Urology Journal

Aim: To compare the effects of RALP and LRP on health-related QoL following radical prostatectomy, focusing on studies performed via validated QoL questionnaires measuring particularly general health-related QoL.

Material and Methods: A systematic search was conducted using Web of Science, PubMed (MEDLINE) on 15 January 2023 with the following search terms solely or in combination: "robotic radical prostatectomy", "laparoscopic radical prostatectomy," and "quality of life". After retrieving the titles and abstracts of selected articles, the full texts of related articles were screened.

Results: After full-text evaluation, among 185 articles, 23 articles were found eligible for inclusion. Hoze et al. reported that the global health status at the 12th month of the surgery was almost the same in both groups according to EORTC- QLQ-C30 scores (76.3 in the RALRP group vs. 76.1 in the LRP group). Wang et al. reported a 75 point of EORTC-QOL-C30 global health status ten years after LRP. Wyler et al. found that the 1-3 month EORTC-QLQ-C30 global health score was significantly worser than the baseline score, 65.3±18.3 vs. 77.2±18.2; however, it returned to baseline in 13-24 months (77.7±16.8) even proceed baseline score in experienced hands at 49-58 months follow up, 78.2±17.8 vs. 85.3±15.5. The frequently used patient-reported quality of life questionnaire following RALRP was EORTC-QLQ.

Conclusion: Both robotic-assisted and laparoscopic radical prostatectomy are valid treatment options to achieve a good quality of life following surgery. The intermediate and long-term results in regard to QoL are comparable between the two procedures. RALRP might be superior to LRP in terms of immediate health-related quality of life, which might contribute to early recovery of urinary function.

Introduction: The comparison of ibuprofen with ketorolac remains controversial for the pain control of renal colic. We therefore conduct this meta-analysis to compare the analgesic efficacy of ibuprofen with ketorolac for renal colic.

Methods: We have searched PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through December 2022 for randomized controlled trials (RCTs) assessing the analgesic efficacy of ibuprofen in comparison with ketorolac for renal colic. This meta-analysis was performed using the random-effect or fixed-effect model based on the heterogeneity.

Results: Four RCTs were included in the meta-analysis. In patients with renal colic pain, intravenous ibuprofen and ketorolac produced comparable pain scores at 15 min (MD=-0.46; 95% CI=-1.24 to 0.31; P=0.24), 30 min (MD=-0.81; 95% CI=-1.75 to 0.31; P=0.09), 60 min (MD=-0.63; 95% CI=-1.40 to 0.13; P=0.10) and 120 min (MD=-0.74; 95% CI=-2.18 to 0.70; P=0.31), as well as adverse events (OR=0.95; 95% CI=0.61 to 1.49; P=0.83).

Conclusions: Ibuprofen can obtain the comparable analgesic efficacy to ketorolac for renal colic pain.

Prostate cancer (PCa) is the second most commonly diagnosed cancer and the sixth leading cause of cancer death among men worldwide. Prostate-specific antigen (PSA) is one of the oldest biomarkers for the early detection of PCa. Digital rectal exam (DRE) is another screening test for PCa detection, which is considered as an irritating experience for patients. Biopsy is still the most reliable method for PCa diagnosis; however, patients are prone to complications. Therefore, developing non-invasive and accurate methods for PCa screening seems urgent to avoid unnecessary biopsies. There has been remarkable development in PCa molecular biomarkers discovery, largely through progress in omics technologies. Due to the many benefits of liquid biopsies, a significant set of PCa diagnostic kits have been developed using urine samples. Despite the unique benefits of these kits, there are still many challenges to their widespread use in clinic. Here, we have reviewed the latest developments of PCa biomarkers in liquid biopsies.

Objective: Intracavitary chemotherapy is one of the current treatment options for kidney-sparing treatment of upper tract urothelial carcinoma (UTUC). The purpose of this meta-analysis was to assess the efficacy and safety of intracavitary perfusion.

Methods: We carefully selected publications for study from four databases (Embase, PubMed, Web of Science, and Scopus) up to January 2023. The R 4.0.4 software was used to calculate the pooled ratio and its 95% confidence intervals (95% CIs). The I² score was used to test heterogeneity, and the funnel plot was used to estimate the publication bias.

