Characteristics of the Patients Aged Less than 40 Years Operated for a Renal Mass

The incidence of renal cell cancer (RCC) is low in individuals aged less than 40 years; however several studies have shown this increasing trend over the years. Hereditary syndromes are associated with RCC and are more frequently observed in early-onset cases. In this study, we investigated the characteristics of the patients, aged less than 40 years, who were operated for a renal mass with the suspicion of RCC. We analyzed patients aged <40 years who underwent partial or radical nephrectomy between January 2012 and December 2022. A total of 618 patients underwent partial or radical nephrectomy and 60 (9.7%) patients were aged <40 years. A total of 62 renal masses were resected. The median age of the patients was 34 (31.75-38) years. RCC was detected in 50 (80.6%) lesions, while 12 (19.4%) lesions were benign. The most commonly observed benign tumors were oncocytoma and multicystic nephroma. Low-stage RCC (stage 1) was detected in 78% of patients. Recurrence was observed in two patients and both had von Hippel-Landau gene mutation. During follow-up, two patients were found to have lung metastasis, while another patient had bone metastasis. Three patients died during the follow-up period. Disease free survival rate was 89.58% and cancer specific survival rate was 93.88%. The incidences of kidney cancer in young adults are increasing; therefore, early discovery and the diagnosis are important. Further research is required to gain a better understanding.

C-reactive protein and procalcitonin levels in prostate cancer

AIM

Prostate cancer (PCa) is one of the most common cancers among men in the world. Prostate-specific antigen is the most used biomarker for PCa diagnosis. In this study, we aimed to measure the procalcitonin (PCT) and C-reactive protein (CRP) levels in patients with PCa.

METHODS

The patients who underwent transrectal prostate biopsy and transurethral prostate surgery in the last 4 years were included in the study. The patients were divided into two groups according to the pathology reports, group1; benign prostate hyperplasia and group2; prostate cancer. MedCalc Statistical Software version 17.6 was used for statistical analyses.

RESULTS

The current study includes 149 patients. There were 118 patients in group 1 and 31 patients in group 2. The mean age of the patients was 66.85 and 69.41 years in groups respectively. Serum CRP and PCT levels were 3.33 and 0.01 in group 4.07 and 0.04 in group 2. Serum PCT levels were significantly higher in patients with PCa.

CONCLUSION

We found that the elevated procalcitonin level was associated with prostate cancer. Further studies are needed to define the relationship between procalcitonin and prostate cancer.

The optimal settings of holmium YAG laser in treatment of pediatric urolithiasis

The aim of this study is to present our experience on the use of the holmium:yttrium-aluminum-garnet (Ho:YAG) laser in pediatric patients for pediatric urolithiasis and describe the optimal settings. A total of 116 children who underwent urolithiasis treatment (percutaneous nephrolithotomy (PNL), ureterorenoscopy (URS), retrograde intrarenal surgery (RIRS)) were included. The mean age of the patients was 8.4 ± 5.2 years (1-18). The mean follow-up was 26 ± 8.8 months (9-45). There was no difference between the mean stone sizes of PNL and RIRS patients (p = 0.816). Operations were performed with 200, 272, and 365-μm fibers. In mini-URS, stone fragmentation was achieved with the energy settings set between 0.5 and 1 J and frequency set to > 8 Hz. In RIRS, fragmentation was achieved with the setting of 0.5-0.8 J at 10-20 Hz. Stone fragmentation was performed with energy settings of 0.8 to 2 J between 5 and 15 Hz for PNL. There was no significant difference between the stone-free rates of the PNL and RIRS (p = 0.150). Four postoperative complications occurred (Clavien II), which included febrile urinary infections in two patients who underwent mini-URS, one patient who underwent PNL, and one patient who underwent RIRS. Our results confirmed that Ho-YAG laser can be effectively used in children for stone treatment by using low-energy high-frequency settings for URS and RIRS and a high energy setting for PNL.

