Does preoperative neutrophil/lymphocyte rate have an effect on survival of the bladder cancer patients who received radical cystectomy?

Introduction

Radical cystectomy (RC) is the standard treatment model in invasive bladder cancer patients. Risk definitions before RC is mainly based on pathological results. Neutrophil/lymphocyte (N/L) rate is one of the inflammation markers. Some other studies reported negative prognostic results with increased N/L rates. In our study, we reviewed the relationship between preoperative N/L rate and clinicopathological results following RC.

Materials and Methods

Data gathered from 296 bladder cancer patients that received RC between 2002 and 2012 were retrospectively reviewed. All patients received preoperative routine hematological and biochemical tests and metastasis screening. All patients were treated with radical cystoprostatectomy and standard pelvic lymph node dissection. The cutoff value for N/L rate was calculated using a web-based "cutoff finder" software.

Results

Patient mean age was calculated as 65.7 years. Mean follow-up period was 24.5 (2-84) months. Cancer-related death was seen in 132 (44.6%) patients. Multivariate analysis showed age, lymph node metastasis, and low N/L rate as significant in cancer-specific survival.

Conclusion

In our study, age, lymph node metastasis presence, and preoperative low N/L rates were detected as independent risk factors in RC cases. N/L rate, which is relatively easy to assess during preoperative period, could be beneficial in planning postoperative adjuvant treatments in those patients.

Evaluation of sex hormones and sperm parameters in male epileptic patients

OBJECTIVES

The aim of this study was to investigate the effect of carbamazepine (CBZ) and sodium valproate (VPA) monotherapy on sexual functions, sex hormones, and semen analysis and quality in male patients with epilepsy.

METHODS

A total of 59 male patients with epilepsy, of which 30 were on VPA monotherapy and 29 were on CBZ monotherapy, were included in the study between January 2015 and March 2016. A control group was established with 30 healthy males. Luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin (PRL), free testosterone (fT), estradiol (E2), sex hormone-binding globulin (SHBG) levels and bioactive testosterone (BAT)/bioactive estradiol (BAE), and BAT/LH ratio were studied in groups. All groups received semen analysis and International Index of Erectile Function Scale (IIEF-5) test for erectile dysfunction.

RESULTS

E2 and DHEAS levels were higher in VPA and CBZ groups compared to control group (P < .001, P = .014). The decrease in fT levels in the VPA group was statistically significant (P = .038). No significant difference was detected in levels of SHBG, LH, and FSH (P > .05). BAT/BAE ratios were low both in VPA and CBZ groups (P < .001; P < .001), while BAT/LH ratios were low only in CBZ group (P = .033). In semen analysis, semen volume and number of normal sperms were found to be significantly lower in patients receiving antiepileptic drugs compared to control group (P < .05). There were no differences between the groups in rates of abnormal sperm morphology. IIEF-5 scores were found to be significantly lower in VPA and CBZ groups (P < .001).

CONCLUSION

VPA or CBZ therapy may lead to dysregulation of sex hormones, sexual dysfunction, and alterations in semen analysis in male patients with epilepsy. This must be considered for the selection of antiepileptic drugs in young male patients.

Does a previous prostate biopsy-related acute bacterial prostatitis affect the results of radical prostatectomy?

OBJECTIVE

To The standard technique for obtaining a histologic diagnosis of prostatic carcinomas is transrectal ultrasound guided prostate biopsy. Acute prostatitis which might develop after prostate biopsy can cause periprostatic inflammation and fibrosis. In this study, we performed a retrospective review of our database to determine whether ABP history might affect the outcome of RP.

MATERIALS AND METHODS

441 RP patients who were operated in our clinic from 2002 to 2014 were included in our study group. All patients' demographic values, PSA levels, biopsy and radical prostatectomy specimen pathology results and their perioperative/postoperative complications were evaluated.

RESULTS

There were 41 patients in patients with acute prostatitis following biopsy and 397 patients that did not develop acute prostatitis. Mean blood loss, transfusion rate and operation period were found to be significantly higher in ABP patients. Hospitalization period and reoperation rates were similar in both groups. However, post-op complications were significantly higher in ABP group.

CONCLUSION

Even though it does not affect oncological outcomes, we would like to warn the surgeons for potential complaints during surgery in ABP patients.

