Vol 15 Issue 3

Objective: To evaluate the reliability and quality of information about chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) available on YouTube.

Material and Methods: A total of 200 videos were gathered using the search terms “chronic prostatitis” and “male chronic pelvic pain syndrome.” Two urologists analyzed and rated the videos based on their usefulness, quality, and reliability of content. The modified DISCERN tool and the Global Quality Score (GQS) ranking system were used to assess the reliability and quality of the videos.

Results: Out of the 200 videos, 120 were found to be suitable for evaluation. The majority of videos were found to be useful ( 65.83%), and were mostly produced by healthcare professionals (86 videos). Videos produced by healthcare professionals of academic origin had higher views and longer duration compared to those from private origin (p=0.043 and 0.011 respectively). Time since upload was longer for videos uploaded by academic healthcare professionals (p=0.003). The average reliability score, average GQS score, and average content score were all significantly higher for videos uploaded by academic healthcare professionals (p<0.001). All variables were not different according to the specialty of healthcare professionals (p=0.349; 0.349; 0.263; 0.307; 0.901; 0.118 ; 0.308 ; 0.114 ; 0.435 and 0.187 respectively)

Conclusion: Patients seeking information on CP/CPPS on YouTube are likely to find valuable and trustworthy content, particularly when focusing on videos created by healthcare professionals, notably those associated with academic institutions.

Keywords: Prostatitis; Pelvic Pain; Quality of Life.

Objective: The aim of this study was to assess the impact of using video as an educational tool in the informed consent process for retrograde intrarenal surgery (RIRS) on patient understanding, satisfaction, and preferences compared to traditional written consent forms.

Material and Methods: A total of 114 patients scheduled for RIRS participated in this study. After reading informed consent, participants completed a questionnaire assessing their baseline knowledge about the RIRS procedure. They then watched an educational video about the procedure and completed a post-video questionnaire to assess changes in knowledge and preferences between written and video-based informed consent.

Results: The results demonstrated that incorporating a video into the informed consent process led to significant improvements in patients’ knowledge about the RIRS procedure (p<0.001). A majority of participants (94.5%) found the video presentation to be more helpful than the written consent form and preferred it over the traditional method. Additionally, the use of video was associated with increased confidence in making informed decisions about the procedure. The majority of participants found the video to be easily accessible and comprehensible, which contributed to their overall satisfaction.

Conclusion: Video-enhanced informed consent process can be a valuable addition to the standard informed consent process in clinical practice. By providing easily accessible and comprehensible information, healthcare providers can better meet patients’ needs and improve the overall quality of care. This approach may lead to better patient outcomes, increased trust in healthcare providers, and a more patient-centered approach to medical care.

Keywords: Retrograde Intrarenal Surgery, informed consent, videoinfography

Objective: In this study, we aimed to determine the effectiveness of Guy’s score, S.T.O.N.E score, and CROES nomogram, the most widely used models in percutaneous nephrolithotomy (PNL) for predicting stone-free status, and to determine which model predicts stone-free status more successfully.

Materials and Methods: The data of patients older than 18 years of age who underwent PNL for kidney stones at our tertiary academic center between 2009 and 2018 were retrospectively analyzed. Examined parameters included the demographic data of patients, stone characteristics, Guy’s score, S.T.O.N.E. score, CROES nomogram, surgical duration, transfusion rate, length of stay, and stone-free status. Prediction values for stone-free status were determined using receiver operating characteristic (ROC) curve analysis.

Results: A total of 200 patients were included in the study. The mean age of the patients was 43.7 ± 14.6 years. The mean stone scores of the patients were as follows: Guy’s score: 2.11 ± 1.01; S.T.O.N.E. score: 7.54 ± 1.73; and CROES nomogram: 194 ± 62.7. The stone-free rate was determined to be 66%. The Guy’s and S.T.O.N.E. scores were significantly higher, and the CROES nomogram was significantly lower in non-stone-free patients compared to stone-free patients (p<0.001, p<0.001, and p<0.001, respectively). The cut-off value and area under curve (AUC) were 2.5 and 0.770 for Guy’s score, 7.5 and 0.722 for S.T.O.N.E score, and 185 and 0.843 for CROES nomogram, respectively.