Efficacy of varicocelectomy in primary infertile patients with isolated teratozoospermia. A retrospective analysis

The present study assessed the results of varicocelectomy in patients with isolated teratozoospermia. Sixty-two infertile men with isolated teratozoospermia were evaluated retrospectively. There were significant improvements between preoperative and postoperative mean percentages of spermatozoa with normal morphology (1.15 ± 1.1% versus 2.3 ± 1.8%, p < .001) and spermatozoa with head abnormalities (92.9 ± 4.5% versus 88.6 ± 7.4%, p < .001). Nineteen (31%) patients had children through natural conception, 4 (6%) patients had children with assisted reproductive techniques and 39 (63%) patients had got no children within a mean follow-up period of 31.3 months. In patients who had children with natural conception, significant improvements were detected in postoperative mean percentages of spermatozoa with normal morphology (p < .001), head abnormalities (p < .001), neck/midpiece abnormalities (p = .003) and tail abnormalities (p = .007). When semen parameters of men who had children via natural conception was compared with the men with no children, we found that the percentage of spermatozoa with normal morphology was significantly higher (p = .008) and percentage of spermaztozoa with head anomalies was significantly lower (p = .019) in men who had children via natural conception. We believe that varicocelectomy is a beneficial surgical method for the treatment of isolated teratozoospermia and better postoperative rates of spermatozoa having normal morphology and head abnormalities are related with natural conception.

The relationship of neutrophil to lymphocyte ratio with testicular cancer

Purpose:

To assess the relationship between testicular germ cell tumors (TGCT) and neutrophil to lymphocyte ratio (NLR) and to determine whether this ratio can be used as a serum tumor marker.

Material and Methods:

Sixty-one patients with testicular germ cell tumors were included into the study. Patients were grouped as localized and non-localized. Histologically patients were categorized as seminoma and nonseminomatous germ cell tumors. Complete blood cell count was measured the day before surgery and at the postoperative 1st month. Preoperative and postoperative mean NLR values were compared.

Results:

Thirty-six patients (59%) had seminomas and 25 patients (41%) had nonseminomatous testicular cancer. Forty-five patients (73.8%) had localized and 16 patients (26.2%) had non-localized testicular cancer. There was a statistically significant difference between preoperative and postoperative mean NLR of the localized patients (p=0.001) but no such difference was detected for non-localized patients (p=0.576). Nineteen patients with localized seminomas had normal preoperative serum tumor markers. There was a significant difference between preoperative and postoperative mean NLR in this group of patients (p=0.010). Twenty-six patients with localized tumors had preoperative increased serum tumor markers which normalized after orchiectomy. Mean NLR of these patients significantly decreased from 3.10±2.13 to 1.62±0.59 postoperatively (p=0.010).

Conclusions:

NLR appears to be a useful marker for TGCT. It is successful in predicting localized and non-localized disease in early postoperative period.

Bibliometric and Comparative Analysis of Castration Resistant and Refractory, Hormone Resistant and Refractory Prostate Cancer Publications

INTRODUCTION

Prostate cancer is one of the most common cancer among men in the world. Radical prostatectomy is the gold standard treatment for localized prostate cancer but advanced diseases are treated with hormonal therapy. Unfortunately, this treatment is not curative and approximately after 2 years, castration resistant prostate cancer occurs. In this study we aimed to investigate the terminology of castration resistant and refractory, hormone resistant and refractory articles on Web of Science database.

MATERIALS AND METHODS

We searched the articles in the title section such as castration resistant prostate cancer, castration refractory prostate cancer, hormone resistant prostate cancer and hormone refractory prostate cancer between 1975 and 2018. Categories, publication years, document types, authors, countries, funding agencies and citation reports were recorded in 4 groups.

RESULTS

There were 6733 articles in the system. Most of the articles (72.16%) were published as using castration resistant title. The United States of America and Italy were in the top 5 countries in 4 titles. Oncology and urology nephrology categories consisted more than 80% of the articles. Of these articles, only 1745 (26%) articles had funding agency.

DISCUSSION

Different terminology can be used in some diseases. One of these diseases is castration resistant prostate cancer which is referred to different terms such as castration refractory, hormone resistant and refractory. In this study we searched the literature and discussed the results.

