Turkish journal of urology最新文献

Objective: To improve perioperative outcomes, robot-assisted radical cystectomy has gained increasing interest. This study aimed to assess the detailed perioperative complications of robot-assisted radical cystectomy in elderly aged ≥80 years and compare them with those of non-elderly.

Material and methods: We retrospectively analyzed the clinical features of 74 patients who underwent robotassisted radical cystectomy for bladder cancer between September 2018 and September 2021. Perioperative complication was classified by the Clavien-Dindo classification and organ system-based categories. We assessed the relationship between age or Charlson comorbidity index score (≥3 or <3) and the incidence of perioperative complication or rehospitalization rate within 90 days postoperatively.

Results: Of the 74 patients, perioperative complication of all grades and grade ≥IIIa occurred in 54 (73%) and 15 (20%) patients, respectively. The postoperative rehospitalization rate was 20%, and the perioperative mortality rate was 0%. Elderly (n = 20) showed no difference in the incidence of perioperative complication of all grades or grade ≥IIIa compared with non-elderly, and no organ system-based category had a higher incidence in elderly than that in non-elderly. Gastrointestinal tract-related perioperative complication incidence was higher in non-elderly and those with Charlson comorbidity index ≥3 (P = .044, .039, respectively); cardi ovasc ular- relat ed perioperative complication incidence was higher in those with Charlson comorbidity index ≥ 3 (P = .0068).

Conclusion: The incidence perioperative complication of robot-assisted radical cystectomy in elderly was not different from those in non-elderly, suggesting that robot-assisted radical cystectomy may be an option for the treatment of bladder cancer in elderly as well as non-elderly.

Objective: Infertility affects about 15% of couples in reproductive age worldwide. Male factors are the main causes for this condition. Antioxidants have long been used for infertility treatment as they are easily available with a low cost. In this systematic review, we focused on the relation between antioxidant supplementation and sperm DNA fragmentation and other sperm parameters.

Material and methods: An online search from PubMed and ScienceDirect databases was conducted by 2 reviewers. We reviewed full-text articles to obtain detailed information.

Results: Nine articles were included in this study. Four studies revealed a statistically significant reduction of sperm DNA fragmentation and five studies revealed an insignificant decrease of sperm DNA fragmentation. Sperm concentration, sperm motility, and morphology were also increased after antioxidant supplementation. Pregnancy rates were reported in 3 studies; the rates increased in 2 studies, and similar rate to placebo group was observed in 1 study.

Conclusion: Antioxidant supplementation can counteract against oxidative stress and improve spermatogenesis process reflected by decrease of DNA Fragmentation Index (DFI), improvement of sperm parameters, and elevation of pregnancy rates confirmed by those included studies.

Male infertility is a common problem. There is growing evidence that infertile men may harbor significant illness and disease. Many of the genetic causes of male fertility have implications on other systemic illnesses. This review aims to discuss various genetic conditions and gene mutations and alterations associated with male infertility and evidence for associated systemic conditions. These findings highlight the importance of a thorough workup in men presenting for a fertility assessment.

Sufficient functional repair of damaged peripheral nerves is a big clinical challenge in terms of long-lasting morbidity, disability, and economic costs. Nerve damage after radical prostatectomy is the most common cause of erectile dysfunction. In recent years, low-intensity extracorporeal shockwave therapy has been explored to improve the outcomes of peripheral nerve repair and regeneration. Research indicated that application of low-intensity extracorporeal shockwave therapy after nerve surgery promoted nerve regeneration and improved the functional outcomes, underlined the mechanisms related to increase of neurotrophic factors, Schwann cells activation, and cellular signaling activation for cell activation and mitosis induced by low-intensity extracorporeal shockwave therapy. We searched PubMed for articles related to research on these topics in both in vitro and in vivo animal models and found numerous studies suggesting that the application low-intensity extracorporeal shockwave therapy could be a novel treatment for erectile dysfunction induced by nerve injury and other disease related to nerve injury.

Objective: To evaluate the impact on continence rate during 1-year follow-up of a preservation technique that included nonligation of the dorsal vascular complex and sparing of the puboprostatic ligaments and the endopelvic fascia during laparoscopic radical prostatectomy.

Material and methods: Information from 30 patients who underwent the preservation technique was prospectively collected and compared with data from 60 patients who underwent the nonpreservation traditional technique. A single surgeon performed all procedures.

Results: Demographic and preoperative characteristics were similar. The mean patient age was 59 years in both groups. All patients were stage cT1c or cT2. Operative time was significantly lower in the preservation technique group (229.6 vs. 262.7 minutes, P < .001). There were no significant differences in intraoperative bleeding, discharge hemoglobin level, blood transfusion rate, length of hospitalization, and drop in the hemoglobin level. The probability of continence recovery was significantly higher in the preservation technique group than in the traditional technique group (hazard ratio = 0.50, 95% CI = 0.31-0.81). The continence rate (0 pads/day) for the preservation technique group versus the traditional technique group at 1, 3, 6, and 12 months was, respectively, 53.3% versus 30% (P = .031), 90% versus 45% (P < .001), 90% versus 63.3% (P = .008), and 96.6% versus 78.3% (P = .024). There were no significant differences between the groups regarding potency and oncologic outcomes.

Conclusion: Nonligation of the dorsal vascular complex and preservation of the puboprostatic ligaments and the endopelvic fascia improved urinary continence compared with the traditional nonpreservation technique, with no impact in terms of bleeding and oncologic outcomes.

Objective: The aim of this study is to compare systematic, cognitive fusion, in-bore, and software fusion prostate biopsies regarding rates of and risk factors for pathological upgrading.

