Urology Journal

Purpose: To evaluate risk factors and outcomes of Pulmonary Complications (PCs) in Percutaneous Nephrolithotomy (PCNL) under Spinal anesthesia (SA).

Material and method: 286 patients who underwent PCNL under SA between 2017 and 2021 were identified retrospectively and divided into group 1 (clinically significant PCs) and group 2 (no clinically significant PCs). Demographic, preoperative, and intraoperative variables and postoperative outcomes were compared between both groups. Independent risk factors for PCs were evaluated by univariable and multivariable logistic regression analyses.
Results: PCs were noted in 90 patients (31.5%). Advanced age (P = .011), high body mass index (BMI) (P < .001), and the presence of chronic obstructive pulmonary disease (COPD) (P < .001) were risk factors for PCs.

Conclusion: SA is an effective method of anesthesia for all PCNL patients and carries a lower rate of PCNL-associated PCs. Risk factors for PCs after PCNL were advanced age, obesity, and preoperative COPD.

Purpose: To investigate the impact of learning curve (LC) on flexible ureterorenoscopy (f-URS).

Materials and Methods: Patients who underwent kidney stone surgery in a urology clinic from a tertiary health care institution with f-URS were enrolled in the study. Patient characteristics, the properties of kidney and kidney stones were recorded. Also, f-URS-related parameters, hospitalization time, the success of the procedure, and complications were noted. Patients were categorized equally into 4 groups, the first 20 f-URS cases in Group 1, and the last 20 f-URS cases in Group 4. Groups were compared according to patient preoperative parameters, intraoperative outcomes, success rate and complication rate.

Results: Time from the induction of anaesthesia to insertion of flexible ureterorenoscope was 18.6 min in group 1 and 17.2 min in group 2; then it significantly decreased to 15.0 min for cases 40 through 60 and 12.4 min for cases 60 through 80 (p = 0.001). Operation time in group 3 and group 4 was significantly shorter than in group 1 and group 2 (p = 0.001). Also, fluoroscopy time was significantly longer in group 1 (82.9 seconds) and reached a plateau in group 3 (50.3 seconds) and group 4 (41.7 seconds) (p = 0.001). Additionally, after the 20th case, we achieved a significantly higher success rate in comparison to the first 20 cases (65% in group 1, 85% in group 2, 85% in group 3, and 90% in group 4, p = 0.001).

Conclusion: Flexible ureterorenoscopy is a surgery that requires high technique and experience. The present study found that success of f-URS reached satisfactory levels after 20th cases. In addition, 40 cases may be enough for surgical proficiency regarding decreases in preparation time, operation time, and fluoroscopy time.

Purpose: Laparoscopic donor nephrectomy (LDN) is the most commonly used method for kidney removal in kidney transplantation and, various incisions are used for kidney extraction. In this study, we aimed to compare the results of LDN operations using iliac fossa incision and Pfannenstiel incision.

Material and Method: LDN cases performed in our institute between June 2016 and February 2020 were retrospectively analyzed. Patients with previous abdominal surgery, bleeding coagulation disorders, ectopic kidneys, and patients who were converted to perioperative open surgery were excluded. Demographic data of the patients, operation times, warm ischemia times, complications were recorded and the patients were divided into two groups according to incision types.
Results: After the inclusion and exclusion criteria, 203 patients were included in the study. Iliac fossa incision was used in 65% of the patients and the Pfannenstiel incision was used in 35% of the patients to remove the donor’s kidney. There were no difference in age, body mass index, gender, and Charlson Comorbidity Index (CCI) scores between the two groups. Operation time and warm ischemia time were significantly longer in the Pfannenstiel group (p = 0.001 and p = 0.016 respectively). There was no significant difference between the two groups in terms of bleeding amount, length of hospital stay, need for narcotic analgesic, visual analog scale scores, and postoperative complications.
Conclusion: Both types of incisions can be used successfully and safely for the extraction of the kidney in LDN. Although WIT and operation time has been observed to be longer when a Pfannenstiel incision is made, complications and analgesic use are not different between Pfannenstiel incisions and iliac fossa incisions.

Purpose: To evaluate oncological outcomes in patient with positive surgical margin (PSM) following partial nephrectomy
(PN).
Material and methods: In this retrospective study, we enrolled the data of patients who underwent PN between
2008 and 2017. The inclusion criteria were a definite diagnosis of kidney tumor who underwent PN with at least
one year follow up.
Results: From the 450 patients who underwent PN, The PSM was found in 35 (22 male/13 female) patients. 18/237
(7.6%) and 17/213 (7.9%) of them were in open and laparoscopic group, respectively. Clear cell RCC was the most
prevalent pathology (18 patients) in the PSM patients. The mean time of follow up was 46 ± 2.02 months. Recurrence was developed in 5 (14.2%) patients. There was no correlation between recurrence and sex (p=1.00), surgery type (p = 0.658), age (p = 0.869), tumor size (p = 0.069), pathology (p = 0.258) and stage (p = 0.744) in PSM patients. Recurrence free survival was similar between the open and laparoscopy groups in PSM patients (p = 0.619).
Conclusion: Beside numerous advantages of minimally invasive techniques, laparoscopic approach would be
comparable to conventional open partial nephrectomy in terms of oncologic outcomes. The rate of recurrence following
partial nephrectomy in PSM patients is considerable and closely monitoring is mandatory.