Bladder cancer diagnosis from bladder wash by Fourier transform infrared spectroscopy as a novel test for tumor recurrence

This study proposes Fourier Transform Infrared (FTIR) spectroscopy as a more sensitive, rapid, non-destructive and operator-independent analytical diagnostic method for bladder cancer recurrence from bladder wash than other routinely used urine cytology and cystoscopy methods. A total of 136 patients were recruited. FTIR spectroscopic experiments were carried out as a blind study, the classification results of which were then compared with those of cytology and cystoscopy. Firstly, 71 samples (n = 37; bladder cancer and n = 34; control) were studied with transmittance FTIR spectroscopy. After achieving successful differentiation of the groups, to develop a more rapid diagnostic tool and check the reproducibility of the results, the work was continued with different samples (n = 65 as n = 44; bladder cancer and n = 21; control), using the reflection mode (ATR) of FTIR spectroscopy by a different operator. The results revealed significant alterations in moleculer content in the cancer group. Based on the spectral differences, using transmittance FTIR spectroscopy coupled with chemometrics, the diseased group was successfully differentiated from the control. When only carcinoma group was taken into consideration a sensitivity value of 100% was achieved. Similar results were also obtained by ATR-FTIR spectroscopy. This study shows the power of infrared spectroscopy in the diagnosis of bladder cancer.

Is a second look necessary in multiple and/or large Ta tumors?

Introduction: Most of the bladder cancers are tumors without muscle invasion at the time of diagnosis. Transurethral resection is the standard treatment in bladder tumors without muscle invasion. Proper review of transurethral resection is important for correct risk classification. In this study, our main objective was to show that a “second look” in patients with multiple and/or &gt; 3 cm tumors regardless of T stage during the early term can be helpful in detection of possible residues and determining risk classification. Materials and methods: 156 patients with primary, multiple and/or &gt; 3 cm tumors were included in the study. Patients were divided into 3 groups as Group 1 (Ta), Group 2 (T1 without second TUR) and Group 3 (T1 with second TUR). Macroscopic tumor occurrence rates were compared in their 3rd month control cystoscopy. Results: Macroscopic tumor detection rates in patients’ 3rd month control cystoscopy were 21 (46.7%) in Group 1, 18 (30%) in Group 2 and 4 (7.8%) in Group 3. When compared with Group 3 patients, Group 1 and Group 2 had higher statistically significant macroscopic tumor detection rates (p = 0.001) Conclusion: A second look in patients with multiple and/or &gt; 3 cm tumors during early term will enable the surgeons to detect possible tumors and do a better job in risk classification.

The efficacy of duration of prophylactic antibiotics in transrectal ultrasound guided prostate biopsy

Introduction:

We aimed to evaluate the efficacy of the duration of prophylactic antibiotic administration in patients undergoing transrectal ultrasound (TRUS) guided biopsy.

Material and Methods:

A total of 367 patients undergoing a prostate biopsy between September 2007 and June 2009 was reviewed retrospectively and divided into 2 groups according to prophilaxy: oral ciprofloxacin (750 mg every 12 hours) for 3 or more days in Group-1 and single day in Group-2. Demographic characteristics of patients, symptoms, PSA values, IPSS scores, prostate sizes, pathologic results and complications were compared between the groups.

Results:

The mean age of all patients was 63.92 years and the mean PSA was 13.61ng/ dL. The pre-biopsy mean IPSS score was 12.47 and mean prostate volume 52.53 mL. For 78.2% of patients the current biopsy was their first biopsy. Cancer detection rate was 24.2%. Fever was observed in 3 (1.2%) patients in Group-1 and 5 (4.0%) patients in Group-2. Local infections occurred in 2 (0.8%) and 1 (0.8%) patients respectively in Groups 1 and 2. Acute prostatitis was observed in only 1 (0.8%) patient in Group-2. Accepted after revision: None of the patients developed septicemia or other serious infection. There was no statistically significant difference in terms of fever, local infections (epididimitis, orchitis, etc.) and acute prostatitis.

Conclusions:

In a selected patient population single dose prophylaxis with ciprofloxacin can be safely administered compared to other regimens of 3 or more days. Increasing the duration of antibiotic prophylaxis does not decrease infectious complications.

