bladder cancer

OBJECTIVES

 The aim of this study was to evaluate relationship between preoperative Prognostic Nutritional Index (PNI) values and tumor stage and to identify predictive value of PNI in patients with primary bladder cancer (BC).

METHODS

 A total of 164 patients with primary bladder cancer were retrospectively analyzed using institutional bladder cancer database between January 2008 and January 2018. The PNI was calculated using preoperative blood sample results. According to pathological results, the patients were divided into groups as pTa (n=94), pT1 (n=54), and pT2 (n=16) and further into subgroups as Group 1 (pTa patients, n=94) and Group2 (pT1 + pT2 patients, n=70). Subgroups were compared statistically in terms of PNI values and independent risk factors were evaluated using Backward Step wise multivariate logistic regression analysis.

RESULTS

 Of patients, 145 (88.4%) were males and 19 (11.6%) were females with a mean age of 66.46±10.57 (range, 36 to 93) years. Mean total peripheral lymphocyte count was 2.11±0.71 (×109/L), mean serum albumin was 4.11±0.53 (gr/dL), and mean PNI score was 51.66±6.36. There was a statistically significant difference in serum albumin levels and PNI scores according to tumor stages (p=0.008 and p=0.003, respectively). There was a statistically significant difference in mean serum total protein, albumin, and PNI scores (p<0.01, for all). Tumor size, tumor grade, PNI, carcinoma in situ,and atypical variant status were independent risk factors for predicting tumor stage.

CONCLUSIONS

 Our study results demonstrate that PNI is a potential preoperative predictor of tumor stage and is an independent risk factor for predicting tumor stage in patients with primary bladder cancer. Lower PNI levels are associated with high stage disease.

Comparison of the outcomes of laparoscopic pyeloplasty with and without concomitant pyelolithotomy

Objective

We aimed to evaluate the results of laparoscopic pyeloplasty with concomitant pyelolithotomy and compare results with a cohort of patients undergoing laparoscopic pyeloplasty without pyelolithotomy.

Materials and Methods

We retrospectively reviewed records of 43 patients undergoing transperitoneal laparoscopic Anderson-Hynes dismembered pyeloplasty between December 2012 and July 2018 at our department. Eighteen patients (42%) underwent laparoscopic pyeloplasty with concomitant pyelolithotomy. The results of patients with renal stones were compared with 25 matched patients undergoing laparoscopic pyeloplasty without concomitant renal stones. Demographic data, operative and stone parameters were compared between the groups.

Results

The groups were similar regarding to demographic characteristics. All operations were completed laparoscopically with no conversions to open surgery. In 3 cases without renal stones and 15 cases with renal stones, transposition of the ureter due to crossing vessels was performed. The mean stone size was 13±5.24 mm, and the median number of stones was 1 (1-18). The success of laparoscopic pyeloplasty with and without pyelolithotomy was 93.3% and 92.9%, respectively, as confirmed by negative diuretic renogram at postoperative 3rd months. Overall stone-free rate after laparoscopic pyelolithotomy was 93.3%. Mean operative time was 222.6765.71 minutes vs. 219.11±75.63 minutes for the pyeloplasty with concomitant pyelolithotomy vs. pyeloplasty, respectively (p=0.88).

Conclusions

Laparoscopic pyeloplasty with concomitant pyelolithotomy is a safe and effective intervention with associated good cosmetic results and high stone-free rates without significant increase in operative time or complications.

Relationship between plasma Atherogenic index and final pathology of Bosniak III-IV renal masses: a retrospective, single-center study

Background

There is an increased incidence of renal cell carcinoma (RCC) in patients with metabolic syndrome who usually have high levels of serum triglyceride (TG) and low high-density lipoprotein-cholesterol (HDL-C). Plasma atherogenic index (PAI) is the logarithmic ratio of serum TG level to HDL-C and related to cardiovascular diseases. In this study, we aimed to determine the accuracy of PAI in determining renal malignancy in localized renal masses preoperatively.

