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.

Tadalafil versus alpha blockers (alfuzosin, doxazosin, tamsulosin and silodosin) as medical expulsive therapy for < 10 mm distal and proximal ureteral stones

Objectives: To evaluate the effect of tadalafil compared with four alpha blockers (alfuzosin, doxazosin, tamsulosin and silodosin) as medical expulsive treatment for ureteral stones in male adults. Materials and methods: Male adults who were admitted to urology clinic with flank pain and diagnosed with non complicated < 10 mm ureteral stone on non-contrast computed tomography (NCCT) between June 2014-September 2015 were retrospectively evaluated. A total of 273 patients with ureteral stone were divided into five groups. Alfuzosin 10 mg/daily, doxazosin 8 mg/daily, tamsulosin 0.4 mg/daily, silodosin 8 mg/daily and tadalafil 5 mg/daily for 6 weeks were prescribed respectively. Stone localization, diameter, volume and Hounsfield units were noted as NCCT findings. The patients were divided into the two groups based on their stone localization as distal and mid-proximal stones. These two groups were evaluated separately. Expulsion rate were noted at the end of 6 weeks. NCCT and treatment findings were compared between five drug groups in distal and mid-proximal stones separately. Results: Age was higher in tadalafil group in distal stones (p = 0.032). Expulsion rate was found 78.1% for alfuzosin, 75.7% for doxazosin, 76.5% for tamsulosin, 88.6% for silodosin and 90% for tadalafil in distal (p = 0.44) and 21.7%, 30%, 30%, 30% and 54.5% in mid-proximal stones (p = 0.034) respectively.Conclusions: Expulsion rate was higher in silodosin and tadalafil for distal ureteral stones but the difference didn’t meet statistical significance. However the expulsion rate was significantly higher in tadalafil than in the other groups for mid-proximal ureteral stones. The result of this study showed that tadalafil may increases ureteric stone expulsion.

The effect of alpha blockers on uroflowmetric parameters in different voiding positions

Introduction: We assessed the effect of different voiding positionson uroflowmetric parameters and post-void residual (PVR)urine volume in symptomatic benign prostatic hyperplasia (BPH)patients. We also evaluated the effect of alpha blockers on PVR indifferent voiding positions.Methods: The study was performed with 110 BPH patients over 50years old. In total, 4 uroflowmetries were performed in all patients:2 patients in the sitting position and 2 in the standing position. PVRwas measured with transabdominal ultrasonography. Also, patientswere divided into two groups according to the alpha adrenergicblocker treatment; the effect of this treatment on their uroflowmetricparameters in different positions was evaluated.Results: Maximum flow rate (Qmax) and average flow rate (Qave)were significantly higher in patients in the sitting position, butthere were no differences in other uroflowmetric parameters andPVR volume (Qmax: 15.5±5.9 mL/s vs. 13.7±5.2 mL/s, Qave:11.4±4.6 mL/s vs. 10.7± 3.9 mL/s, respectively; p < 0.05). TheQmax and Qave were significantly higher in sitting position, comparedto the standing position, in both alpha adrenergic treatmentand non-treated groups; again, there were no differences in otheruroflowmetric parameters and PVR volume.Conclusion: Qmax and Qave values were significantly higher inthe sitting position. Alpha blockers did not affect any change.

The effect of alpha blockers on uroflowmetric parameters in different voiding positions

INTRODUCTION

We assessed the effect of different voiding positions on uroflowmetric parameters and post-void residual (PVR) urine volume in symptomatic benign prostatic hyperplasia (BPH) patients. We also evaluated the effect of alpha blockers on PVR in different voiding positions.

METHODS

The study was performed with 110 BPH patients over 50 years old. In total, 4 uroflowmetries were performed in all patients: 2 patients in the sitting position and 2 in the standing position. PVR was measured with transabdominal ultrasonography. Also, patients were divided into two groups according to the alpha adrenergic blocker treatment; the effect of this treatment on their uroflowmetric parameters in different positions was evaluated.

RESULTS

MAXIMUM FLOW RATE (QMAX) AND AVERAGE FLOW RATE (QAVE) WERE SIGNIFICANTLY HIGHER IN PATIENTS IN THE SITTING POSITION, BUT THERE WERE NO DIFFERENCES IN OTHER UROFLOWMETRIC PARAMETERS AND PVR VOLUME (QMAX: 15.5±5.9 mL/s vs. 13.7±5.2 mL/s, Qave: 11.4±4.6 mL/s vs. 10.7± 3.9 mL/s, respectively; p < 0.05). The Qmax and Qave were significantly higher in sitting position, compared to the standing position, in both alpha adrenergic treatment and non-treated groups; again, there were no differences in other uroflowmetric parameters and PVR volume.

CONCLUSION

Qmax and Qave values were significantly higher in the sitting position. Alpha blockers did not affect any change.