Percutaneous nephrolithotomy with one-shot dilation method: Is it safe in patients who had open surgery before?

INTRODUCTION

This study aimed to evaluate whether one-shot dilatation technique is as safe in patients with a history of open-stone surgery as it is in patients without previous open-stone surgery.

METHODS

Between January 2007 and February 2015, 82 patients who underwent percutaneous nephrolithotomy (PNL) surgery with one-shot dilation technique who previously had open-stone surgery were retrospectively reviewed and evaluated (Group 1). Another 82 patients were selected randomly among patients who had PNL with one-shot dilation technique, but with no history of open renal surgery (Group 2). Age, gender, type of kidney stone, duration of surgery, radiation exposure time, and whether or not there was any bleeding requiring perioperative and postoperative transfusion were noted for each patient.

RESULTS

The stone-free rates, operation and fluoroscopy time, and peroperative and postoperative complication rates were similar in both groups (p>0.05).

CONCLUSIONS

Our experience indicated that PNL with one-shot dilation technique is a reliable method in patients with a history of open-stone surgery.

C-reactive protein levels in girls with lower urinary tract symptoms

INTRODUCTION

Daytime lower urinary tract (LUT) conditions are identified as daytime incontinence problems for children in whom any cause of neuropathy and uropathy has been excluded. C-reactive protein (CRP) is a common marker of acute or chronic inflammation and infection. Increased CRP levels have been detected in the studies conducted on adults diagnosed with overactive bladders and interstitial cystitis.

OBJECTIVE

This study aimed to investigate the role of serum CRP levels in girls suffering from daytime LUT conditions.

STUDY DESIGN

Out of the 752 patients who presented to the outpatient clinics with lower urinary tract symptoms, 709 were excluded due to: being boys, having previous urinary tract surgery, an active urinary tract infection, a neurological anomaly, a urinary system anomaly, having rheumatic disease, any chronic disease, any febrile infection over the past week, a history of constipation, and enuresis nocturna. Forty-three girls with LUT conditions and aged 8-10 years were included in the study as the patient group. Forty girls who attended the urology outpatient clinic without LUT conditions, or active urinary tract infections and any chronic disease requiring follow-up constituted the control group. Under the control of the parents, all subjects were asked to fill out 3-day voiding diaries. The voiding diaries identified frequency, urgency, urgency urinary incontinence, and functional bladder capacity data. All subjects also completed a dysfunctional voiding scoring system (DVSS). The serum CRP levels of all subjects were measured.

RESULTS

There was a significant difference in serum CRP levels and DVSS between the patient group and the control group (P = 0.001, P = 0.001). The mean serum CRP levels showed a significant increase when frequency and urgency scores were ≥8, the urge incontinence score was ≥2 and the DVS score DVSS was ≥14 in the voiding diaries of the patient group (Table).

DISCUSSION

Lower urinary tract dysfunction is defined as a condition involving abnormalities of filling and/or emptying of the bladder. This frequently encountered problem constitutes >40% of all pediatric urology outpatient visits. The relationship between LUT conditions and serum CRP in both genders has been detected. However, it is believed that to our knowledge, this is the first study looking at the relationship between daytime LUTS and increased CRP levels in children. The most important limitations of the study were: having a small number of patients, and the sample consisting of only one gender and a specific age group.

CONCLUSION

The serum CRP levels were significantly higher in the girls with daytime LUT conditions than in the control group. Also, the CRP levels significantly increased as DVSS, frequency, urgency, and urge incontinence scores increased.

Predictive factors for biochemical recurrence in radical prostatectomy patients

Introduction

Radical prostatectomy (RP) is considered the best treatment for the management of localized prostate cancer in patients with life expectancy over 10 years. However, a complete recovery is not guaranteed for all patients who received/underwent RP treatment. Biochemical recurrence is frequently observed during the post-operative follow-up period. The main objective in this study is to evaluate the predictive factors of biochemical recurrence in localized prostate cancer patients who underwent RP surgery

Material and methods

The study included 352 patients with prostate cancer treated by RP at a single institution between February 2004 and June 2014. Detailed pathological and follow-up data of all patients were obtained and analyzed to determine the results.

