Our results showed that observation could be considered for patients with asymptomatic lower pole stones. However, patients should be counseled about the 33% disease progression and 11% intervention rates.

Due to the widespread usage of prostate-specific antigen screening, the number of patients diagnosed with prostate cancer is steadily increasing. Many factors such as high operating room demand, insurance reimbursement, patients' desire to assess multiple treatment options, and anxiety can cause delays in radical treatment. In this study, we examined the effect of delay from prostate biopsy to surgery on outcomes of men with localized prostate cancer. Materials and Methods: The data of 359 patients who underwent radical prostatectomy (RP) in our clinic between 2008 and 2017 were analyzed retrospectively. Surgical delay was defined as the time from transrectal ultrasound-guided prostate biopsy to surgery. Patients were divided into 3 groups according to the interval between prostate biopsy and RP (≤60, 61-120, ≥120 days) and classified according to the D'Amico risk classification. Results: A total of 248 patients were included in the study. Of these patients, 107 (43.1%) were operated within 60 days of biopsy, 113 (45.6%) 61-120 days after biopsy, and 28 (11.3%) over 120 days after biopsy. Statistical analysis of patients with follow-up of at least 12 months did not reveal a significant difference between the groups in terms of biochemical recurrence (p=0.06). A delay of over 120 days was not associated with adverse pathological or oncological findings at surgery for the low-risk group. Extraprostatic invasion increased significantly in the intermediate-risk group with longer surgical delay (p=0.044). Conclusion: Our data demonstrated that a delay of more than 120 days was not associated with adverse pathological outcomes in men with low-risk localized prostate cancer. For men with intermediate-risk disease, delays over 60 days were significantly associated with risk of extraprostatic invasion. Our findings indicate that RP should be performed within 60 days of biopsy for intermediate-risk patients.

Ali Serdar Gözen, et al.; Robot-assisted vasovasostomy and vasoepididymostomy: Current status and review of the literature.

The yield of extended 14-core repeat biopsy protocol was higher in patients with previous negative sextant biopsy compared to the patients with previous negative 10-core biopsy. HGPIN history found on previous sextant biopsy was a strong cancer predictor on repeat biopsy; same was not true for the patients with previous 10-core biopsy. The yield of lateral peripheral cores and TZ biopsies were lower in patients with prior negative extended biopsy.

Objective: To report our initial experience and short-term results in post-chemotherapy robot-assisted retroperitoneal lymph node dissection (RA-RPLND) for advanced testicular cancer. Material and methods:We analyzed prospectively collected data of 5 patients who underwent post-chemotherapy RA-RPLND between August 2017 and May 2018. All patients had a diagnosis of non-seminomatous germ cell tumor (NSGCT) of testis and received three or four cycles of BEP chemotherapy for their clinical stage IIC disease before the surgery. Perioperative parameters (operation time, estimated blood loss and intraoperative complications) and postoperative findings (change in hematocrit, duration of hospitalization and postoperative complications) were noted. Pathological outcomes and postoperative radiological imaging in the 3 rd month were investigated.Results: RA-RPLND was completed successfully in all patients, and none of them required conversion to open surgery or early intervention. The median operation time was 309 minutes (range, 275-360), and median estimated blood loss was 180 mL (range, 150-210). One patient required postoperative transfusion of 1U red blood cells. The histologic examination of the specimens revealed necrosis in 3, and mature teratoma in 2 patients. The median hospitalization time after surgery was 2 days. During a median follow-up of 10 months (range 7-12), there were no retroperitoneal recurrences or distant metastasis in radiological imaging. No major complication (Clavien ≥3) or death occurred. The only minor complication was transfusion of red blood cells in one patient (Clavien 2) and the overall complication rate was 20 percent. Conclusion:Post-chemotherapy RA-RPLND appears to be a feasible and oncologically safe procedure with acceptable operative morbidity. However, this technique should be applied in centers highly experienced in robotic surgery, considering that RPLND is a surgery with fatal complications.