Results: Thirty-four studies with a total of 788 patients were included in this study. The overall survival at a median follow-up of 26.3 months was 87.2% (95% CI 0.80–0.93). The cancer-specific survival at a median follow-up of 30 months was 94.1% (95% CI 0.89–0.98). At a median follow-up of 30 months, the recurrence rate of UTUC was 27.5% (95% CI 0.21–0.34). By subgroup analysis, we found that the recurrence rate in patients with T1 / Ta stage was 35.1% and CIS stage 29.0%. The recurrence rates of BCG, Mitomycin C, and Mitomycin Gel (UGN101) were 31.2%, 41.3% and 12.9%, respectively. The recurrence rates for anterograde and retrograde perfusion were 28.5% and 21.8%, respectively.

Conclusion: With the advent of new drugs, including UGN101, patients with UTUC have a better prognosis. Therefore, kidney preservation therapy for patients with UTUC would be promising.

Objective: utilizing the combination of fluoroscopy and ultrasonography during Percutaneous Nephrolithotomy (PCNL) to minimize radiation exposure.

Methods: In this randomized clinical trial, 118 patients with urinary stones who were candidates for PCNL surgery in the prone position were selected and divided into two groups (with an allocation ratio of 1:1). Cases were grouped according to whether ultrasonography was used for renal tract dilation and Amplatz sheath placement. The number of attempts to establish proper renal access, the time interval between access to the targeted calyx and nephroscope entrance, and the Clavien-Dindo score were collected.

Results: The mean age of all patients was 46.12±11.28 (45.6±11.2 in the total fluoroscopy group and 46.5±11.4 in the combined group) years (20-66). The intergroup differences in the baseline features were not significant. The mean duration of fluoroscopy time was significantly reduced in the combined guidance group (36.22±10.73 vs. 23.05±8.94 seconds, [P-value = 0.001]). Moreover, the difference in the distribution of Amplatz location on the nephroscopy time was meaningful (P-value = 0.016). However, intergroup differences in the number of attempts to successful puncture, length of hospitalization, recovery time, and postoperative complications, including gross hematuria duration, blood loss volume, pack cells requirement, pain score immediately and 6 hours after the surgery, and Clavien-Dindo score were not meaningful.

Conclusion: It can be concluded that the use of ultrasound with X-ray in prone PCNL compared to the use of X-rays alone can significantly reduce the duration of radiation without increasing the risk of intra-operative and postoperative detrimental events.

Purpose: Few studies have evaluated the usefulness of anteroposterior dissection holmium laser enucleation of the prostate (HoLEP). Thus, this study investigated the incidence of stress urinary incontinence (SUI) after HoLEP and usefulness of anteroposterior dissection HoLEP in preventing postoperative SUI.

Materials and Methods: In total, 288 patients who underwent HoLEP performed by a single experienced surgeon between May 2014 and September 2021 were enrolled. Furthermore, 134 patients underwent retrograde dissection using the modified Gilling method (surgery 1) and 154 patients underwent anteroposterior dissection HoLEP (surgery 2). The risk factors for SUI, as well as the rates of SUI improvement for the two surgical procedures, were evaluated.

Results: Postoperative SUI was observed in 58 (20.1%) of 288 patients, of whom, 48 (82.8%) recovered continence within 6 months. Ten patients (17.2%) required more than 6 months to recover continence. SUI incidence 1 month after HoLEP was 29.9% (40/134 patients) for surgery 1 and 11.7% (18/154 patients) for surgery 2; a statistically significant difference was observed between the two groups (odds ratio [OR], 0.311; 95% confidence interval [CI], 0.168–0.575; p < 0.001). In addition, surgery 2 was significantly associated with early recovery from SUI compared with surgery 1 (stratified hazard ratio, 0.782; 95% CI, 0.615–­­­­­0.995; p < 0.001). The multivariable analysis demonstrated that only surgical procedure (OR, 0.350; 95%CI, 0.168–0.732; p=0.005) was an independent predictor of SUI.­

Conclusion: We reaffirmed that anteroposterior dissection HoLEP is a useful procedure for reducing the risk of postoperative SUI and early recovery of urinary continence.