Results

Mean follow-up duration was 39.7 months. 83 patients (23%) experienced biochemical recurrence (BCR) during the follow-up period. Mean BCR duration range was 6.56 (1–41) months. In multivariate logistic regression analysis, Gleason score (GS), PSA and extra-capsular tumour spread (ECS) variables were found to be statistically significant as BCR predictive factors.

Conclusions

According to our study results, it is thought that PSA, GS and ECS can all be used for guidance in choosing a treatment modality for post-RP biochemical recurrence and metastatic disease as predictive factors. However, there is no consensus in this matter and it is still debated.

Results of Intravesical Chemo-Hyperthermia in High-risk Non-muscle Invasive Bladder Cancer

PURPOSE

To examine the effectiveness of mitomycin-C and chemo-hyperthermia in combination for patients with high-risk non-muscle-invasive bladder cancer.

MATERIALS AND METHODS

Between November 2011-September 2013, 43 patients with high-risk non-muscle-invasive bladder cancer undergoing adjuvant chemo-hyperthermia in two centers were evaluated retrospectively. Treatment consisted of 6 weekly sessions, followed by 6 sessions. Recurrence and progression rate, recurrence-free interval and side effects were examined. Analyzed factors included age, gender, smoking status, AB0 blood group, body mass index, T stage and grade, concominant CIS assets. The associations between predictors and recurrence were assessed using multivariate Cox proportional hazard analyses.

RESULTS

A total of 40 patients completed induction therapy. Thirteen (32.5%) were diagnosed with tumor recurrence. Median follow-up was 30 months (range 9-39). Median recurrence-free survival was 23 months (range 6-36). The Kaplan-Meier-estimated recurrence-free rates for the entire group at 12 and 24 months were 82% and 61%. There was no statistically significant difference between patient subgroups. Cox hazard analyses showed that an A blood type (OR=6.23, p=0.031) was an independent predictor of recurrence- free. Adverse effects were seen in 53% of patients and these were frequently grades 1 and 2.

CONCLUSIONS

Intravesical therapy with combination of mitomycin-C and chemohyperthermia seems to be appropriate in high-risk patients with non-muscle-invasive bladder cancer who cannot tolerate or have contraindications for standard BCG therapy.

Renal cell carcinoma in patient with crossed fused renal ectopia

Primary renal cell carcinomas have rarely been reported in patients with crossed fused renal ectopia. We presented a patient with right to left crossed fused kidney harbouring renal tumor. The most frequent tumor encountered in crossed fused renal ectopia is renal cell carcinoma. In this case, partial nephrectomy was performed which pave way to preservation of the uninvolved both renal units. Due to unpredictable anatomy, careful preoperative planning and meticulous delineation of renal vasculature is essential for preservation of the uninvolved renal units.

The factors predicting biochemical recurrence in patients with radical prostatectomy

OBJECTIVE

The main objective of this study was to evaluate the factors predicting recurrence in patients who underwent radical prostatectomy (RP) for localized prostate cancer.

MATERIALS AND METHODS

A total of 275 patients who underwent RP between 2000 and 2012 years in our clinic were evaluated retrospectively and 238 patients who met our criteria were included in the study. The effect of PSA values at diagnosis in addition the histopathological variables on the risk of recurrence was evaluated. Biochemical recurrence (BCR) is defined as "an increase of &gt; 0.2 ng/ml or more in the serum total PSA count". The statistical analysis of this study was done using SPSS for Windows Version 15.0 package program. Values below p &lt; 0.05 are accepted as statistically significant.

RESULTS

The mean follow up, age and PSA of patients were 37,2 months, 66,01 ± 6,85 years and 11,12 ng/ml, respectively. BCR rate was 28% (68/238). Univariate analysis revealed that PSA levels during initial diagnosis (p &lt; 0.0001), Gleason score (GS) (p &lt; 0.0001), prostatic capsule involvement (p &lt; 0.005), extracapsular extension (p = 0.0001), seminal vesicle involvement (p &lt; 0.003) and surgical margin positivity (p &lt; 0.014) were significant factors in predicting recurrence, while multivariate analysis showed that PSA at initial diagnosis (p = 0.002) and GS (p = 0.003) were independent prognostic factors. PSA &gt; 10 ng/ml and Gleason score &gt; 7 are considered as the risk factors for BCR.

CONCLUSION

Our study results showed that PSA value during initial diagnosis as well as Gleason score were independent factors in predicting BCR following radical prostatectomy.

