Turkish journal of urology最新文献

Objective: Urinary tract infection is one of the most common and distressing complications of radical cystectomy with urinary diversion. This study aimed to elucidate the usefulness of the geriatric-8 screening tool for predicting postoperative complications, especially urinary tract infections, in patients who underwent radical cystectomy with urinary diversion.

Material and methods: Ninety-one patients with bladder cancer who underwent radical cystectomy with urinary diversion were assessed for geriatric-8 and classified into 3 groups according to their geriatric-8 score: 14 as the high score group. We retrospectively analyzed the association between geriatric-8 score and postoperative complications classified according to the Clavien-Dindo classification.

Results: The median age of the patients was 75 years (interquartile range 71-80 years) and 75 (82%) were male; 41 of the patients (45%) had high geriatric-8 score (>14), 40 of the patients (44%) had intermediate geriatric-8 score (11-14), and 10 of the patients (11%) had low geriatric-8 score (< 11). In multivariate analysis, low score of geriatric-8 was independently associated with the occurrence of grade 2 or higher urinary tract infection within 30 days [odds ratio=5.9; 95% CI=1.2-30.3; P=.03], along with female [odds ratio=6.1; 95% CI=1.7-21.7; P=.006] and open surgery [odds ratio=6.0; 95% CI=1.8-19.6; P=.003].

Conclusion: The geriatric-8 score may contribute to predict postoperative urinary tract infection in patients with bladder cancer who underwent radical cystectomy with urinary diversion.

Objective: At the time of diagnosis, approximately 16.5% of prostate cancer patients are metastatic. The main framework of metastatic prostate cancer treatment is androgen deprivation therapy, which is performed surgically or medically. The aim of this study is to evaluate the attitudes of medical oncologists and urologists about orchiectomy as androgen deprivation therapy.

Material and methods: A total of 387 physicians working in the Departments of Urology (n=217) and Medical Oncology (n=170) were included in this descriptive study. Data were collected through an electronic survey.

Results: Only 7.5% of participants indicated that they offered surgical castration to their patients. Urologists preferred surgical castration more than oncologists for the treatment of metastatic castration-sensitive prostate carcinoma (P=.003). The reasons why medical oncologists preferred surgical castration less are that it is an invasive procedure, has risk of morbidity and mortality, high cost of hospitalization, and may cause deterioration of the patient's body image (P < .05).

Conclusion: This study showed that physicians were less likely to perform orchiectomy as an androgen deprivation therapy. Although the most important reason for this is the patient preference, the biased presentation of treatment options to patients, the lack of knowledge of physicians about orchiectomy, and the effect of the pharmaceutical industry should also be kept in mind.

Objective: The aim of this study is to compare the outcomes of right- and left-sided live donor nephrectomies using the inverted kidney transplantation technique for right live donor nephrectomy on transplantation.

Material and methods: A retrospective review was done for the cases of live donor nephrectomy, either as open donor nephrectomy or laparoscopic donor nephrectomy between 2004 and 2019. Inverted kidney transplantation was used with right-sided grafts. The variables of the right- and left-sided live donor nephrectomies were compared.

Results: There were 202 live donor nephrectomies including 71 (35.1%) open donor nephrectomies and 131 (64.9%) laparoscopic donor nephrectomies with 4 cases of conversion to open donor nephrectomy. There were 119 (58.9%) right-sided and 83 (41.1%) left-sided live donor nephrectomies with insignificantly different mean operative time (123 and 127 minutes; P=.09), mean warm ischemia time (82.3 and 84.5 seconds; P=.32), and mean blood loss (73 and 78 mL; P=.18), respectively. Inverted kidney transplantation was performed for 86% of grafts from right live donor nephrectomies. Discharge from hospital was on an average of 4.3 days postoperatively. There were only 3 complications (1 in right live donor nephrectomy and 2 in left live donor nephrectomies) with grade 2 according to Clavien-Dindo Classification. Incidence of delayed graft function (P=.09), transplant vein thrombosis (1 case in each group), 1-year graft survival rate (93.2% vs. 94.8%; P=.12), and 1-year serum creatinine levels (1.4 ± 0.3 vs. 1.3 ± 0.2; P=.09) revealed statistically insignificant differences.

Conclusion: Regardless of the surgical technique, the right live donor nephrectomy seems to be technically as safe as the left live donor nephrectomy for both the donors and the recipients. Using inverted kidney transplantation provided convenient extensions of graft's vessels to full length with no significant increased incidence of vascular thrombosis.

Objective: The aim of the study is to identify whether crossing vessel is a cause or an associated finding in Pelvi Ureteric Junction Obstruction.

Material and methods: This is a prospective study of a total of 128 patients who underwent laparoscopic pyeloplasty from January 2016 to June 2020. All patients who underwent laparoscopic pyeloplasty and pelvi ureteric junction segments were sent for histopathological examination. The presence of crossing vessels is documented intraoperative and patients were divided into two groups, group 1 having pelvi ureteric junction obstruction with crossing vessel, and group 2, pelvi ureteric junction obstruction without crossing vessels. Histopathological examination findings of pelvi ureteric junction segment including inflammation, fibrosis, muscle hypertrophy, muscle disarray, and synaptophysin were recorded. Unpaired Student t-test was used for comparing differences between continuous normally distributed data from 2 samples and non-parametric tests were applied for continuous data.

Results: Of the total 128 patients, crossing vessels were identified in 42 (32.8%), and 86 (67.2%) were without crossing vessels. The demographic profile of patients between the 2 groups was comparable. On histopathological examination, moderate-to-severe chronic inflammation was seen in 23.8% and 44.2% (P > .05) in group 1 and group 2, respectively; fibrosis and muscular hypertrophy were higher in group 2 but statistically insignificant (P > .05), and muscle disarray was higher in group 1 but statistically insignificant (P > .05). Synaptophysin was positive in 4.8% and 4.7% in group 1 and group 2, respectively.

