Turkish journal of urology最新文献

Prostate specific antigen (PSA) remains the most used test to assess the response after therapies including the radiation therapy (RT). Apparent diffusion coefficient (ADC) derived from the conventional diffusionweighted imaging (DWI), as a part of noncontrast or biparametric MRI (bpMRI) (T2-weighted and DWI), offers diagnostic accuracy and cancer detection rate equivalent to that of multiparametric MRI. Cellular changes induced by RT can be quali-qualitatively demonstrated as early as 3months after RT as an increase in the signal intensity of the tumor on the ADC map. ADC, in association with PSA, represents a potential biomarker imaging for evaluating treatment efficacy in PCa both during and shortly after RT.

In recent years, several studies have reported promising results of Yohimbine as a natural supplement for erectile dysfunction (ED). However, several studies suggested that the aphrodisiac effects of the extract were only a placebo or due to the increase in peripheral vascular congestion. In contrast, other studies reported that it could provide excellent curative effects on organic impotence. We aimed to review the efficacy of Yohimbine as a pharmacological treatment for ED and performed a comprehensive systematic search of published articles in PubMed and Science Direct databases for eligible randomized controlled trials comparing Yohimbine to placebo or no treatment for ED patients. A total of eight studies out of 543 studies were included in this review. Both Yohimbine alone (odds ratio [OR] ¼ 2.08, 95% CI 1.30-3.32, P ¼ .002) and combined (OR ¼ 6.35, 95% CI 3.01-13.41, P < .001) showed a significantly greater probability of erectile function improvement compared to the placebo group (OR ¼ 2.87, 95% CI 1.94-4.25, P < .001). Yohimbine alone did not show a significant difference in the rate of improved sexual function (P ¼ .07); however, the pooled results of both subgroups indicated a higher rate of improved sexual function (OR ¼ 2.65, 95% CI 1.43-4.92, P ¼ .002). Sole administration of Yohimbine and its combination with other supplements can improve the erectile function in ED patients. However, it is not able to improve the sexual function if not combined with other treatments.

Objective: To investigate an adapted enhanced recovery after surgery (ERAS) protocol in adult augmentation cystoplasty (AC).

Material and methods: A total of 33 consecutive cases with a history of refractory idiopathic detrusor overactivity (IDO) or neurogenic bladder (NGB) with low capacity, poor compliance, high sustained detrusor pressure, and whose previous therapeutic methods had failed were enrolled. The adapted ERAS fasting8 hours, high protein, low carbohydrate diet, antibiotics, did not use narcotics as much as possible during anesthesia, acetaminophen, early nasogastric tube removal, neostigmine injection postoperation, metoclopramide, early oral diet, and mobilization were applied, and morbidity and hospital stay duration were analyzed.

Results: Twenty-two patients had IDO, and the remained cases were NGB or had low bladder capacity or compliance. The mean age of patients in the IDO group was higher than in NGB cases (P ¼ .020). Following the adapted ERAS protocol implementation, more than two-third of patients returned to a regular diet on the second day postoperation in both groups. The mean (SD) hospital stay duration was 7.7 (1.5) days. Postoperative fasting time was 8.8 6 3. 7 hours, and bowel function was returned 1 day postoperation in 82% of patients. Only 33.3% of adults need postprocedure acetaminophen for 2 days, and in 11 cases, it prescribed for 1 day. All subjects except paraplegic patients had early mobilization 1 day postoperation.

Conclusion: Our findings revealed that adapted ERAS protocol could be safe and effective in adult AC. It accompanied by few complications, reduced intestinal motility problems, and a short length of hospital stay.

Objective: The protective effect of androgen deprivation therapy (ADT) against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel hypothesis. ADT may protect patients with prostate cancer through the inhibition of androgen receptor-dependent transmembrane serine protease type 2. We analyzed the role of ADT on SARS-CoV-2 infection risk and disease severity.

Material and methods: Between August 2020 and June 2021, patients with prostate cancer were included in our study. Patients were divided into two groups as men receiving ADT or not. Patients' characteristics such as prostate cancer grade and stage, comorbidities, SARS-CoV-2 infection status, and infection severity were assessed. SARS-CoV-2-infected close relatives and patients' compliance with the precautions against SARSCoV- 2 were also analyzed.