Purpose: This study aimed to evaluate the effect of Ziziphus jujuba (Z. jujuba) leaf hydroalcoholic extract on the prevention/treatment of kidney stones.

Materials and Methods: Thirty-six male Wistar rats were randomly divided into six groups: control, Sham (kidney stone induction (KSI) by ethylene glycol 1% + ammonium chloride 0.25% through drinking water for 28 days), Prevention groups 1, 2 (KSI and Z. jujuba leaf (250 and 500 mg/kg, respectively) through gavage for 28 days), and Treatment groups 1, 2 (KSI and Z. jujuba leaf (250 and 500 mg/kg, respectively) from the 15^th day). On the 29^th day, the rats’ 24-hour urine was assessed, the animals were weighed, and blood samples were taken. Finally, after nephrectomy and weighing the kidneys, tissue sections were prepared to examine the number of calcium oxalate crystals and tissue changes.

Results: The results indicated a significant increase in kidney weight and index, tissue changes, and the number of calcium oxalate crystals in the Sham group compared to the control; using Z. jujuba leaf considerably reduced them in experimental groups compared to the Sham. Body weight decreased in the Sham and experimental groups (except the prevention 2 group) compared to the control, while this observed reduction was lower in all experimental groups compared to the Sham. The mean urinary calcium, uric acid, creatinine, and serum creatinine in Sham and experimental groups (except the prevention 2 group) indicated a substantial increase compared to the control and decreased significantly in all experimental groups compared to the Sham.

Conclusion: Hydroalcoholic extract of Z. jujuba leaf is effective in the reduction of calcium oxalate crystals forming, and its most effective dose was 500mg/kg.

Purpose Three-Dimensional (3D) could help for planning and creating an optimal access route in percutaneous nephrolithotomy (PCNL) procedure by achieving a more accurate approach to the renal collecting system and stone treatment while decreasing the risk of complications. The aim of our study is to compare the efficacy of 3D imaging technique with standard fluoroscopy method as guiding tools for renal stone location, while striving to reduce intra-operative X-ray exposure in the former method.

Materials and Methods This randomised clinical trial enrolled 48 PCNL candidates who were referred to Sina Hospital (Tehran, Iran). Participants were divided to two equal groups of intervention (3D virtual reconstruction) and control, using block randomization method. Age, sex, stone type and location, X-ray exposure during the procedure, stone access accuracy rate and the necessity of blood transfusion during surgery were taken into account.

Results the Mean age of participants (n=48) was 46.4 ± 4.8 years, 34 (70.8%) were male, 27 (56.3%) had Partial Staghorn stones and all participants had stones within the lower calyx. The radiation exposure time, stone access time and stone size were 2.99 ± 1.81 seconds, 272.3 ± 108.9 seconds and 23.06 ± 2.28 mm, respectively. In the intervention group, the accuracy rate for lower calyceal stone access was 91.5%. Also, X-ray exposure and time to stone access were significantly lower in the intervention group compared to the controls (P<0.001).

Conclusion We concluded that the utilization of 3D technology in the pre-operative location of renal calculi in PCNL candidates may result in a significant improvement in the accuracy and time to access the renal calculi, as well as reduction in X-ray exposure. 

Purpose: This study was designed to evaluate risk of mortality from chronic obstructive pulmonary disease (COPD) in patients with bladder cancer (BC).

Methods and materials: Data on patients diagnosed with BC by pathology between 2000 and 2016 were collected from the Surveillance, Epidemiology, and End Results (SEER) database. Based on reference data from the general population, the standardized mortality rate (SMR) is calculated. Nelson-Aalen cumulative hazard curves were used for assessment of the risk of COPD mortality in BC patients. Multivariable competing risk models were conducted. The proportional hazards assumption was tested using Schoenfeld residuals, which were scaled and plotted over time for each risk factor.

