Urology Journal

Purpose: The purpose of this study is to evaluate the preoperative, early and late postoperative homocysteine levels and its relationship with kidney function in patients after undergoing percutaneous nephrolithotomy (PNL).
Materials and Methods: Twenty-three patients with kidney stones underwent PNL and blood samples were taken preoperatively as well as at 48 hours and three months after the operation. The homocysteine level was determined by high pressure liquid chromatography and the fluorometric method in blood samples with ethylenediaminetetraacetic
acid. The Cockcroft – Gault formula was used to calculate the glomerular filtration rate (GFR). Non-contrast computed tomography was performed for all patients before surgery. Stone burden was calculated as
the sum of the area of each stone in mm2.
Results: Fourteen male (60.9%) and nine female (39.1%) patients were recruited for this study, and the median age was 44.3 ± 15.17 (20 – 71) years. There were no statistically significant differences between the preoperative homocysteine level and the level at 48 hours post-operation (P = .460). However, the homocysteine level three months after the operation was significantly lower than the preoperative and 48 hour levels (P = .001 and P = .003, respectively).
Conclusion: Renal function, which deteriorated after the PNL procedure, was preserved or improved over time. Homocysteine may be a sensitive indicator to assess the change in renal function pre-and post-PNL.

Purpose: To determine the perioperative risk factors for postoperative infections among patients undergoing flexible uretero-renoscopy with laser lithotripsy (FURSLL). In addition, the resistance patterns of pathogens isolated from positive preoperative urine cultures were investigated.
Materials and Methods: We retrospectively reviewed data from 492 consecutive patients who had undergone FURSLL for stone disease in our department. Postoperative infection was defined as fever (? 38°C) with pyuria (? 10 white blood cells per high power field), or systemic inflammatory response syndrome, or sepsis. Pre-operative and intra-operative characteristics between patients with and without postoperative infectious complications were compared using univariate analyses. Significant variables on univariate analyses were included in a multivariate
logistic regression analysis to evaluate risk factors associated with postoperative infection following FURSLL.
Results: 42 (8.5%) of 492 patients had postoperative infectious complications after FURSLL. 59 (12%) of 492 patients had a positive preoperative urine culture. 19 (32.2% of 59) patients had multidrug resistance (MDR) isolates recovered from positive preoperative urine cultures. 75% (9/12 cultures) of the positive preoperative urine cultures of patients in whom a postoperative infectious complication developed consisted of gram-negative pathogens. On multivariate analysis positive preoperative MDR urine culture (OR:4.75;95%CI:1.55-14.56; P = .006) was found to be significant with the dependent variable as the postoperative infectious complications despite appropriate preoperative antibiotic therapy.
Conclusion: We found that positive preoperative MDR urine culture is a significant risk factor for infectious complications after FURSLL. Our findings point to the need for further research on assessment of risk factors for
MDR infections to reduce the rate of postoperative infectious complications.

Purpose: To evaluate the intraoperative pain score of patients who undergo percutaneous nephrolithotomy under spinal anesthesia and to evaluate surgeons' and patients' convenience with this type of anesthesia.
Materials and Methods: PCNL cases who were performed by two endourology fellows under spinal anesthesia during June to July 2014 were included. Spinal anesthesia was performed using injection of 0.25mg/kg bupivacaine 0.5% in the intrathecal space. All procedures were performed with the patient in the prone position. Stone access was made by using ?uoroscopic guidance, and the tract was dilated using a single-stage technique. Visual analogue pain score was used to assess patients' pain during operation, immediately after, and 2 hours later.
Results: 50 patients were enrolled during the study period. Visual analogue pain score of 10 and 8 were observed in 5 and three patients respectively. In two patients the operation was terminated because of patient anxiety and pain. In another patient a second access was not obtained to remove a staghorn stone because of patient's agitation. Gross agitation was observed in six patients. Apart from flank pain, intraoperative pain was felt in the flank, scapula, abdomen and/or chest.
Conclusion: Spinal anesthesia does not provide enough analgesia for the patient in a limited frequency of percutaneous nephrolithotomy operations. We could not find statistically significant predictors of insufficient analgesia
based on patients' demographics, stone characteristics or access location.