Objective: To investigate whether core length is a significant biopsy parameter in the detection of prostate cancer. Material and methods:We retrospectively analyzed pathology reports of the specimens of 188 patients diagnosed with prostate cancer who had undergone initial transrectal ultrasound (TRUS) guided prostate biopsy, and compared biopsy core lengths of the patients with, and without prostate cancer. The biopsy specimens of prostate cancer patients were divided into 3 groups according to core length, and the data obtained were compared (Group 1; total core length <10 mm, Group 2; total core length 10 mm-19 mm, and Group 3; total core length >20 mm). Biopsy core lengths of the patients diagnosed as prostate cancer, and benign prostatic hyperplasia were compared, and a certain cut-off value for core length with optimal diagnostic sensitivity and specificity for prostate cancer was calculated. Results:Mean age, PSA and total length of cores were 65.08±7.41 years, 9.82±6.34 ng/mL and 11.2±0.2 mm, respectively. Assessment of biopsy core lengths showed that cores with cancer (n=993, median length 12.5 mm) were significantly longer than benign cores (n=1185, median length=11.3 mm) (p<0.001). Core length analysis yielded 12 mm cores have an optimal sensitivity (41.9%) and specificity (62%) for detection of cancer (odds ratio: 1.08). Conclusion:Biopsy core length is one of the most important parameter that determines the quality of biopsy and detection of prostate cancer. A median sample length of 12 mm is ideal lower limit for cancer detection, and biopsy procedures which yield shorter biopsy cores should be repeated.

No abstract

Objectives: After radical prostatectomy, surgical margin positivity is an important indicator of biochemical recurrence and progression. In our study we want to compare the surgical margin positivity rates for retropubic radical prostatectomy (RRP) and robotic assisted radical prostatectomy (RALP) and investigate the factors affecting surgical margin positivity in RALP. Materials and methods: Data from 78 RRP and 62 RALP patients operated from 2011 May to 2016 March were retrospectively screened. Patients in both groups were compared in terms of age, postop hematocrit reduction, hospital stay, duration of follow-up, surgical margin positivity, biochemical recurrence and oncologic parameters. In RALP group it was searched the relationship between the surgical margin positivity and prostate specific antigen (PSA), positive biopsy core, biopsy Gleason scoring, pathologic stage and Gleason scoring, lymph node positivity, lymphovascular and perineural invasion, extracapsular extension, seminal vesicle invasion, prostate weight. Additionally the high cost associated with robotic radical prostatectomy has led to questions about the necessity for use of this technique in developing countries such as ours (10). Surgical margin positivity after radical prostatectomy is one of the important causes of biochemical recurrence and progression. When comparing retropubic radical prostatectomy (RRP) and RARP one of the important topics of interest is the effect on surgical margin positivity. In this study we compared the surgical margin positivity rates of RRP and RARP and aimed to investigate the factors affecting surgical margin positivity in RARP. MATERIALS AND METHODSThe data belonging to 173 patients who underwent RRP or RARP for prostate cancer, without neo-adjuvant therapy, at our center from May 2011 to March 2016 were retrospectively scanned. Our study was in accordance with the Helsinki Declaration and did not gain ethics committee permission as it included retrospective data. While RRP was performed with the classic retropubic technique, the robotic technique used the da Vinci robotic surgical system (Intuitive Surgical, Sunnyvale, CA, USA) with 5 port transperitoneal approach. The operations were performed by 3 different surgeons experienced in open surgery and inexperienced in robotic surgery. Patients with lymph node metastasis risk above 5% according to the Briganti nomogram (11) had extended lymph node dissection (2) performed. For low risk prostate cancer (T1c, PSA < 10, Gleason < 7) patients, a nerve-sparing approach was chosen. Patients who underwent RRP had a urethral Foley catheter inserted for 2 weeks, while RARP patients had a catheter inserted for 1 week. The patient age, prostate