Relationship between circumcision scar thickness, postcircumcision mucosal cuff length measures and premature ejaculation

OBJECTIVE

The etiology of premature ejaculation (PE) is unknown. Over the past two decades several studies have suggested that lifelong and acquired PE may be caused by somatic disorders and/or neurobiological disturbances. One controversial factor is the effect of circumcision on ejaculation. This prospective study investigated the relationship between postcircumcision penile mucosal cuff length, circumcision scar thickness and the PE syndromes. Features of PE patients were compared with those of a normal healthy control (NHC) group.

MATERIAL AND METHODS

In total, 160 circumcised men were studied: 80 men with PE and 80 men in the NHC group. The following data and measurements were evaluated: age, type of PE syndrome, intravaginal ejaculation latency time (IELT), circumcision scar thickness and postcircumcision mucosal cuff length.

RESULTS

In terms of the mean IELT, a statistically significant difference was detected between the PE syndromes (p < 0.05), and between the PE patients and the control group (p < 0.05). Among the four PE syndromes, there was no significant difference related to the mean mucosal cuff length and mean circumcision scar thickness (p > 0.05). No significant difference was observed between the two groups for mean mucosal cuff length (p > 0.05) or mean circumcision scar thickness (p > 0.05).

CONCLUSION

In this study, no relationship was observed between PE and postcircumcision penile mucosal cuff length and circumcision scar thickness. Further studies are required to evaluate the positive and negative effects of circumcision on PE syndromes.

Temperament and Character Inventory Dimensions in Alcohol Dependency

Aim:

The aim of this study is to evaluate the differences in dimensions of temperament between alcohol dependent inpatients and healthy control subjects.

Method:

The study is consisted of 77 alcohol-dependent patients according to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition and 80 healthy control subjects. Cloninger's Temperament and Character Inventory (TCI), Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire (TEMPS-A) scale and semi structured sociodemographic form were applied to the subjects after detoxification period.

Results:

Age and education level were similar rates in both alcohol dependent (mean age= 43.7 ± 10.1 and education level= 9.0 ± 4.2) and healthy control subjects (mean age: 42.5 ± 11.8 and education level: 10.2 ± 3.8). Alcohol-dependent patients were characterized by higher Novelty-Seeking (p=0.006) and Harm Avoidance (p=0.002) than non-psychiatric control subjects. Also, subjects suffering from Alcohol-dependence exhibited significantly more depressive (p=0.003), anxious (p=0.001), irritable (p=0.004) and cyclothymic (p=0.001) temperament. Novelty-Seeking [95% C.I = 1.08 (1.07-1.16)] and cyclothymic temperament [95% C.I = 1.13 (1.03-1.23)] were predictors of alcohol dependency.

Conclusion:

Novelty seeking and harm avoidance were significantly higher in the patients than in the healthy subjects. Novelty-Seeking and cyclothymic temperament were predictors for alcohol dependency. It seems to be important to consider TCI dimensions and affective temperaments in planning the treatment and maybe in preventing of alcohol dependence.

Evidence for theory of mind deficits in euthymic patients with bipolar disorder

OBJECTIVE

i) To investigate the subtle ToM (theory of mind) deficits in euthymic patients with bipolar disorder. ii) To investigate the impact of non-ToM cognitive deficits on ToM abilities.

METHOD

Forty-three euthymic patients with bipolar disorder and 30 healthy control subjects were involved in this study. ToM was assessed by the Eyes test and the Hinting task. Both groups were also evaluated with a comprehensive neuropsychological battery including tasks for basic emotion and face recognition.

RESULTS

The patient group was impaired on both of the ToM tasks. The patient group also showed impairment in many cognitive tasks including tasks related to sustained attention.

CONCLUSION

Even euthymic patients with bipolar disorder may be impaired in advanced ToM tasks. Executive dysfunction and some other cognitives deficits such as basic emotion recognition may be at least partly responsible for this result.

A comparison of different filters for white cell reduction

Removal of white blood cells (WBCs) from blood components before transfusion by filters with at least 3 log10 depletion may prevent or delay leukocyte-associated transfusion reactions such as HLA alloimmunization, non-hemolytic febrile reactions, transmitted infections (e.g., CMV, HTLV-1), and immunomodulation. The aim of this study was to compare the leukocyte removal efficiency (LRE) of six commercial bedside filters that are said to achieve 3 log10 (Bio R-01), Leucostop 4LT-1, Pall RC 50) and 4 log10 (Bio R-01 Plus, Pall RC 400, Pall RC XL-1) WBC depletion. A total of 430 units of whole blood ranging from 32 to 92 for each filter type were analyzed by an automated counter before and after filtration. Postfiltration blood samples were also evaluated for WBCs by Nageotte chamber. All the filters demonstrated leukocyte removal about 1 log10 less than the manufacturer's claim. The fourth generation filters showed a better performance than the third generation filters. Of them, Pall RC XL-1 showed the best efficacy with 99.93 percent leukocyte removal and a median residual WBCs of 1.6 x 10(6) per unit. These results indicate that the fourth generation filters, which are designed for the filtration of packed red cells, in particular Pall RC XL-1, are also able to reduce WBCs from whole blood below the critical antigenic leukocyte load (5 x 10(6)), and can be efficiently used for polytransfused patients to prevent alloimmunization.