Purpose: The aim of this study was to identify factors that can be used to predict severe neutropenia (grade 3 or higher) in patients with advanced urothelial cancer after cisplatin-based systemic chemotherapy.
Materials and Methods: The study examined 79 Korean patients with advanced urothelial cancer who were treated with several cycles of cisplatin-based systemic chemotherapy from May 2006 to May 2015. Risk factors for neutropenia (grade 3 or higher) and for the occurrence of neutropenia (grade 3 or higher) during the first cycle of chemotherapy were examined.
Result: Thirty-six out of the 79 patients (45.6%) developed neutropenia at grade 3 or higher during the first cycle of cisplatin-based systemic chemotherapy: 18 (22.7%) of these experienced grade 3 neutropenia and 18 (22.7%) experienced grade 4. Multivariate analysis identified pretreatment neutrophil counts (P = .001) as the only significant factor predictive for severe neutropenia.
Conclusion: The pretreatment neutrophil count was found to be the factor that poses a significant and independent risk in development of severe neutropenia induced by applying cisplatin-based systemic chemotherapy to patients with advanced urothelial cancer.

Purpose: Enuresis can cause loss of self-esteem in children, change relations with family and friends, and decrease the school success. This study was conducted to determine the prevalence of urinary incontinence (UI) in school children aged between 11-14 years and identify the emotions and social problems of enuretic children.
Materials and Methods: A mixed methods approach was used on a group of students who reported UI by combining quantitative data from school population-based cross-sectional design with qualitative data using in-depth interview techniques. The data of this descriptive and cross-sectional study were collected from 2750 primary school students aged between 11-14 years in Istanbul.
Results: The overall prevalence of UI was 8.6% and decreased with age. Prevalence of the diurnal enuresis in children was 67.9% and all of them had non-monosymptomatic enuresis. 83.3% of the children were identified
with secondary enuresis for 1-3 years. UI was significantly more common in boys and those who had frequent urinary infections, whose first degree relatives had urinary incontinence problem in childhood, and who reported
low socioeconomic level in the family. The emotional and social effects of urinary incontinence were given in the context of children's own expressions.
Conclusion: Urinary incontinence is an important problem of school-age children. In this study the prevalence of UI was found to be 8.6%, diurnal UI and secondary enuresis were very common, and all of the children were
non-monosymptomatic. Enuresis has negative emotional and social effects on children.

Purpose: The aim of this study is to determine the relationship between abdominal muscle strength, trunk control and urinary incontinence in children with diplegic cerebral palsy.
Materials and methods: The current study had a cross-sectional design using analytical study as well as an observational research model. Fifty children between the ages of 5 and 18 years who were diagnosed with diplegic clinical type of cerebral palsy were included in this study using improbable-random sampling method. After patients' demographic information were obtained, Dysfunctional Voiding and Incontinence Symptoms Score Questionnaire (DVISS), Dysfunctional Voiding Symptom Score (DVSS), the manual muscle test of the muscles, Trunk Control
Test (TCT) and Trunk Control Measurement Scale (TCMS) were completed in order to evaluate trunk control. Also, Gross Motor Function Classification System (GMFCS) was performed in order to define the functional level.
Results: In this study, a highly correlated negative relationship was found between DVISS and DVSS scores with muscle abdominal strength, TCMS and TCT. In addition, a highly correlated positive relationship was found between both GMFCS and DVISS and GMFCS and DVSS.
Conclusion: This is the first study that describes the effect of trunk control and muscle strength on urinary incontinence in children with diplegic cerebral palsy. This study showed that there is a correlation between trunk control, muscle strength and urinary incontinence.

