Vol 14 Issue 3

Objective: To compare prone and supine percutaneous nephrolithotomy (PNL) in obese patients with respect to efficacy and safety.

Material and Methods: Individuals with kidney stones larger than 2 cm undergoing either prone or supine position PNL were included in the study based on the World Health Organization (WHO) classification of body mass index (BMI) ≥30 kg/m2 between January 2011 and September 2020 retrospectively. Demographic characteristics, intraoperative, postoperative data, and complications according to Modified Clavien Grading System were listed. Patients were followed for 3 months, documenting their stone-free status.

Results: Out of the total 156 obese patients, 74(47.4%) underwent supine PNL (group 1), and 82 (52.6%) were prone to PNL (group 2). There was no statistically significant difference between the groups concerning hemoglobin drop, the number of pelvicalyceal access, blood transfusion, length of hospital stay, complications rates, and stone-free status (p>0.05). The location of pelvicalyceal access (upper, middle, lower calyces) was significantly different (18.9%, 32.4%, 42.6% in group 1, 3.2%, 19.3%, 77.5% in group 2, respectively) (p<0.001). Mean operative times were statistically different between the groups (97.2 ± 18.1 minutes in group 1, 119.5 ± 18.9 minutes in group 2, respectively) (p<0.001).

Conclusion: In the prone or supine position, PNL is a safe and effective method for managing kidney stones in obese patients. Access through the upper calyx may be favored in the supine position considering to patient’s characteristics. Additionally, the supine position has the greatest advantage over the prone position due to shorter operative times.

Keywords: percutaneous nephrolithotomy, obese, supine, prone

Objective: In this study, we investigated the understanding of the consent forms used for invasive procedures in the urology clinic by the patients. It was evaluated which age and education groups could comprehend the consent forms used in our clinic.

Material and Methods: In this investigation, we employed two intelligibility formulas proposed by Ateşman and Bezirci-Ylmaz for Turkish. In the study, 69 separate consent forms were evaluated.

Results: An average of 62.02 points was obtained in the study after evaluating the consent forms using the Ateşman intelligibility index. This value indicates that a person with a 9 and 10th education level will be able to comprehend the text. The Bezirci-Yılmaz index yielded an average of 11.13 points when the same forms were analyzed. This value indicates that consent forms can be understood by those with a 10 and 11th grade education grade.

Conclusion: In our study, it was found that the informed consent forms given to the patients before the operation were insufficient to be understood by the patients. Similar findings were obtained in previous studies in the literature. Each country’s own health literacy and education level should be taken into account when creating informed consent forms.

Keywords: urology consent forms, intelligibility, urology

Objective: In this study, we aimed to investigate the accuracy of the “Vesical Imaging Reporting and Data System” (VI-RADS) scoring system in predicting preoperative muscle invasion of bladder cancer.

Material and Methods: Patients with bladder cancer who underwent pre-operative mp-MRI between August 2020 and March 2022 were included in the study. Bladder tumors were evaluated by an experienced uroradiologist using the VI-RADS scoring system. The VI-RADS score was compared with postoperative pathology to determine muscle invasion. Sensitivity, specificity, positive predictive value (PPD), negative predictive value (NPD), and accuracy were calculated for the VI-RADS ≥3 and VI-RADS ≥4 cut-off points.

Results: Benign pathology (cystitis cystica in three patients, nephrogenic adenoma in one patient) was found in four of 102 patients. The remaining 98 patients were included in the study. Muscle-invasive bladder cancer was detected in 38 patients and non-muscle-invasive bladder cancer in 60 patients. When the threshold value of the VI-RADS score was taken as 3 in determining muscle invasion, sensitivity, specificity, PPD, NPD value and accuracy were calculated as 92%, 85%, 94%, 80% and 88%, respectively. However, when the threshold value of the VI-RADS score was taken as 4, sensitivity, specificity, PPD, NPD value and accuracy were found to be 82%, 95%, 89%, 91% and 90%, respectively.

Conclusion: In conclusion, bladder mp-MRI is a successful method in the detection of muscle-invasive bladder cancer with a VI-RADS threshold value of 3 or 4, accompanied by VI-RADS criteria, and may increase the diagnostic performance.

Keywords: bladder cancer, MRI, urogenital cancers, VI-RADS

Objective: In this study, we aimed to investigate factors predicting the development of biochemical recurrence (BCR) in our clinical experience with patients over a long follow-up.

Material and Methods: The data of 758 patients who underwent robot-assisted radical prostatectomy (RARP) were retrospectively reviewed. In the postoperative period, the prostate-specific antigen (PSA) value is measured as 0.2 ng/mL and above, regarded as biochemical recurrence (BCR). The non-BCR group was regarded as Group 1, and the BCR group as Group 2.

Results: The mean age was similar between the two groups. The PSA values were significantly higher in the group that developed BCR (p<0.001). The biopsy Gleason score (GS), risk classification, and specimen GS were significantly higher in this group (p=0.02, p<0.001, and p<0.001, respectively). The BCR group also had statistically significantly higher positive surgical margin (PSM), extraprostatic extension (EPE), seminal vesicle invasion (SVI), and lymph node invasion rates. According to the multivariate analyses, PSA, risk classification, specimen GS, PSM, SVI, and T stage were significant parameters in the prediction of BCR.

Conclusion: The parameters that predict the development were determined as the PSA value, risk classification, specimen GS, PSM, SVI, and T stage. The widespread adoption of commonly accepted methods will help achieve better patient management and optimize patient expectations.

Keywords: robot-assisted radical prostatectomy, biochemical recurrence, prostate cancer, PSA

Objective: It is important that the anastomosis time of renal vascular structures is not prolonged to minimize the potentially harmful effect of warm and cold ischemic times. This study aimed to determine the effect of the needle holder design used in vascular anastomosis during renal transplantation on the duration of anastomosis.

Material and Methods: Patients that underwent renal transplantation at our clinic between September 2011 and February 2020, were divided into groups according to the two types of needle holders used in anastomoses. In Group 1, a conventional, Hegar-type, straight, 180-mm (7”) Ryder Diadust needle holder was used. In Group 2, a pen-type, straight, 215-mm (8 ½”) Castroviejo Durogrip TC micro needle holder was used. Demographic characteristics, vascular characteristics, and vascular anastomosis times were compared between the two groups.

Results: A total of 75 patients were included in the study. There were 39 (52%) patients in Group 1 and 36 (48%) patients in Group 2. The mean number of arteries was 1.2 ± 0.4, and the mean arterial diameter was 5.3 ± 1.2 mm in the whole cohort, with no statistically significant difference between the two groups (p=0.196 and 0.304, respectively). The mean arterial anastomosis time was 15 ± 5.1 minutes in Group 1 and 10 ± 3.9 minutes in Group 2. The mean venous anastomosis times were 18.4 ± 6.1 in Group 1 and 14.7 ± 4 minutes in Group 2. In the statistical analysis, the arterial and vein anastomosis times were found to be significantly shorter in Group 2 than in Group 1 (p=0.038 and p=0.020, respectively).

Conclusion: In our study, it was observed that the renal arterial and venous anastomosis times were significantly shorter in the group in which the pen-type Castroviejo needle holder was used in anastomoses performed during renal transplantation.

Keywords: renal transplant, vascular anastomosis, needle holder