Objectives Transcutaneous tibial nerve stimulation (TTNS) is a noninvasive method used in OAB treatment. Purpose of this study is to compare the effectiveness of the TTNS procedure applied once a week and three times a week in women diagnosed with wet type refractory OAB. Methods A total of 60 patients diagnosed with wet type OAB that was refractory to medical treatment were included in the study. Participants were equally and randomly divided into two groups: TTNS treatment was performed with a duration of 30 minutes for 12 weeks, once a week to Group I and three times a week to Group II. Pretreatment and posttreatment OAB‐V8/ICIQ‐SF scores and voiding frequencies recorded in the bladder diary were compared between groups. Results Four patients in Group 1 and eight in Group 2 left the study without completing the treatment. TTNS was performed in both groups for 12 weeks. There was a significant decrease in the voiding frequency, OAB‐V8, ICIQ‐SF scores in both group 1 and group 2 (P < .001). A significant decrease in the OAB‐V8 score was observed in the 5th week in Group 1, and in the 3rd week in Group 2. Complete response was observed in 6 patients (23.1%) in Group 1 after 12 weeks of TTNS procedure. In Group 2, 10 patients (45.5%) had a complete response. After the 12‐week TTNS procedure, no significant difference was observed between the groups in terms of treatment response. Conclusion TTNS can be safely used before invasive treatments in resistant OAB. TTNS procedure three times a week seems more effective than performing it once a week.

The eosinophilic vacuolated tumor (EVT) of the kidney is a newly identified and pathological emerging entity. In this case report, EVT diagnosed due to a partial nephrectomy performed for a suspicious kidney mass in a 47-year-old patient is presented. A review of the literature and this case indicates that EVT, also called high-grade oncocytoma, does not show clinically aggressive behavior. However, in case of clinical suspicion, tumors with this oncocytic morphology should be treated with nephron-sparing treatment methods, considering that they may be hybrid malignancies.

Background: This study aimed to demonstrate the effectiveness of transcutaneos tibial nerve stimulation (TTNS) in the treatment of bladder pain syndrome (BPS). Materials and methods: The data of 16 female patients, diagnosed with BPS in our clinic between 2019 and 2021 and had TTNS twice a week for 12 weeks, were retrospectively analyzed. Results: The mean age of the patients was 46.00 ± 13.11 years, and the mean body mass index was 26.43 ± 3.07 kg/m 2 . After the treatment, the median day time frequency of the patients decreased from 13.37 (3.69) to 10.25 (4.56) (p < 0.001). Nocturia also decreased after treatment from 4.37 (1.81) to 3.00 (1.94) (p = 0.001). The median voiding volume increased by 26.5 mL (p = 0.001). The median of the patients' visual analog scale scores decreased after treatment (median of visual analog scale score changed from interquartile range 8 [1] to 7 [4]) (p = 0.001). In addition, the median interquartile range interstitial cystitis symptom index scores decreased from 17 (4) to 15 (10) (p = 0.002). Conclusions: In this study it was demonstrated that TTNS is an alternative method that can be successfully applied before invasive methods in the treatment of BPS.

Objectives: Transcutaneous Tibial Nerve Stimulation (TTNS) is a non-invasive method used in OAB treatment. We aimed to compare the effectiveness of the once a week and three times a week TTNS procedure in women diagnosed with wet type refractory OAB. Methods: A total of 60 patients diagnosed with wet type OAB was refractory to medical treatment included in the study. Participants were equally and randomly divided into two groups: TTNS treatment was performed with a time duration of 30 minutes for 12 weeks, once a week to Groıp-I and three times a week to Group-II. Pre and post-treatment OAB-V8/ICIQ-SF scores and voiding frequencies recorded in the bladder diary were compared between groups. Results: Four patients in Group-1 and eight in Group-2 left the study without completing the treatment. TTNS was performed in both groups for 12 weeks. There was a significant decrease in the voiding frequency, OAB-V8, ICIQ-SF scores in both group-1 and group-2 (p<0.001). A significant decrease in the OAB-V8 score was observed in the 5th week in Group-1, and on the 3rd week in group-2. Complete response was observed in 6 patients (23.1%) in Group-1 after 12 weeks of TTNS procedure. In group-2, 10 patients (45.5%) had a complete response. After the 12-week TTNS procedure, no significant difference was observed between the groups in terms of treatment response. Conclusion: TTNS can be safely used before invasive treatments in resistant OAB. TTNS procedure three times a week seems more effective than performing it once a week.

Background: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a heterogenous condition that impacts the Quality of life severely, and it has multimodal complex treatment options. We aimed to compare the efficacy of two well-described neuromodulation therapies, transcutaneous tibial nerve stimulation (TTNS) versus percutaneous tibial nerve stimulation (PTNS) in the treatment of category IIIB CP/CPPS. Methods: This study was designed as a randomized prospective clinical trial. We randomized category IIIB CP/CPPS patients into two treatment groups as TTNS and PTNS groups. Category IIIB CP/CPPS was diagnosed by two or four-glass Meares-Stamey test. All patients included in our study were antibiotic/anti-inflammatory resistant. Transcutaneous and percutaneous treatments were applied 30 min sessions for 12 weeks. Patients were evaluated by Turkish-validated National Health Institute Chronic Prostatitis Symptom Index (NIH-CPSI) and visual analogue scale (VAS) initially and after treatment. Treatment success was evaluated within each group and also compared with each other.Results: A total of 38 patients in the TTNS group and 42 patients in the PTNS group were included in the final analysis. The mean VAS scores of the TTNS group were lower than the PTNS group initially (7.11 and 7.43, respectively), (p = 0.03). The pretreatment NIH-CPSI scores were similar between groups (p = 0.