Conclusion: Guy’s score, S.T.O.N.E score, and CROES nomogram are effective models in predicting stone-free status in PNL.

Keywords: CROES nomogram, Guy’s score, percutaneous nephrolithotomy, S.T.O.N.E score, stone-free

Objective: The aim of this study is to determine whether there is a genetic predisposition in young patients with transitional cell carcinoma (TCC) of the bladder.

Material And Methods: Data were collected from a total of 652 patients who underwent transurethral resection of bladder tumor (TUR-BT) between January 2010 and January 2021. Seven patients under the age of 40, non-smokers, and without occupational predisposing factors to urinary tract TCC were included in the study. Age, body mass index (BMI), sex, occupation, and five-year follow-up were collected retrospectively. A total of 403 cancer-related genes were analyzed from the patients’ blood samples. The Clinical Exome Sequencing test was used to identify genetic mutations.

Results: Six of the patients were male and one patient was female. The mean age and BMI were 31.42 ± 2.12 (22-39) years and 21.72 ± 33.14 (22-27.7) kg/m2, respectively. None of the patients had a first-degree relative with urinary tract TCC. Of all the patients, only one patient had a deletion of exons 1 to 17 in the breakpoint cluster region gene.

Conclusion: Genetic predisposing factors in young bladder TCC have not been clearly identified. Although our study included a limited number of patients, our results showed no genetic predisposition in young patients with bladder TCC without family history of bladder cancer. To evaluate the exact relationship, prospective randomised controlled trials with larger numbers of patients are needed.

Keywords: Bladder cancer, gene alterations, transitional cell carcinoma, young patient.

Objective: This retrospective study aims to compare the success rates of shock wave lithotripsy (SWL) using ultrasound (US) targeting versus X-ray targeting.

Material and Methods: A retrospective chart review was conducted on patients who underwent SWL for urinary tract stones between January 1, 2018, and December 31, 2020. The patients were divided into two groups based on the imaging modality used for stone targeting during SWL: the US group and the X-ray group. The success rates of SWL, defined as complete stone clearance or clinically insignificant residual fragments (<4mm), were compared between the two groups.

Results: A total of 200 patients were included in the study, with 100 patients in each group. The demographics and stone characteristics of the patients were similar between the two groups. The success rate of SWL in the US group was 84%, compared to 72% in the X-ray group (p=0.041). The odds ratio for success in the US group compared to X-ray group was 2.04 (95% confidence interval: 1.02-4.07)

Conclusion: This retrospective study suggests that SWL with US targeting may have a higher success rate compared to X-ray targeting. US provides a safe and effective alternative for stone targeting during SWL, avoiding the use of ionizing radiation. Further research is warranted to confirm these findings and explore the potential benefits of US guided SWL in clinical practice.

Keywords: extracorporeal shock wave lithotripsy, ultrasound, X-ray, urinary stone.

Objective: Percutaneous nephrolithotomy (PNL) is first-line treatment modality for large and complex stones, however it is associated with potential morbidity and severe complications. Therefore, we aimed to evaluate the success and complication rates according to stone localization in large sample group following PNL.

Material and Methods: Total number of 782 patients who underwent PNL, were included in this retrospective multicenter study. Patients were divided into two major groups; simple stones group (upper pole, pelvis, lower pole) and complex stones group (partial staghorn, multi-caliceal, pelvis+lower pole, complete staghorn). Surgery time, fluoroscopy time, complications, hospitalization and nephrostomy catheter removal day were recorded.

Results: In our study, 525 cases (67.1%) had simple stones, 257 (32.9%) complex stones. The most frequent (34.3%) stone localization was lower pole. Overall blood transfusion rate was 15.1%. Significantly increased in mean number of accesses, surgery time, fluoroscopy time, nephrostomy removal time and hospitalization documented in cases with complex stones (p-values = 0.000, 0.000, 0.009, 0.000 and 0.000, respectively). Overall complication rate was 9.7% (n=76) and the most frequent complication (4.4%) was severe hemorrhage. Overall stone-free rates (SFR) are 74.6% (n=583). Furthermore, complication rate (14.4% vs. 7.4%) was statistically higher and SFR (57.6% vs. 82.9%) was lower in cases with complex stones than simple stones (p-values = 0.002 and 0.000, respectively).