CONCLUSION

Castration resistant prostate cancer is a serious health problem for clinicians and patients. If international associations, journals and authors use the same terminology, the articles can be published without different titles in the literature.

Impaired Elasticity of Aorta in Patients with Erectile Dysfunction

OBJECTIVES

The close relationship between the elasticity of the aorta and cardiovascular disease has aroused the interest of investigators in performing studies related to aortic stiffness parameters. We investigated the aortic stiffness parameters in patients with erectile dysfunction (ED) without known cardiovascular disease and diabetes were investigated.

METHODS

The study included 40 men with ED (aged 56 +/- 8 years) according to the Doppler penile ultrasound findings and the five-item version of the International Index of Erectile Function score (group 1) and 25 healthy men (aged 53 +/- 5 years; group 2) underwent fasting serum glucose and lipid level determination. Echocardiography (using a 3.75-MHz transducer) and exercise treadmill test were performed. The diameter change, pulse pressure, aortic strain index, and distensibility index as aortic stiffness parameters were investigated in patients with ED and compared with those of healthy subjects.

RESULTS

The average International Index of Erectile Function-5 score of those with ED (group 1) and the control groups (group 2) was 11.2 and 23.2, respectively. Body mass index, age, fasting serum glucose, and lipid profile were not significantly different between the two groups. All patients had negative results on the exercise stress test; and the echocardiography parameters were similar. The percentage of aortic strain (group 1, 4.64 +/- 2.43 versus group 2, 10.21 +/- 5.13, P = 0.021) and the value of the distensibility index (group 1, 0.21 +/- 0.15 versus group 2, 0.51 +/- 0.20 cm2/dyn/10(-3), P <0.001 were significantly lower in the ED group than were those of the control group.

CONCLUSIONS

The results of our study have shown that the aortic strain index and distensibility index are impaired in patients with ED. This suggests that ED is a generalized vessel disease rather than a disorder peculiar to the penile arteries.

The long-term results of transurethral vaporization of the prostate using plasmakinetic energy

OBJECTIVE

To assess the long-term efficacy and the safety of plasmakinetic vaporization of prostate (PKVP, Gyrus Medical Ltd., Bucks, UK) against standard transurethral resection of the prostate (TURP) for symptomatic prostatic obstruction.

PATIENTS AND METHODS

Of 75 patients admitted to our clinic with symptomatic prostatic obstruction between 2001 and 2003, 40 who were randomized to undergo either TURP or PKVP, and who had returned for the follow-up, were included in this study. All treated patients completed the 36-months of follow-up; 25 had had PKVP and 15 a standard TURP. After surgery the treatment outcome was evaluated using the International Prostate Symptom Score (IPSS), maximum urinary flow rate (Q(max)) and long-term complications of surgery.

RESULTS

The two groups had similar baseline characteristics. The improvement in both groups was statistically significant for the IPSS and Q(max) at 24 and 36 months vs the baseline values (P < 0.05). The mean (sd) IPSS decreased from 21 (3.4) to 7.1 (1.5) and 7.6 (1.4) after PKVP and from 22 (3.8) to 5.2 (1.1) and 5.7 (1.2) after TURP, at 24 and 36 months, respectively. The mean Q(max) for the both groups increased significantly from baseline values at 2 and 3 years, respectively, at 20.8 (2.4) and 21.8 (3.1) mL/s after TURP, which was statistically significantly better than after PKVP, at 12.5 (2.1) and 14.4 (2.6) mL/s, respectively (P < 0.05). Although three patients (12%) in the PKVP group had TURP at 14, 20 and 36 months, respectively, for residual adenoma tissue, one patient had an additional operation after TURP. Bulbar urethral strictures occurred in one patient in each group, requiring internal optical urethrotomy. Erectile dysfunction was reported by three patients after PKVP (12%) and by two of 15 after TURP who were potent before surgery (P > 0.05). The retrograde ejaculation rates in patients with erectile function were similar in both groups (56% and nine of 15, respectively; P > 0.05). In the PKVP and TURP groups, 12 (48%) and nine of 15 patients were satisfied overall.