Results: A total of 237,563 BC patients were identified for further analysis from the SEER database, 5,198 of these patients experienced COPD mortality; the overall SMR for COPD mortality in BC patients was 1.58 (95% CI: 1.54-1.63). Age, race, year of diagnosis, histologic type, summary stage, surgery, marital status, college education level, and median household income independently predicted COPD mortality in BC patients.

Conclusions: In comparison to the general population, the risk of COPD mortality is significantly higher in patients with BC. Pre-identification of high-risk groups and respiratory care provisions are important measures to effectively improve survival in this group of patients.

Purpose

Post prostatectomy PSA kinetics and General Grade Groups (GGG) are the strongest prognostic markers of biochemical recurrence (BCR) and prostate cancer (PCa)-specific mortality after radical prostatectomy. Despite having low-risk PCa, some patients will experience BCR, for some, clinically significant BCR. There is a need for an objective prognostic marker at the time of prostatectomy to improve risk stratification within this population. In this study, we investigated the prognostic potential of DNA ploidy.

Materials and Methods

Prostatectomy samples from 97 patients with GGG1 and GGG2 with a low-risk CAPRA-S score were included in this study. PCa tissue with the worst Gleason pattern underwent tissue disaggregation, cell isolation and staining with a DNA stoichiometric stain. Using image cytometry, DNA ploidy was measured and a Ploidy Score (PS) was generated.

Results

Among the 97 patients, 79 had no BCR, 18 experienced BCR, of which 14 had a PSA doubling time (PSA-DT) >1 year (low-risk group) and 4 had a PSA-DT of <1 year (high-risk group). Using Logistic regression analysis, only pathological T stage (pT) and PS independently predicted BCR with PS being the most significant (p=0.001). The number of aneuploid cells was significantly higher in the high-risk group compared to the other groups (p=1.7x10^-11). PS combined with GGG diagnosis further stratified risk groups of biochemical recurrence free survival within CAPRA-S low-risk cohort.

Conclusion

DNA ploidy is an independent prognostic marker of BCR in low-risk PCa after radical prostatectomy, which could early on identify potentially aggressive PCa recurrences and introduce a more personalized approach to salvage treatments.

Bladder cancer is diagnosed at older age compared to all other known cancer types. Radical cystectomy after neoadjuvant chemotherapy or tri-modality treatment (consist of TURB, concurrent chemo-radiation) are the standard treatments. Many of the patients cannot receive tri-modality treatment (concurrent chemo-radiation) because of medical comorbidities. The present study assessed the results of sequential use of chemotherapy and radiotherapy versus concurrent use of them in 266 muscle invasive bladder cancer patients. The results showed similar overall survival but lower disease-free survival in the sequential group. Recurrence rate was higher in the concurrent group. The results showed that sequential use of chemotherapy and radiotherapy provides comparable results to concurrent use of them and provides better results than less than tri-modality treatments.

Purpose: Upper tract urothelial carcinoma (UTUC) can be divided into renal pelvis tumor (RPT) and ureteral tumor (UT) based on the tumor origin. This study aimed to evaluate the efficacy of neoadjuvant chemotherapy with gemcitabine and cisplatin (NAC-GC) in terms of the pathological outcomes and oncological prognoses in patients with UTUC. We also compared its efficacy between RPT and UT.

Materials and Methods: Patients who underwent radical nephroureterectomy for clinical T (cT)3N0M0 UTUC between 1999 and 2021 were included. Patients who underwent NAC-GC and those who did not were included in the NAC-GC and non-NAC-GC groups, respectively. Based on the tumor origin, we divided patients with UTUC into RPT and UT groups. Oncological prognosis was assessed using progression-free survival (PFS) and overall survival.

Results: Of 44 patients, 20 (45.5%) and 24 (54.5%) patients were in the NAC-GC and non-NAC-GC groups, respectively. The NAC-GC group had significantly lower pathological T stage and negative lymphovascular invasion (LVI), and a better PFS (p < .05) compared to those in the non-NAC-GC group. Among patients with RPT, the NAC-GC group had significantly negative LVI and better PFS than the non-NAC-GC group (p < .05). In contrast, in patients with UT, the NAC-GC group had no significant difference in pathological outcomes, and no significant difference in oncological prognosis was observed between the NAC-GC and non-NAC-GC groups.