Methods

Totally 169 patients who were diagnosed with Bosniak III-IV lesions by imaging modalities and treated in our hospital with partial or radical nephrectomy were retrospectively analyzed using institutional renal cancer database between 2013 and 2018. Preoperative images were evaluated by two experienced radiologists. The patients were divided into two groups according to their postoperative pathological diagnosis as malignant or benign tumors. The PAI of each patient was calculated and the statistical significance of PAI in predicting malignancy for renal masses was analyzed using uni- and multivariable analyses.

Results

Of patients, 109 (64.5%) were males and 60 (35.5%) were females with a median age of 61 (33–84) years. Median tumor size was 6.5 (2–18) cm. Pathological diagnosis was malignant in 145 (85.8%) and benign in 24 (14.2%) patients. There was no statistically significant difference in serum TG levels between malignant and benign cases (p > 0.05). The HDL-C levels were significantly lower in malignant cases (p = 0.001). Median PAI value was 0.63 (0.34–1.58) and significantly higher in malignant cases (p = 0.003). The PAI cut-off value for malignancy was ≥0.34. The sensitivity was calculated as 88.2% and specificity as 45.8%, the positive predictive value as 90.8, negative predictive value as 39.3, and odds ratio as 6.37 (95% CI: 2.466–16.458). In multivariable analysis, gender, smoking status, and hypertension had no effect on malignancy, whereas PAI and HDL-C were independent risk factors (p = 0.003 and p = 0.003, respectively). The risk of malignancy was 5.019 times higher, when PAI was > 0.34 (95% CI: 1.744–14.445) in multivariable logistic regression analysis.

Conclusions

The PAI can be used as a predictive tool in suspicion of malignant renal masses. In case of a benign pathology, PAI levels may be encouraging for surgeons for nephron-sparing surgery.

Hypospadias surgery on YouTube: is it valid?

BACKGROUND

This study aims to evaluate video clips of hypospadias surgery on YouTube and to assess their competence for basic steps of hypospadias surgery.

METHODS

The YouTube was screened for videos of hypospadias surgery between 1 December 2018 and 20 December 2018. Videos were divided into three groups based on the subjective utility checklist scores as follows: highly compatible (group 1; ≥7 points), moderately compatible (Group 2; 5-6 points), and less compatible (group 3; ≤4 points). Groups were compared statistically.

RESULTS

A total of 100 videos were included in this study. The mean total score was 4.48±1.97. There were 15 (15%) videos in group 1, 42 (42%) in group 2, and 43 (43%) in group 3. There was a statistically significant difference in the total score, duration of videos, and like/dislike ratios among the groups (P<0.001, for all). There was a strong and significant correlation between the total scores and the step of glanuloplasty and skin closure (r: 0.805, P<0.001 and r: 0.770, P<0.001, respectively).

CONCLUSIONS

Our study results suggest that the educational content of the videos of hypospadias surgery on YouTube is unsatisfactory. We believe that such videos must contain information regarding the surgical steps of glanuloplasty, skin closure, flap transposition, and urethroplasty and detailed information about the suture materials.

Hypospadias surgery on YouTube: is it valid?

BACKGROUND

This study aims to evaluate video clips of hypospadias surgery on YouTube and to assess their competence for basic steps of hypospadias surgery.

METHODS

The YouTube was screened for videos of hypospadias surgery between 1 December 2018 and 20 December 2018. Videos were divided into three groups based on the subjective utility checklist scores as follows: highly compatible (group 1; ≥7 points), moderately compatible (Group 2; 5-6 points), and less compatible (group 3; ≤4 points). Groups were compared statistically.

RESULTS

A total of 100 videos were included in this study. The mean total score was 4.48±1.97. There were 15 (15%) videos in group 1, 42 (42%) in group 2, and 43 (43%) in group 3. There was a statistically significant difference in the total score, duration of videos, and like/dislike ratios among the groups (P<0.001, for all). There was a strong and significant correlation between the total scores and the step of glanuloplasty and skin closure (r: 0.805, P<0.001 and r: 0.770, P<0.001, respectively).