CONCLUSIONS

Although early results showed that PKVP was a good alternative technique among the minimally invasive methods for surgically managing prostatic obstruction, the clinical outcome of PKVP in the long term was not comparable to the results after TURP.

Value of Urinary Flow Patterns in the Follow-Up of Children Who Underwent Snodgrass Operation

The urinary flow patterns and the Toguri nomogram were compared in the intermediate functional results of the tubularized-incised plate urethroplasty (TIPU) to repair distal and midpenile hypospadias by using uroflowmetry. 28 children who were toilet trained, were able to void volitionally, and had no fistulas following hypospadias repair were eligible for the study. The study did not include children who had persistent fistula, meatal stenosis or urethral stricture, and did not return for follow-up. The mean age was 8.4 years and the mean follow-up period was 18 months. The urinary flow pattern, maximum (Q(max)) and average flow rate (Q(ave)) were measured; the results were expressed as percentiles and compared to the Toguri values from normal children. The Q(max) and Q(ave) were considered normal if they were in >25th percentile, equivocally obstructed in the 5-25th percentile and obstructed if <5th percentile. The flow pattern was classified as bell ring shape, plateau or intermittent. According to the Toguri nomogram, 22 of 28 patients (78.5%) were considered normal, 4 patients (14.2%) as equivocally obstructed, and 2 patients (7.1%) as obstructed group. A normal bell-shaped flow curve was obtained in 23 (82.1%) of the children. 4 patients (14.2%) had a plateau flow pattern. Only 1 of the patients had an intermittent shape flow curve. The flow pattern was normal bell-shaped for all of the patients, except 1, with Q(max) above the 25th percentile according to the Toguri nomogram. Of children with Q(max) below the 5th percentile, both of them had a plateau flow pattern and were found to have an asymptomatic meatal stenosis, which was improved with urethral dilatation. However, of the 4 patients with Q(max) between 5 and 25 percentiles, 2 had a plateau flow pattern and the others had a bell-shaped flow pattern. The flow patterns of the 2 patients determined as obstructive by the Toguri nomogram were plateau-shaped. TIPU provides satisfactory functional results for distal and midpenile hypospadias; uroflowmetry is an important noninvasive tool to evaluate this technique. There are no studies in the literature which only used flow patterns for the evaluation of urination for follow-up after the hypospadias repair. Our study showed that the evaluation of obstruction according to the Toguri nomogram may not be necessary in patients with a normal bell-shaped flow pattern in uroflowmetry.

Sexual function in women with coronary artery disease: a preliminary study

We investigated sexual function in female patients with coronary artery disease (CAD). A total of 20 consecutive female patients (38.2+/-3.8 years) with CAD diagnosed by coronary angiography and 15 healthy subjects (37.9+/-5.4 years) were enrolled in this study. The Female Sexual Function Index (FSFI) was used to assess sexual function in all the participants. Women with psychiatric disorders, gynecologic and systemic diseases that may affect sexual function were excluded from the study. The other exclusion criteria were usage of antidepressants and drugs affecting sexual function. Patients with CAD and healthy women were comparable in age, body mass index and education level. Female sexual dysfunction (FSD) was diagnosed in 12 of 20 women with CAD (60%), whereas five of 15 healthy women (33.3%) were found to have FSD (P<0.05). Patients with CAD had a significantly lower number of sexual intercourse episodes per month than healthy women volunteers (2.24 versus 5.2, respectively; P<0.05). The FSFI total score was clearly significantly decreased in the CAD group compared with that in healthy controls (17.8+/-2.9 and 26.0+/-4.8, P=0.001). When the subscores of each domain of FSFI were evaluated, all the subscores of FSFI, except the satisfaction domain, in patients with CAD were significantly lower than those of healthy subjects (P<0.05). This preliminary study demonstrates that female patients with CAD have distinct sexual dysfunction compared with healthy controls. Women with CAD should be evaluated also in terms of sexual function to provide better quality of life.