Conclusions: Our findings clearly demonstrated that PNL achieved higher success rate and lower complication risk in patients with simple stones than complex stones. PNL is significantly associated with shorter operation duration and hospitalization in simple stones group. Furthermore, PNL provided relatively higher overall SFR and lower complication rates in our large sample group compared to the published data.

Keywords: Kidney stones; Urolithiasis; Percutaneous nephrolithotomy; Stone-free rates;

Objective: Perioperative fluid treatment is among the factors affecting transplant kidney function. In this study, the efficacy of biphasic fluid treatment on per-operative patient stabilization and allograft kidney functions were evaluated.

Material and Methods: Data of 65 robotic living releated donor kidney transplantation performed between 2015-2017 were retrospectively analyzed (16/04/2018, Protocol no 2018-07-13). The patients were divided as preemptive (Group Preemptif: GP, n=27) and non-preemptive group (Group Non-Preemptif: GNP, n=38). Biphasic fluid treatment was used in all cases (Phase 1 = before-vascular anastomosis 1-3 ml/kg/h and phase 2 = after-vascular anastomosis 10-12 ml/kg/h, respectively). Hemodynamic and biochemical status of the patients, early and late allograft kidney function were evaluated. Datas were statistically compared within and between the groups.

Results: Hemodynamic/metabolic stability and diuresis were achieved after vascular anastomosis in all patients. There was no difference in the total amount of iv fluid given between the groups, except that the amount of fluid given in phase 1 was significantly less in GP (p<0.05). Pre-operative blood pH and HCO3 values were lower, Na+ and Cl- values were higher in GP(p<0.05). No difference was found in K+ and Ca+2 values at all times and pH values after extubation in both groups. Pre-operative blood urea and creatinine levels were significantly higher in GP (p<0.05) but all decreased to normal on postoperative 1 and 7 days. In long-term follow-up, both groups had similar mortality and rejection rates.

Conclusion: Our results support that biphasic fluid treatment is effective to achieve hemodynamic/metabolic stability and allograft kidney functions in robotic living releated kidney transplantation patients.

Keywords: Anesthesia, Fluid therapy, Hemodynamic monitoring, Kidney transplantation, Transplant recipient, Robot-assisted surgery

Objective: This study was designed to observe how the depressive state due to human papilloma virus infection affects sexual functions in sexually active men.

Material and Methods: Between 2020-2022, 77 primary male patients who applied to the XXX Hospital and diagnosed with genital warts (GW) by physical examination were included in the study. The patients were divided into two groups according to the number and the size of the warts (small size vs. larger size). The patients were asked to fill out the Hospital Anxiety Depression (HAD) scale and International Index of Erectile Function (IIEF-5) forms. The data of the two groups were compared and analyzed.

Results: The mean age was 39.7±10.3, BMI kg/m2 27.0±7.2. Patients divided into 2 groups in terms of wart sizes showed normal distribution. The HAD scale part was found to be abnormal in 13% of patients in small wart size group and 52.5% of 21 patients in larger wart size group (p<0.0001). According to the evaluation of the IIEF-5 scale, it was observed that 13.5% of 5 patients in small size group and 47.5% of 19 patients in larger size group had severe sexual functions (p<0.0001). No significant difference was observed between the 2 groups with chronic diseases (p=0.263).

Conclusion: Anxiety and depression appear and become evident in patients diagnosed with GWs from the moment of diagnosis. It may be necessary to examine this issue carefully and to involve psychiatry consultations in the management when necessary.

Keywords: Genital wart, Anxiety, Depression, Sexual function

Objective: The aim of this study is to present the outcomes of robotic surgery using a da Vinci robotic system (Intuitive Surgical Incorporation, Sunnyvale, CA) in different clinical indications in patients with upper urinary tract stone disease.