Extracorporeal shockwave lithotripsy and especially flexible ureterorenoscopy (URS) are first-choice treatments of upper ureteral and renal pelvis stones. In our study, we aimed to demonstrate that the treatment of upper ureteral and renal pelvis stones smaller than 2 cm could be performed by semirigid URS under spinal anesthesia. The data of 292 patients were retrospectively analyzed. Stones were localized in upper ureter and renal pelvis in 191 (65.4%) and 101 (34.6%) patients, respectively. The stone-free rate was found to be 72.6%. The final stone-free rate was 95.2% after additional treatments administered to 80 patients with residues. While no peri-operative complication was observed, hematuria was observed in three patients during the post-operative period, high fever was observed in 27 patients and sepsis was observed in four patients. It is a well-known fact that flexible URS is the first-choice surgical method in the treatment of upper ureteral and renal pelvis stones. In the current study, we aimed to investigate whether laser lithotripsy with semirigid URS could also be a good and cheap alternative in clinical practice, and if upper urinary tract surgeries could be performed with spinal anesthesia especially in patients with a high risk of general anesthesia. Level of evidence:

Grief mania that is evaluated as psychogenic mania in the literature is related to manic episode that emerges after the loss of a loved one. There are not many cases that associate causality of beginning of mania and mourning in the literature. It is known that mania is induced by traumatic events but the cases that do not suit stages of development of grief process are evaluated as pathological grief. In this case, the woman who experienced manic episode after her son's death is presented. This case is prepared because mania should be considered as possible grief reaction. Case presentation: A patient who is 40 years old, married, mother of 4 children is brought by relatives because of aggressiveness, tension, insomnia for 4 days, fast and talk a lot and nonsense laughing attacks. She was presented to hospital for stressful life events 2 years ago and started to be on medication (escitalopram 10 mg) because of depression and fibromiyaliji diagnosis. She used medication for 1.5 years and she did not use any medication for the last 6months. There is no history for mental disorder in her family. Psychological examination: her interest for the environment was increased, self-care ability got better, her temperament was cheerful, her sociability was respectful, amount of talking and tone of voice increased, mimic and gesture was appropriate for her temperament, sleeping decreased, thought flow increased and achieved goal of conversation late. Moreover, there were grandiose delusions and hypervigilance, affect was close to euphoria, her psychomotor behaviours increased and social functioning decreased. According to biochemical and radiological workup, there was no pathological situation. The client started to use Lithium 900 mg/day and Olanzapin 10 mg/day because of the bipolar disorder diagnosis. The patient's blood lithium level was 0.8mEq/L and lithium was used 1200 mg/day and then 10 days later the patient's blood lithium level was 0.72 mEq/L. According to clinical observations, the patient's manic symptoms remained. Furthermore, the patient started to cry occasionally after 1 month and her grandiosity disappeared. The patient was discharged from the hospital after 45 days. The patient met the criteria for manic episode in DSM 5. The patient did not take any medication for last 6 months. Thus, it is considered that this situation was not induced by medication. It puts the patient into risk group because she was treated for depression before but it is not considered as bipolar depression because there were psychiatric history in the family and depression that experienced 2 years ago was related to stressful life events. It is considered that this case experienced grief/funeral mania because there was contiguity between loss of her son and manic episode, the patient did not react this way to previous challenging life events and the patient was outside of the ordinary 5 stages of grief process.

The study was aimed to investigate the safety of the transrectal ultrasound-guided prostate needle biopsy in the elderly. Material and methods: Five hundered fifteen patients, who underwent prostate biopsy between 2017-2020, were included in the study. All patients' demographic data, comorbidities, laboratory findings, prostate volumes, prostate biopsy pathology results, and post-biopsy complications were retrospectively analyzed. The patients were divided into 2 groups: group-1 consisting of patients under the age of 65 and group-2 with above the age of 65. Results: There were 244 in group-1 and 271 patients in group-2. The mean age of group-1 was 59.50±3.98, group-2 was 71.45±4.57 years. In group-1, post-biopsy fever was observed in 5 (2%), hematuria in 44 (18%), hemospermia in 79 (32.4%), and rectal bleeding in 7 (2.9%) patients. In group-2, post-biopsy fever was observed in 15 (5.5%), hematuria in 69 (25.5%), hemospermia in 21 (7.7%), and rectal bleeding in 11 (4.1%) patients. The severe sepsis findings were observed in 2 patients (0.2%) in group-1 and 6 (2.2%) in group-2. In the logisticregression-analysis, it was determined that the risk of complication increased significantly as the age, PSA, and higher PSA density. Conclusion:In our study, it was revealed that the risk of complications was higher in the elderly and that the complications observed may be more seriously. Therefore, we consider that a more careful approach should be taken in elderly patients to prevent the complications related with prostate biopsy.