Conclusion: NAC-GC improves both pathological outcomes and oncological prognosis in patients with cT3N0M0 UTUC. With regard to tumor location, RPT has better pathological outcomes and oncological prognoses than UT.

Purpose: Recent studies have provided reliable evidence for a relationship between loss of PTEN gene expression and prognosis in patients suffering from prostate cancer, although the results have been somewhat diverse in different populations. We aimed to assess PTEN gene expression loss by immunohistochemistry in prostate cancer and also its link to tumor upgrading in a group of affected patients undergoing radical prostatectomy.

Materials and Methods: This cross-sectional study was performed on 58 tissue samples sourced from the patients with prostate cancer and undergoing radical prostatectomy. TRUS-guided needle biopsies of the cancer tissue samples with histological grade groups of I to IV (the Gleason scores of 6 to 8) were prepared as the study samples. 29 patients with Gleason score (6 to 8) whose tumors on needle biopsy upgraded to Gleason score 7, 8 or 9 at prostatectomy (cases) were compared with 29 patients with Gleason scores of 6, 7 or 8 on both biopsy and prostatectomy samples (controls). Immunohistochemistry (IHC) technique was employed to determine PTEN gene expression status. 

Results: Loss of PTEN gene expression was found in 62.1% of upgraded cases compared with 27.6% of controls, indicating a statistically significant difference, revealing a meaningful association between the loss of PTEN gene expression and tumor upgrading. Furthermore, we demonstrated that deletions of PTEN gene expression and increased Gleason score in control and upgraded case groups, did not reach statistical significance.

Conclusion: A high rate of PTEN gene expression loss can be detected in prostate cancer tumor tissue, and this loss of gene expression is associated with tumor upgrading.

Introduction: Penile cancer is a rare malignancy, where extranodal extension in inguinal or pelvic lymph nodes is associated with decreased 5-year cancer-survival rate in this study, we try to assess survival and quality of life in a penile cancer patient with bulky lymph node.

Method: We retrospectively reviewed data from penile cancer patients with bulky lymph nodes who underwent treatment between July 2016 and July 2021 at tertiary referral hospital care. The inclusion criteria (age >18 yr, histologically proven penile cancer, and completion of last treatment 6 months prior to this study) yielded a cohort of 20 eligible penile cancer patients with bulky lymph nodes (> 4 cm/bilateral mobile/unilateral fixed). Only patients who had completed therapy at least 6 months prior to the study were included. After obtaining consent, they were asked to complete the EORTC QLQ-C30 questionnaire to evaluate the patient quality of life.

Results: Out of 20 patients, 5 patients underwent direct ILND and 15 patients underwent chemotherapy. Median follow-up after primary diagnosis was 114+32 months in patient with early ILND and 52+11 months in patients who underwent delayed lymph node dissection. Out of 5 patients underwent early ILND, all of them survived during follow-up, and achieve cancer-free status without residual tumor and with excellent functional outcome (Karnofsky 90). There is no significant difference in social function (p value = 0.551), physical function (p value = 0.272), role function (p value = 0.546), emotional function (p value = 0.551), cognitive function (p value = 0.453), and global health status (p value = 0.893) between patient which treated with early ILND and Neoadjuvant Chemotherapy. However, patient who underwent early ILND showed a relatively better clinical outcome.

Conclusion: Early ILND followed by adjuvant chemotherapy for penile cancer with palpable lymph nodes is more favourable than neoadjuvant TIP chemotherapy.

Purpose: The present study aimed to develop nomograms based on the SEER database to predict the prognosis for patients with primary sarcomatoid carcinoma of the urinary bladder (SCUB).

Materials and Methods: Patients with primary SCUB was identified in the Surveillance, Epidemiology, and End Results (SEER) database, between 1975 and 2017. Univariate and multivariable Cox analysis were conducted to identify the independent prognostic factors for developing the overall survival (OS) and cancer-specific survival (CSS) nomograms. Then, concordance index (C-index), receiver operating characteristic (ROC) curve and calibration curve were used to evaluate the accuracy of the nomogram model. In addition, the model was further compared with TNM staging system.

