BACKGROUND:Only one diagnostic parameter is not available for acute appendicitis. For the establishment of diagnosis, combination of medical history, clinical, laboratory tests, and radiological imaging modalities are used so as to decrease the rates of negative laparotomy and morbidity secondary to delay in diagnosis. Thepresent study aimed to determine haematological and inflammatory markers which will be used in the discrimination of acute appendicitis (AA) and renal colic which are the most frequent and indistinguishable causes of abdominal pain in patients applying to the emergency service.

Introduction: This study aimed to determine the safety and efficacy of a modified technique for performing transurethral resection of the prostate (TURP) combined with percutaneous cystolithotripsy (PCCL). Methods: Clinical data from 24 patients with benign prostate hyperplasia (BPH) and aggregate stone sizes ≥3 cm were assessed retrospectively between June 2011 and January 2014. All stones fragmented via pneumatic lithotripter were removed. An 18-F Foley catheter was inserted into the Amplatz sheath, which was then removed from the bladder. The Foley catheter balloon was inflated with 15 ml of saline, and suprapubic traction was applied to prevent extravasation. Next, TURP was performed while a suprapubic Foley catheter provided continuous drainage. Results: The mean stone size was 46.25 ± 9.51 mm. The surgical duration for stone removal was 31.25 ± 8.46 min. All patients were stone-free at the first month follow-up. None of the patients experienced extravasation or urethral stricture. Conclusions: PCCL is a short-duration, minimally invasive surgery that avoids urethral stricture. In the presented technique, as the drainage catheter is fixed to the dome of bladder, it is not visualized in the surgical field and remains outside of the resection area, which facilitates prostate resection. It seems to be a safe and efficient technique.

BackgroundNeovaginal perforation can develop following sexual intercourse in patients that have undergone male to female gender reassignment surgery. In such cases urinary tract symptoms may mimic acute cystitis and acute pyelonephritis.Case presentationA 33-year old white transsexual patient presented to the emergency department with dysuria, hematuria, difficulty urinating, widespread groin pain, bilateral side pain, clear vaginal discharge, abdominal pain, and nausea 2-3 h after sexual intercourse. Abdominal tomography showed fluid around the vaginal cuff and air throughout the abdomen. Vaginography showed contrast leaking to the abdomen from the vaginal cuff. The patient was considered as vaginal perforation and admitted to clinic.ConclusionVaginal perforation should be considered in transsexual patients that develop urinary system symptoms following sexual intercourse. Such cases were treated medically without the need surgery.

Aims of the study The aim of this study was to investigate the impact of testosterone deficiency on cognitive functions in metastatic prostate cancer patients receiving androgen deprivation therapy (ADT). Methods In this multicentric prospective study, 65 metastatic prostate cancer patients were evaluated. Demographic and clinical data were recorded. Cognitive functions were assessed using the Symbol Digit Modalities Test, the California Verbal Learning Test Second Edition, the Brief Visuospatial Memory Test—Revised, and the Trail Making Test. Depressive symptoms were assessed using the Beck Depression Inventory. Cognitive functions and depressive symptoms were recorded before the androgen deprivation therapy and at the 3‐ and 6‐month follow‐ups. Results At the basal cognitive assessment, the mean Symbol Digit Modalities Test, the California Verbal Learning Test Second Edition, the Brief Visuospatial Memory Test—Revised scores were 25.84 ± 17.54, 32.68 ± 10.60, and 17.63 ± 11.23, respectively, and the mean time for the Trail Making Test was 221.56 ± 92.44 seconds, and were similar at the 3‐month, and 6‐month controls (P > .05). The mean pretreatment, third and sixth month testosterone levels were 381.40 ± 157.53 ng/dL, 21.61 ± 9.09 ng/dL and 12.25 ± 6.45 ng/dL (P < .05), and the total PSA levels were 46.46 ± 37.83 ng/mL, 1.41 ± 3.31 ng/mL and 0.08 ± 0.14 ng/mL (P < .05), respectively. Conclusion The ADT in patients with metastatic prostate cancer does not affect patients’ cognitive functions and depressive symptoms. However, further prospective randomised studies with higher cohorts and longer follow‐up periods are needed.