Purpose: To investigate the potential relationship between differential gene expression, biological function enrichment, and disease prognosis affecting the sensitivity of prostate cancer radiotherapy by bioinformatics analysis.

Materials and Methods: Retrieve and obtain data on differential gene expression of prostate cancer radiosensitivity in the GEO database (GSM3954350, GSM3954351, GSM3954352), GER2 tool to screen and analyze the differential genes, Enrichr database for enrichment analysis of GO and KEGG, use Cytoscape software builds protein-protein interaction (PPI) networks and analyzes key genes.

Results: A total of 7041 differentially expressed genes were screenedout, including 3842 high expression genes and 3199 low expressed genes. The top 20 differentially expressed genes were selected for further analysis. Their biological functions are mainly enriched in the following aspects: “Cell communication” and “Signal transduction”; cytological components are mainly located outside the cell; molecular functions are enriched in structural molecular activity, receptor binding, serine-like peptidase activity, etc. The KEGG enrichment analysis showed that the differentially expressed genes were mainly enriched in the mismatch repair pathway, non-homologous terminal binding pathway and so on. Survival analysis showed that VGF gene was associated with the prognosis of prostate cancer patients receiving radiotherapy, and high expression of VGF significantly reduced progression-free survival(PFS) in these patients(HR = 4.84, 95% CI: 1.34-17.5, P = .016).

Conclusion: This study identified key genes associated with radiation sensitivity in prostate cancer and verified the relationship between the VGF gene and patient prognosis.

Purpose: We aimed to compare oncological outcomes in the two rare subtypes, unclassified renal cell cancer (unRCC) and translocation RCC (tRCC), vs clear cell RCC (ccRCC).
Materials and Methods: Between 2004 and 2019, from Turkish Urooncology Society Database, we identified 2324 patients for histological subtypes including 80 unRCC (3.4%), 19 tRCC (0.8%) and 2225 ccRCC (95.8%).
Results: The overall (15.8%) and cancer-specific mortalities (11.1%) were found to be higher in tRCC group and the recurrence free mortality (13.8%) was found to be higher in unRCC group. Larger pathological tumor size (p = 0.012) and advanced pathological T stage (p = 0.042) were independent predictive factors on overall mortality in patients with unRCC tumors.
Conclusion: The oncological outcomes of the unRCC and tRCC are worse than ccRCC and pathological tumor size and pathological stage are predictive factors for mortality in the unRCC.

Background: The aim of this study was to investigate the diagnostic performance of mpMRI for detecting cribriform
pattern prostate cancer.

Materials and Methods: This study retrospectively enrolled 33 patients who were reported cribriform pattern
prostate cancer at final pathology. The localization, grade and volumetric properties of the dominant tumors and
areas with cribriform pattern at the final pathological specimens were recorded and the diagnostic value of mpMRI
was evaluated on the basis of the cribriform morphology detection rate. It was analyzed using Wilcoxon test, the
Chi-square test and Fisher's Exact test. The significance level (P-value) was set at .05 in all statistical analyses.

Results: A total of 58 prostate cancer foci were (38 cribriform, 20 non-cribriform foci) identified on the final pathology.
mpMRI identified 36 of the 38 cribriform morphology harboring tumor foci with a sensitivity of 94.7%
(95% confidence interval 82.7–98.5%). In 17 of the 33 patients mpMRI detected single lesion and for these lesions;
mpMRI identified cribriform morphology positive areas precisely in 15 patients with significantly low ADCmean
and ADCmin values compared to the non-cribriform cancer areas within the primary index lesion (P < .001). For
the remaining 16 patients with multiple lesions; all of the tumor foci that harboring cribriform morphology were
identified by mpMRI but in none of them any ADCmean and ADCmin value divergence were detected between
the cribriform and non-cribriform pattern tumor foci within the primary index lesion.

Conclusion: Cribiform pattern should be considered in single lesions with an area of lower ADC value on mpMRI.

Purpose: To investigate the long-term effects of transurethral bladder neck incision (TUBNI) for female primary
bladder neck obstruction (PBNO).