Material and methods: Charts of 291 patients with systematic biopsy (n = 105), magnetic resonance imaging- targeted cognitive fusion (n = 58), in-bore (n = 68), and software fusion biopsy (n = 60), and who subsequently underwent radical prostatectomy were retrospectively evaluated. The degree of similarity between the grade groups reported in the biopsy and radical prostatectomy pathology results was recorded. Analyses of the associated factors for concordance and discordance were performed with univariate and multivariate methods.

Results: The concordance rates were as follows: systematic biopsy = 42.8%, cognitive fusion-targeted biopsy = 50%, in-bore fusion-targeted biopsy = 61.8, and software fusion biopsy = 58.4%. The upgrade rate of systematic biopsy (46.6%) was higher than cognitive fusion-targeted biopsy (27.6%), in-bore fusiontargeted biopsy (26.4%), and software fusion-targeted biopsy (18.3%). The number of positive cores was significantly associated with grade group concordance for the systematic biopsy group (P = .040). Within the cognitive fusion-targeted biopsy cohort, number of positive cores was the only parameter that exhibited a significant association with grade group concordance in multivariate analysis (P = .044). Considering the in-bore fusion-targeted biopsy group, maximum tumor length was statistically significant (P = .021). In the software fusion-targeted biopsy group, low prostate volume was found to be the only significant predictor for grade group accordance (P = .021).

Conclusion: Magnetic resonance imaging-targeted biopsy techniques showed higher concordance and lower upgrade rates compared to systematic biopsy. For systematic biopsy and cognitive fusion-targeted biopsy, the number of positive cores was associated with grade group concordance, while maximum tumor length in in-bore fusion-targeted biopsy and low prostate volume for in-bore fusion-targeted biopsy were associated with grade group concordance. Among the MRI-targeted biopsy methods, in-bore fusion-targeted biopsy and software fusion-targeted biopsy were more accurate than cognitive fusion-targeted biopsy in terms of grade group.

Background: Ureteric reimplantation is the treatment of choice for pelvic lipomatosis with ureteric obstruction. Pelvic adherent fat poses a technical challenge during this surgery.

Description of technique: We describe the robotic approach to facilitate the precise dissection of the ureter and bladder in adherent fat. After creating pneumoperitoneum and port placement, the ureter is exposed at the iliac crossing and dissected distally. Perivesical fat at the intended site of ureteric reimplantation is excised and cystotomy is done. Ureterovesical anastomosis is performed over a stent.

Patients and methods: Two patients with pelvic lipomatosis causing ureteric obstruction and renal function impairment underwent robotic ureteric reimplantation at our institute. Technical aspects and outcomes are discussed here.

Results: Blood loss was minimal. No intra-operative or post-operative complication was noted. Renal function improved for both patients.

Conclusion: Robotic approach helps to overcome the technical difficulties posed by adherent fat during ureteric reimplantation in pelvic lipomatosis.

Background: In this video, we present a new open ureteral reimplantation approach (combined technique) with preliminary results from 32 renal units.

Material and methods: Written informed consent was obtained from the parents of the patients. We used a suprapubic Pfannenstiel incision to reach the bladder. After preparation of the ureters with the guidance of the vesicoureteral reflux surgery principle, they were moved from the bladder to the extravesical area. A submucosal tunnel was created above and below the old hiatus with reference to the old hiatus site. The required submucosal tunnel length is adjusted to be 2/3 above the old hiatus and 1/3 below the old hiatus. The ureters were carried down through the submucosal tunnel using a right-angle clamp and fixed to the bladder with 5/0 polyglactin sutures, step by step, respectively.

Results: A total of 22 patients (9 females/13 males) with a median age of 7 (min: 2and max: 15) years were operated on using the combined technique. There were 16 cases with vesicoureteral reflux and 6 cases with unilateral obstructive megaureter. The success rate was found to be 100% for vesicoureteral reflux and 83.3% for primer obstructed megaureter. When we focus on the number of ureters, the overall success rate was found to be 97%.

Conclusion: The vertical angulation or kinking of the ureter at the entrance to the bladder can be prevented in this modification. New orifice localization is close to the normal position. Short tunnel length is out of the question in this modification. We think that with potential surgical advantages, a novel combined technique can be used in ureteral reimplantation.

Objective: The present study examines the effects of the coronavirus disease 2019 pandemic on radical prostatectomy performed as part of localized prostate cancer treatment in Turkey.

Material and methods: A retrospective analysis was made of the data of 176 patients from 8 centers in Turkey who underwent radical prostatectomy due to localized prostate cancer over the 2 years spanning March 1, 2019, to February 28, 2021. Within this timeframe, March 1, 2019, to February 28, 2020, was denoted the 1-year pre-coronavirus disease 2019 period, while March 1, 2020, to February 28, 2021, was denoted the 1-year coronavirus disease 2019 period. An analysis was made of whether there was a difference in the number of radical prostatectomies performed for prostate cancer, the time from biopsy to operation, and the biopsy and radical prostatectomy pathology between the 2 periods.

Results: It was found that the number of radical prostatectomies performed for localized prostate cancer during the coronavirus disease 2019 pandemic was statistically and highly significantly fewer than in the pre-coronavirus disease 2019 period (P <.001). The patients diagnosed with Gleason 3+3 (low risk) prostate cancer were statistically significantly fewer in number in the coronavirus disease 2019 period (P <.001). The pathological Gleason score was upgrading than the biopsy Gleason score in all patients who underwent in both periods (P <.001). When the periods were compared, the pathological involvement determined by lymph node dissection performed during radical prostatectomy was found to be decreased in the coronavirus disease 2019 period, although the difference was not statistically significant (P =.051).

Conclusion: As with many diseases, the diagnosis and treatment of prostate cancer have been adversely affected by the coronavirus disease 2019 pandemic.