Öz GirişRektal tuşe ile birlikte prostat spesifik antijenin (PSA) kullanılmaya başlanması ve biyopsi tekniklerindeki gelişmelerle birlikte tanı konulan prostat kanseri sayısında büyük artışlar olmuştur. Öyle ki, prostat kanseri, erkeklerde en sık tanı konulan kanser olup Amerika Birleşik Devletleri'nde 2015 yılında erkekler arasında tanı konulan kanserlerin yaklaşık dörtte birini oluşturmakta ve yine erkeklerde kansere bağlı ölüm nedenleri arasında 2. sırada yer almaktadır (1). Prostat kanseri aşırı heterojen davranış gösterebilen bir kanserdir. Uzun süre sessiz kalabileceği gibi çok agresif de davranabilir. Bu nedenle tanının konması kadar, tümör davranışının da belirlenebilmesi önemlidir. Çünkü tanıdaki aşırı artışlar belki de uzun yıllar sessiz seyredebilecek klinik olarak önemi olmayan tümörlere de tanı konmasına ve bunların aşırı tedavisine neden olmaktadır. Bunların önlenmesi, klinik olarak önemsiz kanserler ile agresif seyredebilecek olan kanserlerin ayırt edilebilmesiyle mümkün olabilecektir. Günümüzde tanıda, rektal tuşe ile birlikte kullanılan PSA ve derivelerinin kullanılması ile prostat kanserine özgü mortalitenin azaldığı, buna karşın biyopsi sayısının %70-80 arttığı saptanmıştır (2).Çünkü PSA, organ spesifitesi yüksek; ancak kanser spesifitesi düşük bir belirteçtir. Kanser dışındaki benign durumlarda da PSA'nın serum düzeylerinde artışlar gözlenebilmektedir. Bu nedenle, hem gereksiz biyopsi sayısının azaltılması hem de klinik önemsiz ile agresif seyredecek kanserlerin ayırt edilebilmesi için yeni belirteçlere gereksinim vardır. Bu amaçla, PSA etkinliğini arttırmaya yönelik çalışmalar yapılmış ve yapılmaktadır. Bu çalışmalar sonucunda; özellikle total PSA'nın 4-10 ng/mL arasında olduğu durumlarda kullanılan PSA dansitesi, PSA hızı, PSA ikiye katlanma zamanı ve serbest/total PSA oranı gibi türevleri kullanılmaya başlanmıştır. Bunlarla da istenilen amaca ulaşılamamış olup yeni belirteç arayışları sürmektedir. Ancak, her şeye rağmen günümüzde hala tanı ve tedavi takibinde en çok kullanılan belirteç PSA'dır. Bu yazıda ürologlarca çok iyi bilinen PSA ve yukarıda belirtilen türevlerinden ayrıntılı olarak tekrar bahsedilmeyecek olup bunların dışındaki tümör belirteçlerindeki son durum hakkındaki güncel literatür bilgisine yer verilecektir. Serbest Prostat Spesifik Antijen Alt FraksiyonlarıTotal PSA'nın %5-35'i kanda serbest olarak bulunur (3). Serbest/total PSA oranı prostat kanserlerinde daha düşük Currently the accepted screening tools for prostate cancer are prostate specific antigen (PSA) and rectal examination. PSA is specific to prostate, but not to prostate cancer. Therefore, identifying prostate cancer only by serum PSA measurement has low specificity and may lead to false positive results and unnecessary biopsies. Due to these problems, it is investigated to increase the effectiveness of PSA and/or to find new biomarkers. However, it does not seem possible to have the adequate benefit from only one biomarker due to heterogeneous feature of prostate cancer. Therefore, in the recent years, ...