Objectives: To determine the factors that predict the failure of systematic prostate biopsy by examining the clinical, laboratory, and radiological parameters of patients for whom prostate cancer was detected by magnetic resonance imaging (MRI)-targeted biopsy but not by systematic biopsy. Methods: Patients were included in this study if they had undergone combined targeted and systematic biopsy and had cancer detected in the targeted biopsy. They were biopsy-naive patients and had lesions with a Prostate Imaging Reporting and Data System (PIRADS) score ≥ 3 in the peripheral zone on MRI. The clinical, biochemical, and radiological findings of the groups with and without cancer detected in the systematic biopsy were compared. Results: A total of 100 patients had an index lesion in the peripheral zone and cancer detected by MRI-targeted biopsy. In 43 (43%) of the patients, no cancer was detected in the systematic biopsy, whereas it was detected in the other 57 (57%). Statistically significant differences were found between the two groups in terms of prostate volume and PSA density (p < 0.001 and p < 0.001, respectively). Moreover, the findings of univariate and multivariate logistic regression analyses indicated that prostate volume and lesion size are independent predictors of systematic biopsy failure. Conclusions: The success of systematic biopsy may be lower in patients with high prostate volume and low peripheral zone index lesion size.
The modified Makuuchi incision (MMI) consists of a midline incision from the xiphoid to just above the umbilicus, and a transverse incision to the 12th rib. It is J-shaped on the right and L-shaped on the left side. We aimed to evaluate the postoperative pain, incisional hernia, and cosmetic satisfaction of patients who underwent renal surgery with this technique. Material and Methods: Between January 1, 2015 and March 31, 2021, patients who performed simple, partial, and radical nephrectomy with MMI in our clinic were determined, and whose surgery was performed at least 3 months ago and had contact information in hospital records were called by phone. They were questioned in terms of incisional pain, incisional bulging or hernia, and cosmetic appearance. Results: A total of 152 patients with kidney surgery were identified. Ninety-seven were operated via MMI, and 57 of them were interviewed. Thirty-seven were male and 20 were female. The mean age was 55.3 years (21-86 years) and the mean postoperative follow-up period was 28 months (3-75 months). There was no patient with ongoing pain and was still in need of analgesics. Fortyfive patients (78.9%) stated that they were satisfied with the cosmetic appearance. One patient (1.7%) reported incisional bulging and 1 (1.7%) reported a hernia. Conclusion: In cases with large renal tumors or a history of previous abdominal surgery, MMI did not cause permanent and serious problems in terms of pain, cosmetic, and herniation. We think that it is useful to know this incision for urologists who are interted in complicated renal surgeries.
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