CONCLUSIONS

Our study results suggest that the educational content of the videos of hypospadias surgery on YouTube is unsatisfactory. We believe that such videos must contain information regarding the surgical steps of glanuloplasty, skin closure, flap transposition, and urethroplasty and detailed information about the suture materials.

Surgical and functional outcomes of radical retropubic prostatectomy after biopsy-related acute prostatitis

Introduction

The present study sought to evaluate the intraoperative, postoperative, oncologic, and functional results of radical prostatectomy (RP) after previous prostatitis.

Material and methods

We retrospectively reviewed available data of 320 patients undergoing open radical prostatectomy between 2010 and 2016. From this group, 23 (7.2%) had previous transrectal prostate biopsy-related acute prostatitis history. The perioperative and postoperative data were statistically compared between Group 1 (with previous prostatitis) and Group 2 (without previous prostatitis). The variables that were evaluated included demographic characteristics, perioperative complications, functional and oncological outcomes.

Results

In Group 1, the operative time, hospitalization and bladder catheterization time was statistically increased by 40 min, 1.9 days, and 2.5 days, respectively (p <0.001, p <0.001, p = 0.02). The positive margin rate was not significantly different between the two groups (p = 0 .64). The rate of complications with Clavien >2 increased in Group 1 (G1 26% vs. G2 12%) (p = 0.02). Neurovascular bundle preservation ratio was statistically higher in Group 2 (G1 46.5% vs. G2 76.9%) (p = 0.02). The functional results were similar for both groups 12 months after surgery.

Conclusions

Previously, transrectal prostate biopsy-related acute prostatitis history was associated with a higher operative time, hospitalization and bladder catheterization time, and perioperative complications during RP. According to our study, although the neurovascular bundle preservation is technically more difficult, potency and urinary continence rate was not affected by previous prostatitis history. However, further studies are still required to confirm these results.

Relation between Monocyte to High-Density Lipoprotein Cholesterol Ratio and Presence and Severity of Erectile Dysfunction

Previous studies have evidenced that inflammation and endothelial dysfunction have a crucial role in erectile dysfunction (ED). Increased monocyte count or activity and lower high-density lipoprotein cholesterol (HDL-C) levels have been associated with inflammation. The monocyte to HDL-C ratio (MHR) is a recently emerged indicator of inflammation. We aimed to investigate the relationship between MHR and ED. In this retrospective study, a total of 120 patients were enrolled, 60 of them having ED and 60 having a normal erectile function. The presence of ED was evaluated with the International Index of Erectile Function (IIEF-5). Patients with ED were compared with the control group for IIEF-5 and MHR. The mean ages of patients and controls were 55.6±5.53 and 56.42±6.63 years, respectively (p = 0.47). The risk factors for ED were similar between cases and controls. The total testosterone, glucose and creatinine levels did not differ between groups. While the HDL-C, LDL-C and triglyceride levels were similar between groups, the monocyte count (0.55±0.20 vs. 0.73±0.18, p < 0.0001) and MHR was significantly greater in patients with ED than in those without ED (1.31 vs. 1.77, p < 0.0001). MHR was significantly negatively correlated with IIEF-5 (p < 0.0001). To our knowledge, this is the first study that has shown a significant and independent association between elevated MHR and ED.

Transrectal ultrasound-guided prostate rebiopsy: How many core sampling should be applied to which patient?

Background:

We investigated the correlation between the sampled number of cores in rebiopsy and the cancer detection rate (CDR).

Materials and Methods:

Two hundred and twelve patients with normal rectal examination who had undergone rebiopsy in the past 5 years were examined retrospectively. Moreover, 68% of them had undergone 12 cores (Group 1) while 32% had undergone 20 cores (Group 2). Both groups were compared with respect to the CDR.