Results: A total of 365 patients, 138 (37.8%) with ADT and 227 (62.2%) without ADT, were included in our analysis. Patients with ADT were older (71.8 vs 66.9 years, P ¼ .001) and had a higher rate of chronic obstructive pulmonary disease (11.6% vs 5.7%, P ¼ .044). Patients receiving ADT were more often locally advanced and metastatic (80.4% vs 32.6%, P ¼ .001). SARS-CoV-2 infection rates were statistically similar between patients who received and did not receive ADT (9.4% vs 13.2%, P ¼ .275, respectively). There was no significant difference between two groups in terms of hospitalization rates (2.9% vs 0.9%, P ¼ .205). In multivariate analysis, the presence of SARS-CoV-2-infected close relatives and precautions score were only independent predictors for both risk of SARS-CoV-2 infection and infection severity.

Conclusion: We could not find any effect of ADT on risk and severity of SARS-CoV-2 infection. SARSCoV- 2 infection and hospitalization rates were similar between patients with and without ADT.

Objective: Distraction is a nonpharmacological method commonly used during painful procedures in children. However, there are a few studies investigating the effectiveness of active distraction on pain and anxiety in children during circumcision. The purpose of this study was to evaluate the effectiveness of tablet-based interactive distraction on pain and anxiety in children during circumcision.

Material and methods: To evaluate how tablet distraction could improve children's outcomes during circumcision, a single-center, nonblinded, randomized controlled, parallel group trial research design was employed. In this study, 35 children were included in tablet distraction group, which have a control group (n ¼ 35). The primary outcome measure was the Numeric Rating Scale for pain. Secondary outcome measure was the State- Trait Anxiety Scale for Children, and other outcome variables were physiological parameters and satisfaction levels.

Results: During and after the surgical procedure, pain scores (P < .001, P < .001, respectively) and pulse rates (P < .001, P < .001, respectively) were significantly lower in the tablet distraction group, whereas O2 saturation was higher than the control group (P < .001, P < .001, respectively). After the procedure, the anxiety scores were significantly lower in the tablet distraction group (P < .001), whereas the satisfaction scores were higher than control group (P < .001).

Conclusion: This study concluded that the use of tablet distraction during circumcision has a positive effect on children's pain, anxiety, satisfaction levels, and physiological parameters.

Endoscopic enucleation of the prostate (EEP) techniques for the treatment of benign prostatic hyperplasia (BPH) have become increasingly popular among urologists over the past 23 years. Despite the energy source employed, the aim of all these procedures is to endoscopically remove the prostatic lobes by enucleating them from the prostate surgical capsule. The reasons for which EEP has gained popularity among urologists are the reduction in complications and hospital stay compared to endoscopic gold standard Transurethral Resection of the Prostate (TURP), but especially the possibility to treat large prostates, allowing to abandon open simple prostatectomy (OP) and to avoid the burden related to open surgery. Holmium laser enucleation of the prostate (HoLEP) sets the basic principles of all EEP techniques in 1998 and has become the treatment of reference for BPH. Since then, various lasers have been developed and applied to prostatic enucleation. The thulium laser has a slightly shorter wavelength compared to the holmium laser and a continuous wave output, which increase vaporization and reduce penetration depth. These features make it ideal for prostatic enucleation. A vapoenucleating technique called Thulium Laser Vapoenucleation of the Prostate was presented in 2009, followed by a blunt enucleating technique called Thulium Laser Enucleation of the Prostate in 2010. These techniques have become alternatives to HoLEP and TURP; however, the amount of literature and randomized controlled trials available are inferior compared to HoLEP. The aim of th describe, and discuss current evidence on thulium enucleating techniques.

The aim of this study was to review the available literature on the efficacy and safety of the Rezum system for the treatment of symptomatic benign prostatic hyperplasia (BPH). A revision of literature up to January 2021 was carried out. Medline, Scopus, Web of Science, and PubMed archives were screened to identify all the relevant studies investigating the role of Rezum in the treatment of BPH. Randomized controlled trial (RCT), retrospective, prospective, observational, and comparative studies were included. Finally, 17 studies were included, five of which reporting data of a double blind Rezum RCT. Overall, 1,451 patients underwent Rezum procedure. All the studies performed a minimum of 3 months follow-up. Preoperatively, the mean International Prostate Symptom Score (IPSS) score was 19.8, mean Qmax was 9.2mL s1, and mean PVR was 142 cc. At 3 months after surgery, the mean IPSS score was 1.5, mean Qmax was 13.7mL s1, and mean PVR was 74 cc. Six studies investigated sexual function, most of them using the International Index of Erectile Function (IIEF)-5 questionnaire and a few also the Male Sexual Health Questionnaire (MSHQ). Preoperative mean IIEF-5 score was 18.5, and the mean MSHQ score was 7.4. At the 3 months follow-up, the mean IIEF-5 score was 16.4, and the mean MSHQ score was 9.62. None of the studies reported intraoperative complications. Rezum system is a novel minimally invasive treatment for symptomatic BPH using transurethral water vapor thermal energy. It represents a cost-effective and safe procedure with durable relief of lower urinary tract symptom, preservation of sexual function, low complications rate, and short recovery time.