Results: A total of 238 eligible patients with primary SCUB were selected from the SEER database. As suggested by Cox-analysis, age, sex, T stage, M stage, tumor size, and surgery type of primary site were identified as the independent factors for predicting both OS and CSS. We developed OS and CSS nomograms with a favorable C-index by using these prognostic factors. The C-indexes of the OS and CSS nomogram in present study were 0.738 (0.701-0.775) and 0.763 (0.724-0.802), which were superior to those of the AJCC TNM staging with 0.621 (0.576-0.666) and 0.637 (0.588-0.686) respectively, showing better discriminatory ability. Subsequently, the ROC curves showed that the 1-, 3- and 5-year AUCs (area under curve) of OS nomogram (i.e., 0.793, 0.807 and 0.793) were higher than those of the TNM stage((i.e., 0.659, 0.676, 0.659). Similarly, as for CSS model, them ((i.e., 0.823, 0.804 and 0.804) were aslo exceed those of TNM stage((i.e., 0.683, 0.682, 0.682). Furthermore, the calibration curves indicated a good consistency between the predictive survival and the actual survival. Finally, patients were stratified by risk, and Kaplan-Meier survival curve suggested that the prognosis of the low-risk group was significantly better than that of the high-risk group.

Conclusion: We developed nomograms with the SEER database, which could help predict the prognosis of SCUB individuals more accurately.

Purpose: To compare the efficiency and safety between retroperitoneal laparoscopic nephrectomy and traditional open nephrectomy to treat autosomal-dominant polycystic kidney disease before kidney transplantation.

Materials and Methods: A total of 57 patients diagnosed with huge autosomal-dominant polycystic kidney disease between 2000 and 2020 at our center were included in this study.Patients were divided into a retroperitoneal laparoscopic (RL; n=23) group and traditional open (TO; n=34) group. We retrospectively analyzed and compared preoperative and perioperative variables between the two groups.

Results: Patients in the RL group showed a longer operation time (201.09±83.76min) compared to patients in the TO group (113.38±51.84min, p＜0.001). The RL group also showed significantly less intraoperative blood loss (p=0.025) and less intraoperative blood transfusion volume (p=0.016) compared to the TO group. Meanwhile, time of gastrointestinal function recovery, bed leave, catheter indwelling and postoperative hospitalization in the RL group were 2.13±0.63, 1.30±1.0, 5.22±2.09, 7.35±2.48 days, respectively, which were significantly shorter than the TO group (p＜0.05). Pain degree of patients during the first 48 hours after operation was similar between the RL and TO groups, but Opioid use percentage in the RL group was 8.70% (2/23) and was lower than the 26.47% (9/34) in the TO group (p=0.022). Meanwhile, 5 and 23 patients exhibited postoperative complications in the RL and TO groups, respectively (p＜0.001).

Conclusion: Both retroperitoneal laparoscopic nephrectomy and traditional open surgery are feasible to treat huge polycystic nephrectomy. However, patients who undergo retroperitoneal laparoscopic nephrectomy experience higher levels of safety and recover more rapidly.

Purpose: To investigate the effect of pyeloplasty in pediatric patients with poor function kidneys٫ focusing on the split renal function (SRF) and anteroposterior diameter (APD) of the renal pelvis.

Materials and Methods: A retrospective study included 47 pediatric patients with ureteropelvic junction obstruction (UPJO) who underwent open pyeloplasty with SRF< 20%. All patients were recruited from the Labbafinejad University Hospital center from April 2014 to October 2020. The results of preoperative ultrasonography and Diethylenetriamine pentaacetate (DTPA) scan compared with the results of the ultrasonography and DTPA scan 6 months and one year after surgery. Finally, Wilcoxon signed-rank test was used to test differences by SPSS (version 25) software statistical computer package.

Results: The mean age of participants was 1.5 years. There were 34 cases with SRF between 10% and 20%, and 13 cases with SRF <10%. The findings showed that pyeloplasty for UPJO leads to a significant improvement in renal function in poorly functioning renal units with 10% ≤SRF<20%. Although improvement in renal function occurred in the group with SRF of less than 10%, it was not statistically significant. The APD in both groups was statistically significantly improved. No correlation between genders and outcomes was found.