Prospective comparison of ligation and bipolar cautery technique in non-scalpel vasectomy

OBJECTIVES

There is no trial comparing bipolar cautery and ligation for occlusion of vas in non-scalpel vasectomy. This study aimed to compare the effectiveness of these vasectomy occlusion techniques.

MATERIALS AND METHODS

Between January 2002-June 2009, patients were allocated in alternate order. We recruited 100 cases in cautery group and 100 cases in ligation group. Non-scalpel approach was performed during vasectomy and fascial interposition was performed in all cases. First semen analysis was done 3 months after vasectomy. Vasectomy success was defined as azoospermia or non-motile sperm lower than 100.000/mL.

RESULTS

Four patients from the cautery group were switched to the ligation group due to technical problem of cautery device. Thus, data of 96 patients as cautery group and 104 patients as ligation group were evaluated. After vasectomy, semen analyses were obtained from 59 of 96 (61.5%) patients in cautery group and to 66 of 104 (63.5%) patients in ligation group. There was no statistical significant difference between the two groups in terms of the success of vasectomy (p=0.863).

CONCLUSION

Although bipolar cautery technique is safe, effective and feasible in non-scalpel vasectomy, it has no superiority to ligation. There was no statistically significant difference in terms of the success and complications between the two groups.

Prostate cancer volume estimations based on transrectal ultrasonography-guided biopsy in order to predict clinically significant prostate cancer

INTRODUCTION

Tumor diameter is a reliable parameter to estimate tumor volume in solid organ cancers; its use in prostate cancer is controversial since it exhibits a more irregular pattern of growth. This study aimed to examine the association between the tumor volume estimations based on transrectal ultrasound (TRUS) guided biopsy results and the tumor volume measured on the pathological specimen.

MATERIALS AND METHODS

A total of 237 patients who underwent radical retropubic prostatectomy (RRP) were included in this retrospective study. The differences and correlations between cancer volume estimations based on TRUS guided biopsy findings and cancer volume estimations based on post-prostatectomy pathology specimens were examined. In addition, diagnostic value of TRUS guided biopsy-based volume estimations in order to predict clinically significant cancer (>0.5 cc) were calculated.

RESULTS

The mean cancer volume estimated using TRUS biopsy results was lower (5.5±6.5 cc) than the mean cancer volume calculated using prostatectomy specimens (6.4±7.6 cc) (p<0.041).TRUS guided biopsy examination resulted in 5 false positive and 15 false negative cases. There was a significant but weak correlation between the two parameters (r=0.62, p<0.001). The sensitivity and specificity of TRUS guided biopsy in predicting the presence of clinically significant cancer was 93.4% (95% CI, 89.1-96.1) and 50.0% (95% CI, 20.1-79.9), respectively.

CONCLUSIONS

TRUS guided biopsy-derived estimations seem to have a limited value to predict pathologically established tumor volume. Further studies are warranted to identify additional methods that may more accurately predict actual pathological characteristics and prognosis of prostate cancer.

Visceral obesity: A new risk factor for stone disease

INTRODUCTION

We examined the relationship between stone disease and the amount of visceral adipose tissue measured with unenhanced computed tomography (CT).

METHODS

We included 149 patients with complaints of flank pain and kidney stones detected by CT, from August 2012 to April 2013. In addition, as the control group we included 139 healthy individuals, with flank pain within the same time period, with no previous history of urological disease and no current kidney stones identified by CT. Patients were analyzed for age, gender, body mass index, amount of visceral and subcutaneous adipose tissue, and serum level of low-density lipoprotein and triglyceride.

RESULTS

There were no differences between groups in terms of gender and age (p = 0.27 and 0.06, respectively). Respective measurements for the stone and control groups for body mass index were 29.1 and 27.6 kg/m(2); for visceral fat measurement 186.0 and 120.2 cm(2); and for subcutaneous fat measurements 275.9 and 261.9 cm(2) (p = 0.01; 0.01 and 0.36, respectively). Using multivariate analysis, the following factors were identified as increasing the risk of kidney stone formation: hyperlipidemia (p = 0.003), hypertension (p = 0.001), and ratio of visceral fat tissue to subcutaneous fat tissue (p = 0.01). Our study has its limitations, including its retrospective nature, its small sample size, possible selection bias, and missing data. The lack of stone composition data is another major limitation of our study.