In the last few years, new technologies have been developed to treat benign prostatic hyperplasia (BPH) in order to offer valid surgical alternatives to transurethral resection of the prostate with lower complications and hospitalization while maintaining satisfactory functional results. Among these new approaches, transurethral implantation of first- and second-generation temporary implantable nitinol device (TIND and iTIND, respectively) (Medi-TateVR ; Medi-Tate Ltd., Or Akiva, Israel) has been proposed. The aim of this work is to describe the surgical technique and to perform a systematic review of the available literature on follow-up of functional outcomes. A systematic research of the available literature on this topic was performed via Medline, Embase, and Cochrane databases in April 2021. Current evidence regarding the implantation of iTIND to treat BPH-related lower urinary tract symptoms (LUTSs) is still limited. Seven studies have been found. Only one randomized controlled trial has been published reporting short-term follow-up of implantation of iTIND versus sham procedure. All the studies reported that both procedures are safe, effective, and well-tolerated. Moreover, such treatment seems to not affect patient's sexual and ejaculatory functions. In conclusions, current clinical evidence suggests that temporary implantation of iTIND is a valid option for the minimally invasive surgical treatment of BPH-related LUTS. Further studies are required in order to confirm the functional results, especially over a long-term follow-up.

Objective: This study aimed to translate the IIEF-5 questionnaire into Indonesian and perform a validity and reliability assessment of the translated instrument.

Material and methods: A methodological study on 106 male outpatients, recruited consecutively, was carried out in a tertiary hospital in Surabaya, East Java from January to March 2020. This study was conducted in two stages: translation and validation. Two independent sworn translators performed a forward and backward translation of the first draft. The final version was synthesized by a team of experts comprised two urologists and another sworn translator. The validity of the questionnaire is determined through a Pearson correlation analysis. Cronbach's a internal consistency measurement was used to assess its reliability. Interrater reliability between the patient and the physician was measured using the Cohen's j coefficient.

Results: Pearson's "r" value is significantly higher than the critical value table and indicates a high to a very high level of validity based on Guilford's interpretation (r ¼ 0.70-1.00). A good internal consistency is shown by the Cronbach's a coefficient value (a ¼ 0.828). An almost perfect agreement between the patient's results and the assessment made by the physicians is shown by the Cohen's j coefficient value (j ¼ 0.879, P < .001).

Conclusion: The Indonesian IIEF-5 is a valid and reliable patient-reported outcome measure for evaluating erectile dysfunction in the literate middle-aged and older adult male population in Indonesia.

Objective: The aim of this study is to show the surgical trend over the past 14 years using the data from five major centers in Turkey with accumulated experience in benign prostatic hyperplasia (BPH) surgery.

Material and methods: This study included 94,954 patients with low urinary tract symptoms (LUTSs) secondary to BPH. By using electronic databases, we identified 7,163 patients who underwent BPH surgery, including monopolar transurethral prostate resection (M-TURP), bipolar transurethral prostate resection (BTURP), transurethral incision of the prostate (TUIP), open prostatectomy (OP), and holmium laser enucleation of the prostate (HoLEP) from 2006 to 2019. The years were grouped as 2006-2010, 2011-2015, and 2016-2019.

Results: The total number of outpatient treatments for BPH increased by 72.9% from 5,379 in 2006 to 9,302 in 2019. Until 2019, the annual number of surgeries increased from 375 to 937 (increasing 150%). All surgical approaches for BPH, except TUIP, were most frequently performed between the ages of 60 and 69. The rate of surgery including M-TURP, B-TURP, and TUIP was statistically different between 2006 and 2010, 2011 and 2015, and 2016 and 2019 (P < .001), except OP (P ¼ .071). The highest increase was observed in HoLEP in the first half of the 2010s compared to the second half of the 2010s. The rate of M-TURP decreased from 77.9% to 17.9% from 2016 to 2019.

Conclusion: With the aging population, the number of patients diagnosed and treated with BPH is increasing. B-TURP as a resection technique and HoLEP as an enucleation technique replace M-TURP. Healthcare services and government spending should be organized according to these data.