Conclusion: Poorly functioning renal unit (SRF < 20%) can show functional improvement after the pyeloplasty.

Purpose: Myelomeningocele is the most severe form of spina bifida. Management of urologic consequences of spina bifida is life long, demanding and costly for both patient and public health system. There is a paucity of data in literature regarding concentration defect and its consequences on this disease. This paper aims to describe retrospectively early onset clean intermittent catheterization (CIC) in the severity of urinary concentration defects in myelomeningocele patients with neurogenic bladder.

Materials and Methods: In this 10-year retrospective cohort study, children with myelomeningocele were selected with the Convenience sampling method. Demographic characteristics, polyuria index ratio (PIR) defined as 24 hour urine output of each patient divided by maximum normal  urine output of the same patient in a healthy state  , and nocturnal polyuria index (NPI) were compared between early starters (< 2 years old) or late starters (≥ 2 years old) groups.

Results: Seven patients who underwent cystoplasty were excluded and 130 patients (63.8% male, 5.4 ± 3.2 years old, 14.3 ± 2.83 Kg, 28.5% early onset CIC) were investigated. PIR > 1 in inset (1.7 ± 0.2 vs. 2.2 ± 0.5, P = 0.021) and outset (1.5 ± 0.32 vs. 2.5 ± 0.7, P = 0.004) were lower in early starters group than in late starters group. NPI in inset (0.2 ± 0.007 vs. 0.32 ± 0.10, P = 0.018) and outset (0.25 ± 0.15 vs. 0.42 ± 0.095, P = 0.007) were also lower in early starters group. No further adverse events were reported during  follow-up period.

Conclusions: Early onset CIC is more effective than late-onset CIC preserving urinary ability of kidneys in myelomeningocele patients.

Purpose: Lower urinary tract symptoms (LUTS) are common in women, and negatively affect their lives. The aim of this study is to determine the frequency of LUTS and its affecting factors in female graduate students in Turkey.

Materials and Methods: This descriptive, cross-sectional study consisted of 815 women attending education at Canakkale Onsekiz Mart University. Data were; provided sociodemographic characteristics, a questionnaire, and the Bristol Female LUTS Scale. Linear regression analysis was used to identify the risk factors associated with LUTS.

Results: According to the data obtained, the prevalence of at least one of the LUTS was determined as 71.8% (515/815).  It was determined that the prevalence of storage symptoms was higher than that of voiding and urinary incontinence. According to the results of the linear regression analysis, the risk factors for LUTS in female student were hold urine at school, complaints of urinary incontinence in family, bedwetting in children, constipation, regular drug use, obesity.

Conclusion: Consequently, LUTS is a common condition in female students. It is recommended to organize well-attended and repeated training programs for university students on healthy living behaviors, urinary habits, and hygiene.

Purpose: The choice between using the internal or external iliac arteries to supply a transplanted kidney poses is a dilemma during renal transplantation. As the internal iliac artery branches to the genital tract, cutting it could potentially result in sexual dysfunction. The purpose of this study was to compare the effects of these two surgical methods on sexual function.

Materials and methods: 122 sexually active male patients under the age of sixty were randomly divided into two groups: the internal iliac anastomosis group and the external iliac artery anastomosis group. Before surgery and one year after the procedure, patients completed the International Index of Erectile Function-15 questionnaire (IIEF-15), and the difference in scores of each domain was measured.

Results: Statistically, kidney transplantation  improved all domains of IIEF in both groups, except for the erectile function in for patients who underwent  internal iliac artery anastomosis group. Additionally, Also, there were significant differences between  the two groups in the domains of erectile function (p-value=0.04) and overall satisfaction (p-value= 0.002), while other domains such as orgasmic function, sexual desire, and intercourse satisfaction did not show any statistically significant differences.

Conclusion: In conclusion, the choice between using the internal or external iliac artery for arterial anastomosis during kidney transplantation does not significantly impact graft function. However, it may negatively affect erectile function in patients who undergo internal iliac artery anastomosis.