CONCLUSION

The ratio of visceral to subcutaneous adipose tissue, in addition to obesity, hyperlipidemia, and hypertension, was identified as an emerging factor in the formation of kidney stones.

Factors determining biochemical recurrence in low-risk prostate cancer patients who underwent radical prostatectomy

OBJECTIVE

This study was conducted to research the factors determining biochemical recurrence (BCR) in low-risk localized prostate cancer patients who underwent radical prostatectomy (RP).

MATERIALS AND METHODS

We retrospectively analyzed the data of 504 patients who had undergone RP between 2003 and 2013 at our clinic. One hundred and fifty-two patients who underwent RP for low-risk prostate cancer were included in the study.

RESULTS

The mean follow-up period for patients was 58.7 (21-229) months. The mean age of the patients was 63.7±7.2 years (49-79). The mean prostate specific antigen (PSA) value was 5.25±4.22 ng/mL (3.58-9.45). The BCR rate after the operation was 25% (38/152). In the univariate analysis, recurrence determining factors were shown to include extracapsular involvement (ECI) (p=0.004), capsular invasion (CI) (p=0.001), age (p=0.014), and tumor size (p=0.006). However, only CI was found to be significant in multivariate analysis (p=0.001).

CONCLUSION

Capsular invasion is an independent risk factor in low-risk prostate cancer patients who underwent RP for BCR.

Our percutaneous nephrolitotomy experience in patients with horseshoe kidney

OBJECTIVES

Horseshoe kidney is the most common renal congenital fusion anomaly. Kidney stone formation is more common in horseshoe kidneys and some of them requires surgical procedure. So we want to evaluate the results of PNL in patients with horseshoe kidney anomaly.

MATERIAL AND METHOD

Between January 2009-January 2014 PNL operation was performed in 6 patients with horseshoe kidney anomaly in our clinic. Success of surgery and postoperative/peroperative complications were evaluated retrospectively.

RESULTS

No severe complications occurred in any patient caused by surgery. Three patients became stonefree. One patient had less than 4 mm. residual stone, two patients had more than 4 mm. residual stone.

CONCLUSION

PNL is safe surgical method and it can be performed successfully in patients with horseshoe kidney anomaly.

Primary squamous cell carcinoma of the urethral diverticulum mimicking prostate cancer: Case report and review of the literature

Primary urethral carcinomas are uncommon, with urothelial carcinoma as the most common subtype. Urethral diverticulum is also rarely seen in men. A 44-year-old male presented with voiding symptoms. Abdominoperineal resection, prostatectomy, bladder neck excision, and proximal urethral excision were performed. A pathological examination revealed a well-differentiated squamous cell carcinoma (SCC) located inside an urethral diverticulum. We report this unusual case because primary SCC of the male urethral diverticulum is extremely rare. To our knowledge, our patient is only the second reported case.

Intravesical bacillus Calmette-Guérin versus chemohyperthermia for high-risk non-muscle-invasive bladder cancer

INTRODUCTION

Patients with high-risk non-muscle invasive bladder cancer (NMIBC) need adjuvant intravesical treatment after surgery. Although bacillus Calmette-Guérin (BCG) is highly effective, new adjuvant treatments to decrease recurrences and toxicity have been studies. We performed a retrospective propensity score-matched study to compare the efficacy of BCG and chemohyperthermia (C-HT).

METHODS

We included 1937 patients diagnosed with bladder cancer between January 2004 and January 2014. The primary efficacy endpoint was recurrence-free interval. Patients treated with C-HT were matched with patients treated with BCG using propensity score-matched analysis. Cox-regression models were used to estimate the association between intravesical treatments and the presence of recurrence and progression.

RESULTS

Of the 710 patients treated with intravesical treatments, 40 and 142 were eligible for inclusion in C-HT and BCG groups, respectively. Following case matching, there were no differences in patient or tumour characteristics between treatment groups. The 2-year recurrence-free interval in C-HT and BCG groups were 76.2% and 93.9%, respectively (p = 0.020). C-HT treatment (hazard ratio [HR] 5.42; 95% confidence interval [CI] 1.11-26.43; p = 0.036) and high-grade tumour (HR 4.60; 95% CI 1.01-20.88; p = 0.048) are associated with an elevated odds of tumour recurrence. In multivariate Cox-regression analysis, there was no significant difference between C-HT and BCG in the odds of recurrence (p = 0.054). There were no differences in progression between C-HT and BCG.