Purpose: To compare effects of transcutaneous posterior tibial nerve stimulation (TPTNS) and pelvic floor muscle training (PFMT) in women with overactive bladder syndrome (OAB).
Material and Methods: We randomized 67 women ? 18 years with OAB to three parallel groups: group I (n = 22) received life-style recommendations (LSR) only; group II (n = 24) had LSR + PFMT and group III (n = 21) had LSR + PFMT + TPTNS. Urgency, evaluated by a 3-day voiding diary before treatment and six weeks later, was the main outcome measure. The King‘s College Health Questionnaire was also administered.
Results: Urgency was significantly reduced in all three groups from 5.1 ± 3.7 to 3.8 ± 3.2 episodes/day, P = .016 in group I, from 5.2 ± 3.6 to 3.2 ± 2.9, P = .006 in group II and from 6.8 ± 3.1 to 4.4 ± 3.5 in group III, P = .013. There were no intergroup differences. The questionnaire results improved significantly only in group III as regards general health perception, role limitation, physical and social limitations without intergroup differences. Women
improved their micturition frequency in two groups from 8.9 ± 3.2 to 7.5 ± 2.3 episodes/per day, P = .025 in group II, and from 8.8 ± 2.3 to 7.4 ± 2.0, P = .001 in group III, but only in group II was a significant reduction of urinary incontinence seen from 3.8 ± 4.6 to 2.9 ± 4.8 episodes/day, P = .045.
Conclusion: All three treatments lead to effective short-term reduction of urgency in women with OAB, but longterm efficacy evaluation is required.

Purpose: This study was conducted in descriptive and cross-sectional design in order to determine prevalence of urinary incontinence severity in women with urinary incontinence (UI), correlation between UI and sexual dysfunction
Materials and Methods: The study had descriptive and cross-sectional design. In sample selection, four Family Health Centers areas were determined by lot and totally 384 women with UI were reached by making home visits in these regions. As data collection tool, severity index in female urinary incontinence determining UI condition and Female Sexual Function index determining sexual functioning were used.
Results: Average age of the women participating in the study was 37.3 ± 1.02. Mean body mass index of the women was 26.3 ± 5.41. It was determined that 22.1% of the women participating in the study had UI for 3-5 years and 15.1% had UI for six years and a longer time. It was determined that 53.9% of the women participating in study had mild incontinence, 40.6% had moderate incontinence, 3.6% had severe incontinence, and 1.8% had very severe incontinence. A significant correlation was found between severity index in female urinary incontinence (ISI) score and Female Sexual Function Index (FSFI) score (p < 0.05). There was a positive and weak correlation between ISI scores and age, duration of marriage, and number of pregnancy of the women who participating in the study; and a positive and very weak correlation between ISI scores and body mass index and spontaneous abortion (p < 0.05).
Conclusion: Almost half of women with UI were determined to have moderate and more severe urinary incontinence. A significant correlation was found between ISI and FSFI score.

Purpose: Erectile dysfunction (ED) is a sexual dysfunction described as the inability to develop or maintain an erection of the penis adequate for sexual intercourse, and its prevalence increases with age. Seen as a common sexual disorder worldwide, organic causes are the underlying reason for 80 percent of ED cases, with the most characteristic pathology responsible for organic ED being atherosclerosis. This study investigates the diagnostic value of plasma PTX-3 levels in arterial ED.
Materials and Methods: This study included a total of 45 patients who were admitted to the urology and cardiology
outpatient clinics of the Medical Faculty of Canakkale Onsekiz Mart University (COMU) and consented to participate in this study. Patients were categorized into three equal groups in number: (1) patients with ED diagnosed with coronary artery disease (CAD) (15 patients in total); (2) patients with ED not having coronary artery disease or any other equivalent diseases (diabetes mellitus, hypertension and hyperlipidemia) (15 patients in total);
and (3) ordinary patients with no ED (15 patients in total). An interview was conducted at the andrology polyclinic with each patient in order to ascertain detailed information on their medical and sexual history and on demographic characteristics. All patients were also administered the International Index of Erectile Function (IIEF) questionnaire.
Result: The findings from this study investigating the diagnostic value of plasma PTX-3 levels in ED were statistically significant for two comparisons: the differences between the peripheral blood and cavernous blood values of the patient groups (group 1 and 2) and the control group (group 3), and the differences between the peripheral blood and cavernous blood values of group 2 (patients with ED who do not have CAD) and the control group (group 3).
Conclusion: As PTX-3 is more specific than the formerly recognized biochemical markers in endothelial dysfunction, it can be used in the diagnosis of vascular originated ED.