Purpose: To evaluate the efficacy of frenulum protection technique of the disposable circumcision suture device(DCSD) in adult males.

Materials and Methods: A total of 53 adult males were diagnosed with redundant prepuce and underwent circumcision with DCSD using frenulum protection technique. Main preoperative and postoperative measure of the length of penile frenulum was evaluated. Other data such as edema rate, intraoperative blood loss, operation time, postoperative pain, staple taking off time, incision infection rate, and evaluation of satisfaction rate with penis appearance were documented in the study.

Results: There was no significant difference of preoperative and postoperative frenulum length for each patient. The mean length of the penile frenulum before and after surgery was 2.25 ± 0.36 cm and 2.23 ± 0.39 cm, respectively (P = .31). The rate of frenulum length preservation was 100%. All the patients had no excessive resection of frenulum and no serious complication happened after surgery. The satisfaction rate of postoperative penis appearance from patients’ evaluation was 98.1% (52/53).

Conclusion: The frenulum protection technique was simple and operable, which could help the operator to accurately identify the most distal position of the frenulum and retain a sufficient length of frenulum during DCSD circumcision.

Prostate cancer is among the most central sources of cancer-related mortalities. In order to find novel candidates for therapeutic strategies in this kind of cancer, we developed an in-silico method for identification of competing endogenous RNA network. According to the microarray data analyses between prostate tumor and normal specimens, we attained 1312 differentially expressed (DE)mRNAs, including 778 down-regulated DEmRNAs (such as CXCL13 and BMP5) and 584 up-regulated DEmRNAs (such as OR51E2 and LUZP2), 39 DElncRNAs, including 10 down-regulated DElncRNAs (such as UBXN10-AS1 and FENDRR) and 29 up-regulated DElncRNAs (such as PCA3 and LINC00992) and 10 DEmiRNAs, including 2 down-regulated DEmiRNAs (such as MIR675 and MIR1908) and 8 up-regulated DEmiRNAs (such as MIR6773 and MIR4683). We constructed the ceRNA network between these transcripts. We also evaluated the related signaling pathways and the significance of these RNAs in prediction of survival of patients with prostate cancer. This study provides novel candidates for construction of specific treatment routes for prostate cancer.

Purpose: To explore the safety and efficacy of bipolar plasma-kinetic transurethral resection of the prostate in patients taking low-dose aspirin.

Materials and Methods: Benign prostatic hyperplasia (BPH) patients who underwent surgical treatment from November 2018 to May 2020 were retrospectively analyzed,divided into two groups according to whether taking 100mg aspirin daily aspirin or not. The perioperative indexes, complications and sequelae also were used to evaluate safety. The efficacy was evaluated by the functional outcomes in 3,6,12 months.

Results: There were no statistical differences in the baseline characteristics or perioperative indicators and complications and sequelae, except for a longer operative time(90.49 ± 14.34 vs 84.95 ± 15.49; 95%CI: 0.26-10.83; P = .040) and a shorter hospital stay time(HST) (8.52 ± 1.55 vs 9.09  ± 1 .50; 95% CI: 0.21-1.11; P = .042) in the non-aspirin group.  During the 12-months follow-up period, the functional outcomes of the two groups were significantly improved except International Index of Erectile Function (IIEF-5).

Conclusion:Based on our research results, PKRP a safe and effective method for patients with BPH who taking 100mg aspirin daily.

This essay draws attention to the prostate-specific antigen (PSA) discovery's lack of Nobel Prize acknowledgement despite its significance for prostate cancer (PCa) clinical practice. The Nobel Prize committee gives more weight to discoveries in basic research than to applications in medicine, which may account for PSA's lack of recognition. The prize has been dominated by the identification of cancer-causing viruses. Considering the subject from our -urologists- side, numerous pioneer researchers have uncovered PSA's presence and function, and its overuse in PCa screening has sparked debates about issues like overdiagnosis and overtreatment. We must concur that the factors contributing to PSA's underappreciation include the lack of a clear pioneer in its discovery and the contradictory opinions around its use. As a conclusion, PSA may have to wait for a better application before it receives recognition in the Nobel Prize.