Urology Journal

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: 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: To analyze the risk factors for the relapse of prostate cancer (PC) after radical prostatectomy (RP) and build a nomogram as a predictive model. 

Materials andMethods: The patients who underwent PR from March 2019 to February 2022 were retrospectively enrolled in our hospital's case system. During the follow-up process, two consecutive prostate-specific antigens (PSA) ≥0.2 μg/L were performed. And needle biopsy was performed to further determine whether the patient had prostate cancer recurrence. According to the follow-up results, the patients were divided into non-relapsed and relapsed groups.The related parameters of the two groups were collected. Independent risk factors for postoperative recurrence were determined using a Cox proportional hazards regression model. Statistical software, R, was used to build nomograms. R software was used to construct a nomogram, and the prediction effect of the nomogram was evaluated by the calibration curve and the area under the ROC curve (AUC).

Results: Among the 367 patients who underwent RP, 112 (30.52%) had, and 255 (69.48%) did not have relapses after surgery. Cox multivariableregression analysis revealed that preoperative Gleason score, preoperative PSA, pathological staging, positive margin, and seminal vesicle invasion, were the risk factors for postoperative recurrence after RP (all P < 0.05). Verification of the predictive model by ROC curve demonstrated that the AUC of the ROC curves for patients’ relapses 3 and 5 years after RP was 0.986 (95%CI0.975-0.998) and 0.974 (95%CI0.961-0.987), respectively. This model validation showed that the results of the predictive model were basically consistent with the actual results, suggesting that the nomogram was able to accurately predict a patient’s relapse.

Conclusion: The nomogram of this study was a good predictor of postoperative recurrence of PC after RP, which will help doctors provide personalized treatment and follow-up strategies for patients.

Purpose: To analyze the perioperative factors that influence the risk of biochemical recurrence (BCR) in patients with localized PCa undergoing radical prostatectomy

Materials and Methods: A total of 457 patients, operated by 2 surgeons in our high-volume oncological center were included in the initial database. Patients who underwent RP for clinically localized PCa in our clinic from 2016 to 2021 were included in the study. Perioperative data were retrospectively reviewed for this study. Follow-up data including post-operative PSA and adjuvant treatment was prospectively gathered by contacting the patients or from the follow-up consultation. Final database was composed of 366 patients who underwent open or 3D laparoscopic RP. Statistical analysis was performed to emphasize the most powerful parameters that influence the BCR. 

Results: Accounting for multivariable analysis, 4 parameters were statistically significant: initial PSA (iPSA), Gleason score, vascular involvement and positive surgical margins. For the group of patients with no positive margins, 3 parameters were statistically significant: iPSA above 10,98 ng/mL (AUC=0,71); lymph node involvement and Gleason score. Multivariable Cox regression showed that positive margins and iPSA had a significant impact on the time to BCR. Patients that received adjuvant therapy were excluded from the study. Out of the whole cohort, 27,3% of patients presented BCR.

Conclusion: Perioperative factors need to be carefully analyzed and a detailed follow-up needs to be conducted in order to assess the risk of biochemical recurrence, resulting in the optimal time for adjuvant treatment implementation.

Purpose: To evaluate the performance of the European Organization for Research and Treatment of Cancer (EORTC) and the Spanish Urological Club for Oncological Treatment (CUETO) risk scoring models in non-muscle-invasive bladder cancer (NMIBC) patients defined as high risk according to European Association of Urology guidelines and managed based on current recommendations.

Material and Methods: Data from 187 high-risk NMIBC patients treated at a tertiary center between July 2010 and November 2021 were analyzed retrospectively. One- and five-year recurrence- and progression-free survival were assessed for each patient using the EORTC and CUETO risk scores. The patients were divided into four risk groups according to their risk scores as low, medium-low, medium-high and high risk, as indicated in the models. Discriminative ability was evaluated with the Harrell's concordance index (c-index).

Results: Both risk scoring models overestimated the risk of recurrence and progression at one and five years. Only the prediction of recurrence at five years in the high risk group according to the CUETO model was compatible with our cohort. CUETO (c-indices for recurrence and progression were 0.802 and 0.834, respectively) exhibited better discrimination than EORTC (0.722 for recurrence and 0.752 for progression) in the prediction of disease recurrence and progression.

Conclusion: The CUETO model was superior to the EORTC model in predicting recurrence and progression and stratifying patients with different prognoses in our high-risk NMIBC patient population treated according to current guideline recommendations. However, both models overestimated the probability of disease recurrence and progression. Only the probability of recurrence at five years in the high-risk group of the CUETO model was compatible with our cohort.

Purpose: To compare 90-day  perioperative complications and pathological outcomes between laparoscopic radical cystectomy (LRC) and extraperitoneal radical cystectomy (EORC) approaches.

Materials and Methods: All operations were performed in a single high-volume tertiary referee center by the same surgical team.Males ≥ 18 years with pre-cystectomy clinical T1–T3 disease and having undergone an ileal conduit were included. Exclusion criteria included patients with inflammatory bowel disease, previous pelvic and/or abdominal irradiation, neo-adjuvant chemotherapy, and/or clinical T4 disease. Perioperative outcomes such as operative time, estimated blood loss, transfusion rate, hospital stay, and 90-day complications were evaluated. The recovery duration of regular bowel activity, mean stool passage,and ileus rates were recorded.

