Evaluation of the efficacy and patient satisfaction of the intracavernosal alprostadil in the treatment of erectile dysfunction following robot-assisted radical prostatectomy

Objective: Erectile dysfunction (ED) following robot-assisted radical prostatectomy (RARP) is an important problem. The purpose of this study was to evaluate the effectiveness of and patient satisfaction with intracavernosal alprostadil used in the treatment of ED. Material and Methods: Patients using intracavernosal alprostadil in the treatment of ED following RARP were assessed retrospectively. Patients’ demographic characteristics, pre- and postoperative International Index of Erectile Function (IIEF) scores, and general satisfaction evaluated using questions 13 and 14 of the IIEF form were all recorded. Complications developing during treatment, dosages used, and reasons for discontinuation were investigated. Results: Thirty-four patients with a mean age of 61.73±5.80 years were included in the study. Preoperative ED was determined in 52.9% (n=18) of patients. The mean IEFF of the patients who used preoperative, postoperative 1st month, postoperative 3 months after tadalafil use and intracavernosal alprostadil was 20.64 ± 3.46, 15.08 ± 2.09, 15.32 ± 2.18, 26.67 ± 2.30, respectively. The mean length of use of intracavernosal alprostadil was 8.20±2.48 months, and full erection was achieved in 70.58% of patients. Hematoma associated with intracavernosal alprostadil use developed in 2.9% of patients, ecchymosis in 8.8%, and pain in 8.8%. In addition, 73.5% of patients continued to take their medication during the follow-up process. Patients’ general satisfaction following alprostadil therapy was statistically significantly high. Conclusion: Intracavernosal alprostadil therapy following RARP represents a good therapeutic option due to its high success in achieving full erection, low complication rates, and high patient satisfaction. Keywords: erectile dysfunction, Alprostadil, robot-assisted radical prostatectomy

Chylous ascites after laparoscopic donor nephrectomy: First case report in Turkey

Living-donor kidney transplantation is one of the treatment options of end-stage renal failure. In many transplant centers, laparoscopic live-donor transplantation is recognised as the standard pro- cedure. Chylous ascites (CA) is a very rare complication after laparoscopic donor nephrectomy (LDN). We aimed to present the management of the first case report in Turkey. 62-year-old male patient underwent laparoscopic transperitoneal left donor nephrectomy. One month after discharge, he was admitted with abdominal distention and imaging revealed diffuse free fluid in the abdomen. After diagnosis, milky colored chylous fluid was collected by inserting a percutenous drainage cathe- ter. The patient was treated with combination of percutaneous drainage, somatostatin analogue and total parenteral nutrition. Keywords: chylous ascites; laparoscopic donor nephrectomy; complication

The knowledge and opinions of urology doctors in turkey of hyperbaric oxygen therapy in radiation-induced hemorrhagic cystitis: a survey study

Objective: Radiation-induced hemorrhagic cystitis (RHC) is an accepted hyperbaric oxygen therapy (HBOT) indication. We aimed to analyze the knowledge and the opinions of urology physicians on HBOT in RHS patients with a survey. Materials and Methods: The questionnaires were conducted face to face or online on urology physicians. Results: Seventy-seven urology physicians participated in our study. Physicians have been working for 11 ± 10.5 years in the field of Urology. The 84.4% of our physicians had an average of 0-10 RHC patient administration in a year. However, the majority of the participants stated that they have never referred RHC patients to HBOT. Similarly, 48.1% of the physicians stated that they have insufficient knowledge of HBOT for their specialty. On the other hand, the majority were not sure about the HBOT as an effective treatment option in RHC patients (54.5%), about the cost-effectiveness of HBOT for RHC (66.2%), and the ability of HBOT on shortening the recovery period of RHC patients (49.9%). We observed that physicians who did not have any knowledge on HBOT had statistically significantly lower RHC patient referral rates to HBOT and had more negative opinions on the effectiveness of HBOT in RHC patients (respectively p<0.001, p=0.002). Likewise, physicians who had RHC patient admissions had statistically significantly more positive opinions about HBOT in terms of treatment efficiency, shortening the recovery period, and being a safe treatment option in RHC patients compared to the physicians who did not have any RHC patient admissions (respectively p<0.001, p<0,001, p<0.001). Conclusion: We found that the urology physicians’ knowledge of HBOT application in RHC patients was insufficient. Thus, we realized that they were doubtful about HBOT as an effective RHC treatment option. Likewise, we found out that most of the urology physicians do not refer RHC patients for HBOT. Keywords: hyperbaric oxygen therapy, cystitis, radiation injuries, bladder, urologists

Comparison of intraoperative hemodynamic parameters of recipients in adult living donor and deceased donor kidney transplantations