CONCLUSION

C-HT is not as effective treatment as BCG in high-risk NMIBC patients who are BCG-naive. Although, there were no significant difference in the odds of recurrence, recurrence-free interval is significantly improved by the administration of BCG.

Anterior apical cores in the initial prostate biopsy does not increase detection of significant prostate cancer

PURPOSE

To examine the effect of routine sampling anterior apical cores in the initial prostate biopsy among patients that 14-cores of prostate biopsy (PB) planned.

MATERIALS AND METHODS

Five-hundred twenty-eight patients with increased prostate-specific antigen (PSA) levels and/or abnormal digital rectal examination underwent transrectal ultrasound and initial PB between November 2012 and October 2013. We performed routine 12-cores extended PB, plus 2 anterior apex samples that were taken from the junction of urethra and apex of the prostate. Site-specific and unique cancer detection rate, tumor characteristics, the presence of clinically insignificant prostate cancer (PCa) (clinical stage ≤ T1, serum PSA level of < 10 ng/mL, biopsy Gleason score ≤ 6, number of positive biopsy cores ≤ 3 and no core with > 50% involvement) and biopsy-related pain were evaluated.

RESULTS

PCa was detected in 147 of 451 patients (32.6%). The lateral base of the prostate was the most affected area with 128 of 451 patients (28.3%), followed by unique cancer detection, with 17 of 40 patients (43.5%). Anterior apex (n = 6) was in third place after the lateral apex (n = 8). The patients diagnosed by anterior apex cores were all clinically insignificant PCa. The cancer diagnosis rate would be 31% if 12-cores biopsy was used, but the rate was found to be 32.6% in 14-cores biopsy (P = .016). Average biopsy pain, right anterior apex biopsy pain, and left anterior apex biopsy pain were found to register at 0.61, 1.06 and 1.08 points in the visual analog scale pain score, respectively. When right and left anterior apex biopsy pain is compared to average biopsy pain, the pain level was found to be statistically significantly higher in the biopsies of right and left anterior apex (P = .040 and P = .042, respectively).

CONCLUSION

The gold standard for the diagnosis of PCa is at least 8 cores PB. According to our results, although most PCa diagnosis is carried out with 14-cores PB, it should not be forgotten that these patients might have clinically insignificant PCa.

Toilet training age and influencing factors: a multicenter study

To determine toilet training age and the factors influencing this in our country, 1500 children who had completed toilet training were evaluated in a multicenter study. The mean age of toilet training was 22.32 ± 6.57 months. The duration it took to complete toilet training was 6.60 ± 2.20 months on the average. In univariant analysis, toilet training age increased as the parental education level, specifically that of the mother, increased. The training age of children whose mothers had over 12 years of education differed significantly from that of children of mothers with less education. There was no significant difference in toilet training age with regard to the education level of the father, or the employment status of the mother. We also found significant differences with respect to family income level, toilet type and training method. In multivariant analysis, family income >5000 TL and use of a potty chair were determined to be factors affecting toilet training age. In conclusion, toilet training age in Turkey, a developing country, was found to be lower than that in developed countries.

Robotic Stereotactic Body Radiation Therapy in Patients With Recurrent or Metastatic Abdominopelvic Tumors: A Single Institute Experience

BACKGROUND

The aim of this study was to evaluate the efficacy and toxicity of robotic CyberKnife (Accuray Incorporated, Sunnyvale, California)-based stereotactic body radiation therapy (SBRT) in patients with recurrent or metastatic abdominopelvic tumors.

METHODS AND MATERIALS

A total of 69 patients treated between May 2008 and January 2011 were evaluated retrospectively. Indication for SBRT was persistent disease in 3 (4%) patients, local recurrence in 29 (42%) patients, regional recurrence in 13 (19%) patients, and oligometastatic disease in 24 (35%) patients. Forty-two (61%) patients were previously irradiated to the same region and 27 (39%) patients were treated for the first time. The median age was 59 years (range, 24-86 years). There were 31 (45%) male and 38 (55%) female patients. The median total dose was 30 Gy (range, 15-60 Gy) delivered with a median 3 fractions (range, 2-5 fractions). The tumor response to treatment was assessed by computed tomography, magnetic resonance imaging, or positron emission tomography.