Results: A total of 221 patients met the inclusion criteria(81 LRC and 130 EORC). Demographics and preoperative parameters were comparable. Intraoperative estimated blood lossfavored LRC by a median of 450 mL (200-900) P=.021) vs. a median of 700 mL (300-2900) for EORC. The transfusion rate did not differ between the two groups; %14.8 (N=12) for the LRC and %20.8 (N=27) for EORC (P=.37). The median hospital stay was 9 (4-49) days for EORC and 8 (4-29) days for LRC (P=.011). The need for analgesics to control pain through an epidural catheter was higher for EORC (P=.042). There was no difference in overall complication rates (P=.47).

Conclusion:  Although LRC appears to have a slight advantage over EORC, both techniques yield satisfactory results in regard to ileus rates and 90-day perioperative complications.

Purpose: Considering the inadequacy of PSA measurement in the diagnosis of prostate cancer, it is aimed to establish a potential liquid biopsy diagnostic panel.
Materials and Methods: 39 patients who underwent TRUS-biopsy and 15 healthy volunteers were included.
Approximately 15 ml of venous blood samples taken from healthy volunteers and patients before biopsy were
separated as plasma. Hypermethylation status of GSTP1 and RASSF1:RASSF2 genes was revealed in cfDNA
materials collected from plasma samples. Correlation of this epigenetic change detected in PCa, BPH and healthy
volunteer groups with pathology results was examined.
Results: Pathology reports of 39 patients included were 13 PCa, 3 ASAP, 3 HGPIN, and 20 BPH. In total, 3 of the
patients with PCa had positive GSTP1, 4 had RASSF1 and 9 had positive RASSF2 methylation. It was seen that
RASSF2 had the highest sensitivity (69%), specificity (39%) and NPV (80%), while RASSF1 had the highest PPV
(30%). When the binary combinations of genes were examined it was observed that the GSTP1:RASSF1 combination
had the highest sensitivity (46%), specificity (76%) and NPV (82%). When the methylation of all three
genes was examined, it was observed that the sensitivity was quite low (8%), but the specificity (83%) increased
significantly.
Conclusion: Although we observed that the GSTP1 and RASSF1 methylation positivity rates that we examined in
our study were higher in patients without prostate cancer, we found that the RASSF2 methylation rate was higher
in patients with prostate cancer. randomized controlled studies are needed.

Purpose: Traditionally, an omental flap is employed to reduce the risk of recurrence of vesicovaginal fistula
(VVF) repair. In this study, we employed a modified surgical technique wherein the vaginal defect was closed
using Connell sutures, without incorporation of an omental flap, aiming to mitigate potential complications.
Material and method: Between 2010 to 2018, the current randomized clinical trial was conducted on 52 women
who were candidates for open fistula repair. The patients were randomly allocated into two groups. In one group,
the conventional method of fistula repair was performed involving an omental flap, while in the other group, we
used a modified approach with a variation in the vaginal wall closure technique. In-hospital variables, including the
length of surgery, hospital stay, and occurrences of ileus, were recorded. Patient follow-up extended for one year,
with assessments conducted one, six, and twelve months postoperatively. These evaluations encompassed pad test
to ascertain success rates and identify any potential complications.
Results: The final analysis comprised 49 patients, with an average age of 46.5 years. Baseline characteristics were
comparable between the two groups (P-values > 0.05). The modified technique was associated with significantly
reduced surgical duration (P = ˂ 0.001), and shorter hospital stays (P < 0.001). Ileus occurrence was reduced, but
it was not significant(P = 0.856). However, the success rate showed no significant difference between the groups,
with a success rate of 100% for the modified technique compared to 91.6% for the classic O’Conner method (P =
0.288).
Conclusion: Based on the findings of this study, vaginal wall closure using Connell sutures during VVF repair
demonstrates a success rate equivalent to the classic approach involving an omental flap. Moreover, this technique
presents a reduced incidence of adverse effects, along with decreased surgical duration, hospital stay, and postoperative
ileus.

Transplant renal artery stenosis is the most common vascular complication that occurs following kidney transplantation and can lead to graft dysfunction and even its loss. The present report describes A patient with endstage renal disease who underwent living related renal transplantation. He had oliguria and creatinine rise in the post-operative course but all doppler ultrasonography (DUS) during the 2 months post-operation for the renal graft showed a normal mean resistive index in the graft renal artery. Hemodialysis treatment started and continued for 4.5 months. On post-operative day 137, because of the patient's anuria and resistant hypertension, another DUS
carried out and reported evidence that suggested arterial stenosis. A computed tomographic (CT) renal angiogram
showed a small filling defect in the proximal graft artery that was highly suggestive for transplant renal artery
stenosis (TRAS). Following angiography revealed a short linear stenosis. Endovascular intervention and stent
placement were performed successfully for the patient on post-operative day 139. This case was initially diagnosed
as ongoing acute rejection for which he received antirejection therapy without any significant improvement. After
percutaneous transluminal angioplasty (PTA), serum creatinine trended down and urine output improved within
12 h, and they were stable at one-year follow up with a good renal function. It was noteworthy that, despite after a
4.5-month delay in diagnosis and maintenance need for dialysis, the patient responded to endovascular treatment
and the graft function became normalized. Our case demonstrates that graft can be saved even if renal artery stenosis is diagnosed after several months of dialysis and diagnosis of end stage renal disease post transplantation.