Objective: There are many studies on kidney transplant anesthesia, there is not enough data in the literature in terms of intraoperative parameters according to the donor type. In this study, we aimed to compare the intraoperative hemodynamic parameters in adult patients who underwent living-donor and deceased-donor kidney transplantation (KT). Material and Methods: The patients who underwent KT were divided into 2 groups according to the donor kidney type. Recipients who underwent deceased donor transplantation were included in the study as Group 1. Among the living donor kidney transplant recipients, the same number of patients with similar demographic data as Group 1 were designated as Group 2. Both groups were compared in terms of recorded data and intraoperative hemodynamic parameters. Results: Twenty-four patients were included in the study. The mean durations of dialysis were 81.6 ± 64.8 and 16.8 ± 17.4 months for Group 1 and Group 2, respectively (p = 0.001). The mean cold ischemia time was significantly longer in Group 1 than Group 2 (p = 0.001). The mean operative urine output for Group 1 and Group 2 were 87.3 ± 149.6 and 634.2 ± 534.5, respectively (p = 0.002). Mean arterial pressure, heart rate, peripheral oxygen saturation and CVP values were all comparable between the two groups. Conclusion: Cold ischemia time is longer and operative urine volume is lower in deceased donor transplants compared to living donor transplants. With good preoperative preparation, close intraoperative follow-up, and proper fluid management, similar intraoperative hemodynamic parameters are achieved in both types of donor recipients. Keywords: Anesthesia, cadaver, hemodynamic monitoring, kidney transplantation, living donors

Single center results of magnetic resonance imaging ultrasound guided fusion prostate biopsy obtained patients

Objective: We aimed to evaluate magnetic resonance imaging-ultrasound guided fusion prostate biopsy (MRI- US FPBx) results from a single center and to compare with current literature. Material and Methods: Between January 2016 and July 2019, MRI-US FPBx pathological and imaging results of 358 men were retrospectively analyzed. PI-RADS scores were determined as 3, 4 and 5 in 222 (62%), 107 (29.8%) and 29 (8.1%) patients, respectively. Totally 454 lesions were underwent MRI-US FPBx. 303 (66.7%) lesions were scored as PI-RADS 3, 120 (26.4%) lesions were scored as PI-RADS 4 and 31 (6.8%) lesions were scored as PI-RADS 5. 315 (69.3%) of lesions were in peripheral zone, 26 (5.7%) were in central zone, 111 (24.4%) were in transitional zone and 2 of them were in anterior fibromuscular stroma. Results: Overall prostate cancer detection rate was 36.3%. Concerning detection rates, MRI-US FPBx alone and transrectal ultrasonography guided prostate biopsy (TRUS-Bx) alone were 27.6% and 26.5%, respectively. Cancer detection rate only through MRI-US FPBx PIRADS-3 and PI-RADS 4&5 were 6.9% and 20.6%, respectively. Clinically significant prostate cancer (csPCa) rates were evaluated and csPCa to overall prostate cancer (PCa) rates for TRUS-Bx, MRI-US FPBx and combined techniques were 16.8%, 35.4% and 39.2%, respectively. Results of 11 patients were evaluated as benign. Conclusion: MRI-US FPBx significantly increases success rate of prostate biopsy procedure. Regarding current MRI technology, it is not appropriate to consider MRI-US FPBx as a stand-alone biopsy option without concomitant with TRUS-Bx. Keywords: prostate cancer; biopsy; MRI; fusion

Nephrogenic adenomas of the urinary system: a clinicopathologic analysis of 30 cases

Objective: Nephrogenic adenomas (NA) are benign lesions that may occur in several sites throughout the urinary tract, from the renal pelvis to urethra, and especially in the bladder. They are strongly associated with urinary tract irritation, chronic inflammation, previous urologic surgery, and intravesical instrumentations. Our study aims to evaluate and present the clinicopathologic characteristics and findings of cases that were diagnosed with nephrogenic adenoma accompanied by relevant information from the literature. Material and Methods: Our study includes 30 patients who were pathologically diagnosed with NA from February 2005 to November 2017. Results: Among these patients, 63.3% were males and mean age was 60 years. The most common site of occurrence was the bladder (86.6%), followed by the ureter (6.7%) and the urethra (6.7%). Most patients presented with hematuria (36.7%). History of concurrent bladder cancer was present in 26.7% of patients, but there were no cases of de novo bladder cancer diagnosed after NA. Recurrence of NA after initial resection occurred in only 10% of patients who underwent follow-up cystoscopy. Nephrogenic adenoma is a rare lesion associated with nonspecific symptoms and endoscopic features. Definite diagnosis must be made after histological analysis of resected specimens. Conclusion: Nephrogenic adenoma is a rare lesion associated with nonspecific symptoms and nonspesific endoscopic features. A definite diagnosis must be after histological analysis of resected specimens. Keywords: nephrogenic adenoma, urothelial lesion, bladder, ureter