Results:

There was no difference between groups in terms of age, total prostate-specific antigen, and prostate volume (P > 0.05). Forty-one (19%) of 212 patients were diagnosed with cancer, and the CDR was significantly higher in Group 2 (30.9% vs. 13.9%, P = 0.004). This rate increased from 6.5% to 20% (P = 0.025) and from 0% to 33.3% (P = 0.023), respectively, with 12-core and 20-core rebiopsies in patients whose initial pathology indicated benign and high-grade prostatic intraepithelial neoplasia (HGPIN). Furthermore, cancer was detected in 24 (40%) of 60 patients who were diagnosed with atypical small acinar proliferation (ASAP) in the initial biopsy. However, despite being higher in 20-core biopsy group (47.6% vs. 35.9%), this was not statistically significant (P = 0.377).

Conclusions:

At least 20 cores should be sampled in rebiopsy, especially in the patients diagnosed with benign and HGPIN. However, we believe that standard systematic sampling will be sufficient for the patients diagnosed with ASAP.

Relation between blood vitamin B12 levels with premature ejaculation: case-control study

The aim of this study was to investigate whether vitamin B12 levels are associated with premature ejaculation (PE). A total of 109 subjects (56 PE and 53 controls) were included in this study. PE was defined as self-reported intravaginal ejaculatory latency time (IELT) based on the Diagnostic and Statistical Manual of Mental Disorders IV criteria and those who had had an IELT of <2 min was considered as PE. All participants were evaluated using premature ejaculation diagnostic tool (PEDT), International Index of Erectile Function (IIEF) and Beck Depression Inventory (BDI). The vitamin 12 levels were measured in all subjects. The mean age between the PE and controls was comparable (p = .084). Mean IIEF and BDI scores between the two groups did not statistically differ. The mean IELT values in the PE group were significantly lower than in the control group (p < .0001). PE patients reported significantly lower vitamin B12 levels compared with the controls (213.14 vs. 265.89 ng ml^-1 ; p < .001). The ROC analysis showed a significant correlation between the diagnosis of PE and lower vitamin B12 levels. This study has demonstrated that lower vitamin B12 levels are associated with the presence of PE. This work also shows a strong correlation between vitamin B12 levels and the PEDT scores as well as the IELT values.

Assessment of atrial conduction time in patients with polycystic ovary syndrome

BACKGROUND

Polycystic ovary syndrome (PCOS) is closely related to increased cardiovascular risk in women of reproductive age. Atrial conduction abnormalities in these patients have not been investigated in terms of atrial electromechanical delay measured by tissue Doppler imaging (TDI) as an early predictor of atrial fibrillation development. The aim of this study was to evaluate whether TDI-derived atrial conduction time is prolonged in PCOS.

METHODS

The study included 51 patients with PCOS and 48 age-matched healthy controls. P-wave dispersion (PWD) was calculated on the 12-lead surface electrocardiogram. Systolic and diastolic left ventricular (LV) functions, atrial electromechanical coupling, intraatrial and interatrial electromechanical delays were measured with conventional echocardiography and TDI.

RESULTS

PWD was higher in PCOS women (50.45 ± 3.7 vs 34.73 ± 6.7 ms, p = 0.008). Interatrial and intraatrial electromechanical delay were found longer in patients with PCOS compared to controls (41.9 ± 9.0 vs 22.2 ± 6.6 ms, p < 0.001; 22.6 ± 5.8 vs 5.9 ± 4.7 ms, p < 0.001, respectively). Left atrial (LA) volume index and LV diastolic parameters were significantly different between the groups. PWD was correlated with interatrial electromechanical delay (r = 0.54, p < 0.01). Interatrial electromechanical delay was strongly correlated with homeostatic model assessment insulin resistance index and high-sensitivity C-reactive protein levels (r = 0.68, p < 0.001; r = 0.53, p < 0.001, respectively). Interatrial electromechanical delay was positively correlated with LA volume index and deceleration time (r = 0.31, p = 0.04; r = 0.37, p = 0.021, respectively) and negatively correlated with flow propagation velocity (r = -0.38, p = 0.014).

CONCLUSION

This study shows that atrial electromechanical delay is prolonged in PCOS patients. Atrial electromechanical delay prolongation is related to low-grade inflammation, insulin resistance, and LV diastolic dysfunction in PCOS.