Vol 12 Issue 3

Objectives: During prostate tissue sampling, it is recommended to direct toward the lateral of the prostate as prostate cancer displays more localization toward the periphery of prostate tissue. Insufficient tissue sampling is frequently encountered in lateral biopsies, due to the outside structure of the prostate and the prostatic anatomy. We aimed to determine the factors affecting this failure in systematic prostate biopsies taken accompanied by transrectal ultrasonography (TRUS).

Material and Methods: A total of 2509 patients who underwent systematic 12-core guided TRUS biopsy of the periphery in our clinic were enrolled in the study and scanned retrospectively. Patients were divided into two groups as those with non-prostate tissue identified in pathology specimens (Group 1) and with only prostate tissue in all foci (Group 2). Each of the patients were evaluated for age, prostate volume, prostate-specific antigen (PSA), number of tissue samples taken from the periphery in 12-core guided biopsy, normal or abnormal digital rectal examination (DRE) results, absence or presence of tumor in the pathology.

Results: Of the 2509 patients, 467 (18.61%) were identified to have non-prostate tissue. Mean age was 65.6 years, mean PSA was 14 ng/mL, mean PV was 45.5, 19.7% had suspect digital rectal examination and 25.8% were positive for tumor. Among the groups, statistically significant values were obtained for the effects of age (p=0.220), PSA(p=0.030), prostate volume (0.065), digital rectal examination (DRE) (p=0.09) and identification of non-prostate tissue in pathology result (p=0.052).

Conclusion: The PSA values of those without non-prostate tissue in prostate biopsy taken with systematic 12-core TRUS were higher. Patients with tumor identified (+) were observed to have higher observational rates of no non-prostate tissue compared to patients negative for tumor. Patients with suspect DRE were identified to have higher observational rates of no non-prostate tissue.

Keywords: Biopsy, Transrectal biopsy, Non-prostate tissue, Transrectal Ultrasonograph

Objectives: The ICD-10 coding system is commonly used in organizations providing health services in many countries. This coding system used for diagnosis of diseases is standardized for national and international diagnoses with the aim of determining incidence rates for diseases and acting as a guide for determination of health policies. To determine the amount of ICD-10 diagnosis codes used for all patients attending our hospital in a 1-year period, the rates of ICD-10 related to urogenital system diseases and the distribution of urogenital system diseases.

Material and Methods: From 15/04/2018 to 15/04/2019, a total of 3,764,124 ICD-10 codes were recorded for diagnosis and treatment in all units of Kanuni Sultan Süleyman Education and Research Hospital. Of these, 174,448 (5%) were ICD-10 codes for the urogenital system and urogenital diseases and unused codes were recorded.

Results: Of the 196 ICD-10 codes related to urogenital diseases, 43 (22%) were not used, with 5% of total codes within a 1-year period related to urogenital system diseases and of these 50% were related to infectious diseases.

Conclusion: ICD coding at our hospital mostly uses main diagnostic codes. The use of sub-diagnostic codes is very low. To resolve the difficulties in using sub-diagnostic codes and to standardize WHO practices, ICD code practical certification programs for health personnel will contribute to providing accurate data nationally and internationally.

Keywords: ICD-10 code, urogenital system diseases, WHO, epidemiology

Objectives: To present the results of onabotulinumtoxin-A (BONTA) injections in patients with overactive bladder (OAB) resistant to medical therapy.

Material and Methods: Patients who underwent BONTA injection due to resistant OAB between 2013-2018 were included in this retrospective study. Patients who have used at least two different antimuscarinic drugs for 3 months and not improved or cannot tolerate side effects are identified as resistant OAB. The diagnosis of OAB was made by urodynamic study and/or by clinical findings. All patients were evaluated with urinalysis and urine culture, post-void residual urine measurement (PVR) and voiding diary, and/or symptom scores preoperatively and postoperatively at 2 weeks, 3 months and 6 months. Improvement was determined as continence or> 50% improvement in symptoms. All side effects were recorded.

Results: 71 resistant OAB patients underwent intradetrusor 100 U BONTA injection. Mean patient age was 33,5 years (range:21-86). Improvement rates were 78,8% at 3 months and 67,6% at 6 months. Complications were as follows; clean intermittent catheterization (CIC) due to high PVR (12,6%), microscopic transient hematuria (7,1%), and acute cystitis (8,4%). High PVR values returned to normal within 5 weeks in all patients who underwent CIC. Systemic side effects or acute urinary retention did not occur.

Conclusion: Intradetrusor injection of 100 U BONTA continues to be used as an effective and safe treatment method in patients with resistant OAB.

Keywords: Botulinum toxin, intradetrusor injection, onabotulinumtoxin-A, overactive bladder, resistant

Objective: To determine if preoperative enhanced computed tomography (PECT) yields enough information or not about the invasion to adherent structures before operations for renal cell carcinoma.

Material and Methods: A total of 50 patient who had open radical or partial nephrectomy due to renal mass between January 2015 and March 2018 enrolled in this retrospective study. The radiologist elaborately examined the fat planes, and regularity/irregularity of the border at liver, vena cava, aorta, spleen, pancreas, iliopsoas muscle and abdominal posterior wall. The urologist took part in the operations noted the same parameters while operations or extracted them from operational notes. The diagnosis of invasion in intraoperative setting was based on findings while dissection of mentioned organ.