Material And Methods: The data of 12 patients who underwent robotic stone surgery at our academic center between July 2016 and July 2023 were retrospectively evaluated. The reason to perform robotic stone surgery was large and/or impacted upper tract stone disease after a previous unsuccessful stone surgery (n=7), the need for a partial nephrectomy due to simultaneously detected renal solid lesion (n=4), and the need for pyeloplasty resulting from ureteropelvic junction obstruction (n=1).

Results: Out of 12 patients included in the study, 7 patients (58%) were male, and 5 patients (42%) were female with a median age of 58 (IQR: 44 – 68) years. The median stone size was 38 mm (IQR: 16 – 53) as measured at a preoperative computerized tomography (CT) scan. 7 out of 12 patients (58%) had multiple urinary stones while 5 patients (42%) had a solitary stone. Assistance with flexible ureterorenoscopy was required in 7 out of 12 cases (58%). The median operation time and estimated blood loss were 190 minutes (IQR: 126 – 148) and 50 ml (min:0, max: 300), respectively. In a case who underwent concurrent partial nephrectomy, angioembolization was required due to postoperative bleeding. In another case, prolonged drain activity (6 days) was observed which resolved spontaneously during follow-up. Stone-free status was achieved in 11 out of 12 cases (92%). In the only case without stone-free status, the residual stone was fragmented during JJ stent removal by the technique of retrograde intrarenal surgery (RIRS). After this additional operation, stone-free status was achieved in all cases.

Conclusion: Robotic stone surgery with its high stone-free rate and low complication rate represents an alternative approach in complex clinical scenarios considering the increasing experience of surgeons in robotic surgery.

Keywords: robotic surgery, flexible ureterorenoscopy, urolithiasis, complication

Objective: Holmium:Yttrium Aluminum Garnet (YAG) laser for ureterorenoscopic lithotripsy (URS-LL) is the gold standard. The most important factors affecting laser lithotripsy are stone volume, stone density, location of the stone, laser settings and properties of the laser fiber. We aimed to measure the predictive factors affecting the efficiency of lithotripsy with objective methods.

Materials and Methods: Between October 2020-February 2022 ureterorenoscopic laser lithotripsy (URS-LL) cases performed for ureteral stones in the our hospital. It was examined retrospectively. Patients with remaining clinically significant stones were not included in the study. Holmium:YAG laser 550 μm fiber was used. Demographic data of the patients, stone size, stone volume, stone density (hounsfield unit -HU) was recorded. The energy (joule-J), frequency (hertz-Hz), power (watt) values and total lasing time of the patients determined and the total laser energy amount was calculated. After the data is obtained, the total amount of energy is divided by the stone volume and the amount of energy required to fragment 1 mm³ stone (J / mm³) was calculated. Additionally, dividing the stone volume by on total laser time, fragmented stone volume per second (mm³ / sec) was calculated.

Results: Energy, frequency and power did not differ significantly (p>0.05) between groups with laser duration ≤240 sec and >240 sec. Stone volume, stone HU value, total energy, and energy used to fragment 1 mm³ stone were significantly higher in the group with laser duration >240 sec than in the group with laser duration ≤240 sec. The fragmented stone volume in 1 second (mm³/s) in the group with laser duration >240 sec was significantly lower than the group with laser duration ≤240 sec. Significant efficacy of stone 1050 HU cut-off value was observed in the differentiation of patients with laser duration ≤240 sec and >240 sec. In the group with total energy >2750 J, stone volume, stone HU value, total energy, and energy used to break 1 mm3 stone were significantly (p<0.05) higher than in the group with total energy ≤2750 J. In the group with total energy >2750 J, the fragmented stone volume in 1 second (mm³/sec) was significantly (p<0.05) lower than in the group with total energy ≤2750 J.

Conclusion: In order to determine the effectiveness of laser lithotripsy more objective data is needed, such as fragmented stone volume in 1 second (mm³/s) and the amount of energy required to the fragment 1 mm³ stone (J/mm³).

Keywords: Ureteral Stone, Holmium:YAG Laser Lithotripsy, Joule, Frequency