Purpose: Urethral stricture, known as a scar formation leading to urethral lumen stricture in sub-epithelial tissue, is the most common late complication of transurethral prostate resection (TURP). The aim of study is to evaluate efficacy of colchicine treatment in preventing urethral stricture recurrence in patients after internal urethrotomy, and to determine whether colchicine treatment had a sustained effect in decreasing stricture recurrences in patients with concomitant diseases.
Methods: Patient data with weak urine stream and/or voiding difficulty, and who had internal urethrotomy in Urology Department of Maltepe University Hospital between dates 01 January 2011 and December 2016 were collected. They were randomized to colchicine receiving, and non-receiving arms. Colchicine was given 1 g/day orally for two months, and primary efficacy point was defined as urethral stricture development in 3, 6, and 12 months after internal urethrotomy.
Results: The study was conducted on 84 males with the mean age of 67.7 ± 7.5 years. The mean ages of colchicine receivers and non-receivers were 68.2 ± 7.6 and 67.1 ± 7.6 years, respectively. Recurrence rate of urethral stricture was significantly lower in colchicine receivers (P = .044) than non-receivers. In overall evaluation, recurrence rate of urethral stricture was significantly low, if there was only one comorbidity (P = .006), but rates were significantly higher in presence of three (P = .010) and four (P = .040) comorbidities. No significant difference in recurrence
rates was determined in patients without comorbidities or with two comorbidities (P > .05).
Conclusion: Combination of oral colchicine with internal urethrotomy reduces recurrence rates of urethral stricture
significantly.

A 40-year-old man was referred to our urology clinic due to vague abdominal pain and hematuria. Computed tomography (CT) without contrast material visualized an ectopic kidney in the left iliac fossa with a complete staghorn stone. Under general anesthesia, operation was done in supine position with a gentle lateral elevation on the right side. The surgeon stands on the right side of the patient. First, a 12 mm port was inserted at the umbilicus using the Hasson technique. After creation of pneumoperitoneum, operation was done by three 5 mm trocars were arranges as paraumbilical, the point between umbilicus and inguinal canal at left and right side.
A vertical pyelotomy incision was made over the anterior pelvic wall and then extended to a cross figure. The stone extracted intact with a laparoscopic stone grasper and placed in endobag. A short double J stent was placed via the pyelotomy incision and renal pelvis was closed using continuous 4.0 vicryl sutures. He was discharged from hospital after 3 days without any complication.

The intravascular papillary endothelial hyperplasia (IPEH) or Masson’s tumor is an unusual and rare benign disease.
It is histologically characterized by papillary and anastomosing channel-like structures lined by proliferating e n dothelium. Radiologically, it is usually presented as a heterogenic solid mass with contrast enhancement, withareas resembling necrosis and thrombosis. These signs can easily be attributed to malignancy. The urogenital tractis extremely rarely affected with only 8 cases described in the kidneys and one of the penis. We present a rare
case of IPEH at the base of the penis, visible only on MRI, causing chronic pelvic pain and erectile dysfunction.
According to available English literature our case is the first in this pelvic location and only the second to affect the
penis. Radical excision of the formation cured the condition.

Purpose: The aim of this study is to compare the results of transurethral incision of the prostate (TUIP) and transurethral resection of the prostate (TURP) for the surgical treatment of benign prostate hyperplasia (BPH) in patients with renal transplantation.
Materials and Methods: Between April 2009 and May 2016, BPH patients with renal transplants whose prostate volumes were less than 30 cm3 were treated surgically. Forty-seven patients received TURP and 32 received TUIP. The patients' age, duration of dialysis, duration between transplant and TURP/TUIP, preoperative and postoperative serum creatinine (SCr), International Prostate Symptom Score (IPSS), maximum flow rate (Qmax) and postvoid
residual volume (PVR) were recorded. At 1-,6- and 12-month follow-up, early and long-term complications were assessed. Results were evaluated retrospectively.
Results: In both groups, SCr, PVR and IPSS decreased significantly after the operation, while Qmax increased significantly (P < .001). There was no difference between the two groups in terms of increase in Qmax and decrease in IPSS, SCr and PVR (P = .89, P = .27, P = .08, and P = .27). Among postoperative complications, urinary tract infection (UTIs) and retrograde ejaculation (RE) rates were higher in the TURP group than the TUIP group (12.7% versus 6.2% and 68.1% versus 25%,respectively), whereas urethral strictures were more prevalent in the TUIP group (12.5% versus 6.3%).
Conclusion: For the treatment of BPH in renal transplant patients with a prostate volume less than 30 cm3, both
TUIP and TURP are safe and effective.