Results: There were 16 (32%) female and 34 (68%) males. The mean patient age was 60.14±13.89 (26-88). The effected renal unit was right kidney in 22 (44%) and left kidney in 28 (56%) patients. The mean time lag from PECT and operations was 34.48±12.07 (1-60) days.

Conclusion: For liver, spleen, pancreas, iliopsoas muscle, and abdominal posterior wall, PECT yielded some false positive results of adherence or irregularity than detected in surgery. For vena cava and aorta, PECT could not detect the adherence or irregularity that was seen in surgery.

Keywords: Computed tomography, renal cell ca, invasion

Objective: Gleason score (GS) is one of the most important parameters used in predicting the aggressiveness of prostate cancer. A discrepancy may be detected between the Gleason score in the TRUS prostate biopsy and the Gleason score determined after radical prostatectomy. In this study, we aimed to investigate the importance of mp-MRI features and PI-RADS V2 in predicting the progression of GS stage after radical prostatectomy in patients with GS 3+3 prostate cancer after TRUS-bx.

Material and Methods: The data of patients who were diagnosed with GS 3+3 prostate cancer after TRUSBx and underwent robot-assisted radical prostatectomy between January 2016 and January 2020 were retrospectively analyzed. The patients were divided into 2 groups as with progressive (Group 1) and not (Group 2) after surgery. The PSA level, patient age, prostate volume, PSA density, index lesion size on mpMRI, PI-RADS version 2 scores of the patients were evaluated.

Results: The mean age of 43 patients included in the study was 63.7±7.1 years. Stage progression was observed in 25 patients (58.1%) after surgery. According to the final pathology report, age, PSA density and PIRADS V2 score were found to be statistically significant in the patient group with and without prostate cancer stage progression (p˂0.05). Stage progression was observed in a total of 13 patients, 8 patients with a PI-RADS version 2 score of 4 and 5 patients with a score of 5. Although the mp-MRI index lesion size was not statistically significant between the two groups, it was larger in the group with stage progression (12.15±4.3 vs 15.69±7.6). While there was no stage progression in any of the patients who did not show extra-prostate dissemination in mp-MRI, only 3 patients with extra-prostate spread were reported.

Conclusion: We found that the mp-MRI PIRADS v2 score is important in prostate cancer stage progression.

Keywords: gleason score, multi-parametric magnetic resonance imaging, PI-RADS score, prostate cancer

Objective: Sampling of detrusor muscle tissue (DMT) in the pathological examination of the bladder tumor is very important in the planning of correct staging and treatment. In the present study, we aimed to determine the factors affecting the DMT sampling in the pathology specimen after TUR-BT.

Material and Methods: The medical records of 59 patients who underwent TUR-BT were retrospectively analyzed. Twenty-six patients who had no DMT in the pathology specimen were classified as group I and 33 patients with DMT were classified as group II. Difference between groups in terms of age, gender, tumor number, tumor size and tumor localization were examined.

Results: DMT was found in 56% of pathology specimens. There was no statistically significant difference in terms of gender distribution between the two groups (p=0.646). Tumor localizations were as follows; 11.5% is on the dome, 11.5% is on the opposite wall and 77% is on the side walls in group I; and In group 2, 6.1% were found on the dome, 27.2% on the opposite wall and 66.7% on the side walls. There was no statistically significant difference between group I and group II in terms of tumor localization (p>0.05). The mean number of tumors and mean tumor size were found to be statistically similar in both groups (p>0.05).

Conclusion: It was concluded that variables such as age, gender, tumor size, number of tumors, and localization of the tumor did not affect the presence of DMT in the pathological specimen of the patients.

Keywords: bladder cancer, TUR-BT, tumor localization, detrusor muscle tissue

Objective: Urinary system stone disease is a common disease in our country. Retrograde intrarenal surgery (RIRS) is currently one of the leading minimally invasive treatment options for stone disease. In this study, we aimed to determine the factors affecting success and complications in patients undergoing RIRS surgery for kidney stones.

Material and Methods: A total of 106 patients who were diagnosed with kidney stones and underwent RIRS between June 2019 and July 2020 were included in the study. Demographic, radiological and surgical data of the patients were analyzed retrospectively from the hospital archive. The data were analyzed and interpreted with the SPSS program.

Results: It was observed that the groups were similar in terms of demographic data such as age, gender, presence of comorbidities, Body Mass Index (BMI)(Table 1).When we evaluated the stone localizations, it was observed that there were more stones in the upper pole in Group 1, where RIRS success was achieved, and in the lower pole in Group 2 with RIRS failure (p = 0.027). The average stone size of the patients in our study was 12.7 mm, and it was found as 12.02 mm in Group 1 and 18.3 mm in Group 2 (p = 0.004). When the lower pole infindubulopelvic angles of the patients were measured from CT images, it was measured as 55.8 ° in Group 1 and 48.2 ° in Group 2. It was determined that group 1 was statistically significantly higher (p = 0.02). There was no statistically significant difference between the mean operation time, stone density, fluoroscopy time and preoperative serum creatinine levels.

Conclusion: In our study, the factors affecting the success of RIRS were stone location, stone size and lower pole infindibulopelvic angle. Low complication rates and high stone-free rates can be obtained when used in appropriate patients. It can be chosen as a method that can be used effectively in patients with smaller sizes and fewer kidney stones, who do not have anatomical problems in terms of access to the kidney.

Keywords: kidney stones, flexible ureterorenoscopy, retrograde intrarenal surgery, stone free