RESULTS

At the 12-month (range, 2-44 months) median follow-up, local control was 65% and median overall survival (OS) was 20 months. A larger gross tumor volume (≥ 67 cm(3)) was significantly correlated with worse 1-year OS (81% vs 48%, P = .03). The patients with local recurrence occurring <11 months had a significantly shorter 1-year local control rate than patients with ≥ 11 months (31% vs 91%, P < .001). Grade 3-4 acute and late toxicities were seen in 7% and 15% of patients, respectively. The patients with previous radiotherapy history had significantly higher rate of acute toxicity (19% vs 0%, P = .019). Late toxicity was significantly higher in pelvic tumors than in abdominal tumors (3% vs 28%, P = .004).

CONCLUSION

The SBRT seems to be feasible and resulted in good treatment outcomes in patients with recurrent or metastatic abdominopelvic tumors.

Castleman's disease imitating adrenal mass in the retroperitoneal area

Castleman's disease (CD) is a non-clonal lymph node hyperplasia, mostly seen in the mediastinum. It has various clinical and pathological outcomes. There are different treatments because of its rare occurance and heterogenity. We present 2 cases which were referred to our clinic as retroperitoneal mass and diagnosed as CD after surgical resection.

The effect of video-based education on patient anxiety in men undergoing transrectal prostate biopsy

INTRODUCTION

We assess the effect of video-based education on patient anxiety during transrectal prostate biopsy.

METHODS

A total of 246 patients who underwent transrectal prostate biopsy were prospectively enrolled in the study. Group 1 included 123 patients who received both written and video-based education, while Group 2 included 123 patients who received only written instructions regarding prostate biopsies. State-Trait Anxiety Inventory (STAI) was used to assess state and trait anxiety (STAI-S/T) After completing the STAI-S and STAI-T questionnaires, all patients in Group 1 received written information and video-based education and they again completed STAI-S before the biopsy. On the contrary, after completing the STAI-S and STAI-T questionnaires, the patients in Group 2 received only written information and then they completed the STAI-S before the biopsy. Moreover, a visual analog scale (VAS) was used to assess pain scores during digital rectal examination, probe insertion, periprostatic local anesthesic infiltration, and biopsy.

RESULTS

No difference was noted between 2 groups regarding VAS scores. Comparing the 2 groups on baseline anxiety, we found that trait anxiety scores (STAI-T) were similar (p = 0.238). Pre-information STAI-S scores were similar in both groups (p = 0.889) and they both indicated high anxiety levels (score ≥42). While post-information STAI-S scores remained high in Group 2, post-information STAI-S scores significantly decreased in Group 1 (p = 0.01).

CONCLUSIONS

Undergoing a prostate biopsy is stressful and may cause anxiety for patients. Video-based education about the procedure can diminish patient anxiety.

Fractionated stereotactic radiosurgery treatment results for skull base chordomas

Chordomas are uncommon neoplasms and there is still controversy regarding establishment of diagnosis and management. The aim of this study was to evaluate efficacy and toxicity of fractionated stereotactic radiosurgery (FSRS) in skull base chordomas. There were 4 female (36%) and 7 male (64%) patients. FSRS was delivered with CyberKnife (Accuray Inc., Sunnyvale, CA). The median tumor volume was 14.7 cc (range, 3.9-40.5 cc). The median marginal tumor dose was 30 Gy (range, 20-36 Gy) in a median 5 fractions (range, 3-5 fractions). The median follow-up time was 42 months (range, 17-63 months). At the time of analysis, 10 (91%) patients were alive and 1 (9%) had died due to tumor progression. Of 10 patients, 8 (73%) had stable disease and the remaining 2 (18%) had progressive disease. The actuarial overall survival (OS) after FSRS was 91% at two-years. Two patients developed radiation-induced brain necrosis as a complication in the 8th and 28th months of follow-up, respectively. Our results with robotic FSRS in skull base chordomas are promising for selected patients. However, due to the slow growth pattern of skull base chordomas, a longer follow-up is required to determine exact treatment results and late morbidity.