Conclusion: The differences in histopathological examination between the 2 groups were not statistically significant. However, in patients with crossing vessels, there was a higher degree of inflammation, which may lead to early pelvi ureteric junction obstruction.

About 275 million people worldwide aged between 15 and 64 years used drugs at least once since 2016. Initial estimations suggest that 13.8 million young people between 15 and 16 years used cannabis every year. Recreational drug use contributes significantly to mortality as well as physical and mental health problems. A number of urological complications can arise from the use of common and emerging recreational drugs which can present as wide spectrum affecting lower and upper urinary tracts, kidneys, sexual organs as well as sexual dysfunction. In order to effectively manage these issues, urologists need to be cognizant of these complications in their patients, particularly among youths. This review attempted to consolidate available data and provide insight into this issue; however, further population-based epidemiological studies are needed to provide necessary guidelines.

Hypercalcemia is an uncommon occurrence in urological malignancies except for renal cell carcinoma. However, when seen, it is usually associated with advanced disease and both the osteolytic as well as humoral mechanisms may be causative. Owing to its rarity, hypercalcemia can be easily missed during the initial evaluation of a patient with urologic malignancy. Our article aims to highlight the mechanisms associated with hypercalcemia in malignancy, in general, and review the available literature on hypercalcemia in urological malignancies. We also aim to discuss the management options in case of such an unusual occurrence in any urological cancer.

Objective: Using artificial intelligence and a deep learning algorithm can differentiate vesicoureteral reflux and hydronephrosis reliably.

Material and methods: An online dataset of vesicoureteral reflux and hydronephrosis images were abstracted. We developed image analysis and deep learning workflow. The images were trained to distinguish between vesicoureteral reflux and hydronephrosis. The discriminative capability was quantified using receiver-operating characteristic curve analysis. We used Scikit learn to interpret the model.

Results: Thirty-nine of the hydronephrosis and 42 of the vesicoureteral reflux images were abstracted from an online dataset. First, we randomly divided the images into training and validation. In this example, we put 68 cases into training and 13 into validation. We did inference on 2 cases and in return their predictions were predicted: [[0.00006]] hydronephrosis, predicted: [[0.99874]] vesicoureteral reflux on 2 test cases.

Conclusion: This study showed a high-level overview of building a deep neural network for urological image classification. It is concluded that using artificial intelligence with deep learning methods can be applied to differentiate all urological images.

Background: To describe a step-by-step approach for glans preserving urethroplasty with a dorsal inlay graft used for distal urethral strictures. Description of the Technique: The reconstruction was performed through a keyhole incision in the urethra. In this way, we achieve maximal exposure by a minimal incision and saving of the glans. After incision of the diseased dorsal urethral mucosa through the keyhole and the meatus, a buccal mucosa graft pull-through resulting in a dorsal inlay is done. Patient(s) and Methods: We treated 10 patients in different clinical settings with success by using the newly described technique below. We highlight and illustrate 1 case of a 34-year-circumcised male. Antegrade urethrogram showed a distal penile and fossa navicularis stricture with a total estimated length of 3.5 cm.

Results: In this specific case the glans sparing approach had a surgical duration of 115 minutes. After 3 weeks the urinary catheter was removed. At 12 months, the patient reported no remaining urinary tract symptoms. Examination showed a fully healed lesion and an adequate uroflowmetry with a Qmax of 24 mL/s coming from 4 mL/s pre-operatively. In our 10-patient case series, all treated patients had complete resolution of their complaints, significant improvement in flow rates and excellent cosmetic results without complications.

Conclusion: In selected cases, the described technique is feasible, safe, and effective with excellent functional outcomes and better cosmetic results especially due to the glans preservation.

Objective: This study aimed at improving the discrimination of Prostate Imaging - Reporting and Data System version 2.1 (PI-RADS v2.1) score 3 suspicious prostate cancer lesions using lesion volume evaluation.

Material and methods: Two hundred five PI-RADS v2.1 score 3 lesions were submitted to transperineal MRI/TRUS fusion-targeted biopsy. The lesion volumes were estimated on diffusion-weighted imaging sequence and distributed in PI-RADS 3a (LV < 0.5 mL) and PI-RADS 3b (LV ≥ 0.5 mL) subcategories, using a 0.5 mL cutoff value. Data were retrospectively matched with histopathological findings from the biopsy. Assuming that lesions with LV < or ≥ 0.5 mL were respectively not eligible (benign and indolent PCa lesions) or eligible for biopsy (significant PCa lesions), the diagnostic accuracy of lesion volume in determining clinically significant PCa at biopsy was evaluated using a bi- or multivariate model.

Results: About 55.1% and 44.9% of lesions were distributed in subcategories 3a and 3b, respectively. The overall PI-RADS score 3 detection rate was 273%. 3.5% (1.95% of total), and 25% (11.7% of total) significant PCa were found in PI-RADS 3a and 3b subcategory, respectively. The method showed 85.2% sensitivity, 61.2% specificity, 25% positive predictive value, and 96.5% negative predictive value and avoided 55.1% of unnecessary biopsies. The diagnostic accuracy in determining significant PCa at biopsy was 73.2% or 86.5% depending on whether lesion volume was used alone or in combination with prostate volume and patient age in a multivariate model.

Conclusion: 0.5 mL lesion volume cutoff value significantly discriminates fusion-targeted biopsy need in PI-RADS v2.1 score 3 lesions and its diagnostic accuracy improves when it combines with prostate volume and age in a multivariate model.