Retrospective evaluation of our percutaneous biopsy results of renal masses

Objective: In this study, we aim to present the retrospective results of percutaneous biopsies performed on solid kidney lesions in our clinic with the literature. Materials and Methods: In this retrospective descriptive study approved by the ethics committee in our center, the demographic features and histopathological results of 57 patients who had a solid mass in the kidney between 2017-2020 and underwent ultrasonography-guided percutaneous kidney biopsy in our interventional radiology clinic were analyzed from the hospital database. Patients without pathology results were excluded from the study. Results: Our patients consisted of 35 men (61,4%) and 23 women (38,6%). The average age was 59.02±15.33(6-94). We had 1 child and 56 adult patients. 29 of the kidney lesions were located in the left kidney(50,9%) and 28 were located in the right kidney(49,1%). In 44 patients(77.2%) who had malignant pathology; the results were 41 renal cell carcinoma(93.2%), 2 lung squamous cell carcinoma metastasis(4.5%) and 1 primary metastatic pleomorphic adenoma of the salivary gland(2.3%). In a total of 13 patients(22.8%) whose pathology results were benign; the results were 5 oncocytomas(38.5%), 5 angiomyolipoma(38.5%), 2 chronic pyelonephritis(15.4%) and 1 metanephric adenoma(7.6%). Renal cell carcinoma rate was 71.9% among all lesions. Conclusion: Radiological methods may not provide sufficient diagnostic data in the differential diagnosis of solid renal masses.In our study, the rates of benign lesions as a result of percutaneous biopsy were higher compared to the literature. Therefore, we believe that it is remarkable in terms of the importance of preoperative biopsy in solid lesions. Keywords: renal mass, percutaneous biopsy, renal cell carcinoma

Extraprostatic extension of gleason 6 prostate cancer: single center experience

Objective: For Gleason Score (GS) 3+3:6 prostate cancer (PC) cases, recent guidelines recommend clinical follow-up instead of radical treatment due to complications. One of the most important disadvantages of clinical follow-up is that low-grade PC may include local aggressive behavior. Hence, our aim here was to investigate the incidence of extraprostatic extension (EPE), a local aggressive behavior, in GS6 PC cases. Material and Methods: We examined 119 materials diagnosed with prostatic adenocarcinoma (GS 3+3:6) with no tertiary pattern and that were sent to our department as radical prostatectomy materials between January 2010 – May 2019. We investigated how many of the materials had EPE. Results: We observed EPE in 16 (13.45%) of our cases. 5 of the cases had vesicula seminalis invasion (pT3b) and 11 had EPE and/or bladder neck invasion (pT3a) without vesicula seminalis invasion. Conclusion: Among our patients diagnosed with GS-6 PC, we observed EPE (pT3) in 13.45% and vesicula seminalis invasion (pT3b) in 4.2%, which suggests that the possibility of EPE is not uncommon in GS-6 PC. Based on these findings, we argue that patients with GS-6 PC under clinical follow-up should be followed more carefully for EPE. Keywords: prostate cancer; gleason score; extraprostatic extension

Acute testicular vein thrombosis in a young patient with a solitary testicle: a rare urological emergency

Acute scrotal pain due to testicular vein thrombosis is a rare condition. Thrombosis is defined as clot formation within the blood vessels and as a result, it interrupts the blood supply of the peripheral organs. In routine urology practice, the incidence of thromboembolic diseases is <1%, and it is mostly encountered in patients at the postoperative period. Nevertheless, testicular vein thrombosis should also be remembered in the differential diagnosis of patients admitted to the emergency department due to acute scrotum. In general, conservative treatment is the first choice in treatment management, but surgical intervention may also be required in some cases. Since the available data on this subject are based on the information obtained from case reports, a standard treatment approach should be developed by examining the current treatment methods. We aim to present the case report of testicular vein thrombosis in the light of the literature, which is one of the rarely seen emergencies of urology. Keywords: acute pain; color doppler ultrasonography; venous thrombosis; testicular diseases

An inflammatory marker for predicting prostate cancer in prostate biopsy: monocyte-to-lymphocyte ratio

Objective: To evaluate the predictive role of the inflammatory parameters, especially monocyte-to-lymphocyte (MLR) ratio, on the diagnosis of prostate cancer (PCa). Material and Methods: The data of patients undergoing prostate biopsy between July 2015 and July 2019 were retrospectively analyzed. The data including age, PSA, neutrophil-to-lymphocyte (NLR), platelet-to-lymphocyte (PLR), MLR and histopathologies were recorded. Patients were grouped as benign prostatic hyperplasia (BPH), PCa and prostatitis according to PBx histopathology and all variables were analyzed. Results: Pathology results of 338 patients are as follows: 124 (36.7%) BPH, 132 (39.1%) PCa and 82 (24.3%) prostatitis. Patients with PCa were older and had higher serum PSA, PLR, NLR and MLR values compared to non-PCa patients. In the comparison made by excluding metastatic patients, only serum PSA and MLR values remained statistically high. All three parameters had significant AUC to predict PCa in entire-cohort, but only the MLR had significant AUC to predict PCa in the cohort which metastatic patients were excluded. Multivariate logistic regression analysis revealed that only serum PSA and MLR values were significant independent predictors of PCa. Conclusion: In our study, it was observed that only MLR among all inflammatory markers found to be high in PCa patients continued to be high in nonmetastatic PCa patients. In the multivariate regression model created from age, PSA and MLR, MLR was found to be a significant independent predictor of PCa like PSA. MLR can be used as an inexpensive, easily accessible and applicable new marker to predict PCa. Keywords: inflammatory markers, monocyte-to-lymphocyte ratio, prostate biopsy, prostate cancer