Materials and Methods: We retrospectively reviewed seventy women diagnosed with bladder neck obstruction
by video-urodynamic study (VUDS). TUBNI was performed for each patient, with incisions made at 2 different
sites on the bladder neck. Postoperatively, patients were assessed by international prostate symptom score (IPSS),
quality of life (QOL) and uroflowmetry.

Results: Follow-up data were available for 4-108 months (median 42 months) postoperatively. During follow-up,
the IPSS, QOL, time to maximum uroflow rate, postvoid residual urine volume decreased significantly after TUBNI
compared with preoperative [13.0 (10.0, 15.0) versus 3.0 (3.0, 8.0), P ＜ .001], [5.0 (5.0, 5.0) versus 2.0 (1.0,
3.0), P ＜ .001], [9.0 (5.0, 37.0) versus 6.1 (4.2, 8.7), P ＜ .001], [77.5 (23.5, 165.8) versus 0.0 (0.0, 30.0), P ＜
.001]. The maximum uroflow rate, average uroflow rate and the voided volume increased significantly compared
with preoperative [7.0 (4.0, 10.3) versus 19.8 (12.8, 25.2), P ＜ .001], [3.0 (2.0, 5.0) versus 8.0 (4.9, 10.7), P ＜
.001] and [156.5 (85.0, 211.3) versus 261.3 (166.2, 345.6), P ＜ .001]. Several complications were identified after
surgery, including bladder neck reobstruction, urethral stricture, and stress urinary incontinence, the corresponding
number was 5 (7.1%), 7(10%) and 7(10%). Successful operation was achieved in 60/70 (85.7 %) patients.

Conclusion: PBNO is a very rare yet easily treatable condition. VUDS is the primary diagnostic tool for the diagnosis
of bladder neck obstruction in women, while TUBNI can effectively relieve obstruction symptoms and
improve the quality of life for patients.

Purpose: The aim of this study is to evaluate the results of the surgical technique used by the authors on Peyronie's
disease (PD) patients who underwent surgical treatment with a temporalis fascia autograft.
Materials and Methods: Patients with normal erectile functions and > 60° penile curvature who underwent surgical
treatment with temporalis fascia autografts were included in this retrospective study. The patients were recruited
between January 2017 and May 2021. Preoperative assessment included the International Index of Erectile
Function erectile function (IIEF-EF) score, penile duplex and penile curvature angle measurement. Postoperative
self-reports, penile deformity, IIEF-EF scores and the Patient Global Impression of Improvement (PGI-I) questionnaire
were assessed every three months.
Results: Twenty-two patients with a mean age of 52.09 ± 6.61 years were included in the study, and no major complications developed in any case. Postoperative assessment revealed curvature relapse in seven patients (31.8%), although no intervention was performed on five patients with < 20° curvature. Six patients experienced a postoperative decrease in penile length and erectile function was completely preserved in 68.18%. The mean level of satisfaction with surgery measured using the visual analogue scale was 79.13 ± 21.23.
Conclusion: The temporalis fascia graft, thin and durable graft, is a highly successful therapeutic option in the
surgical treatment of PD patients and a good alternative in terms of its cosmetic and functional results.

Purpose: To study the incidence, risk factors for developing asymptomatic venous thromboembolism and the
compliance of patients on anticoagulants for asymptomatic venous thromboembolism (VTE) in nononcological
urological medium-high risk inpatients, and build a risk assessment model (RAM) for early screening for asymptomatic
VTE.
Materials and Methods: We conducted a retrospective analysis of 573 inpatients admitted to a nononcological
urological ward of a tertiary hospital in China from January 1, 2017, to June 30, 2019. Data were collected using
the electronic medical record system, and patients underwent a follow-up by phone 6 months after discharge.
Results: Among the 573 medium-high risk inpatients, 73 (15.4%) were diagnosed with VTE, including 20 (4.2%)
symptomatic and 53 (11.2%) asymptomatic. Prior history of VTE, a history of anticoagulants or antiplatelet agents
before admission, and D-dimer ≥ 1 were the potential risk factors identified for asymptomatic VTE. Patients with
poor awareness of VTE and its dangers, and patients who lived more than 1 hour away from the hospital had a
high probability of poor compliance with anticoagulation therapy after discharge. Using D-dimer (1.785 μg/ml),
we built a RAM for the early diagnosis of asymptomatic VTE.
Conclusion: We found that patients with urinary nontumor VTE had low compliance with anticoagulation therapy
after discharge. The key factors for determining asymptomatic VTE in nononcological urological inpatients
included prior history of VTE, a history of taking anticoagulants or anti-platelet agents before admission, and
D-dimer ≥ 1. Furthermore, we found that the threshold of D-dimer should be elevated to 1.785 μg/ml to predict
asymptomatic VTE.