Aim: The aim of this study was to reveal the effect of manual detorsion on testicular salvage rates and the factors affecting the success of manual detorsion in adult testicular torsion. Material and Methods: The records of patients who applied to the emergency department with pre-diagnosis of acute scrotum were examined. A total of 62 adult patients diagnosed with testicular torsion were included in the study. Manual detorsion was attempted in all patients before surgery. Demographic characteristics of the patients, time from onset of scrotal pain to hospital admission (<24 hours/>24 hours), physical examination and ultrasonography findings, type of surgery performed, and long-term results were evaluated. The data were statistically compared between patients with manual detorsion considered successful and unsuccessful. Results: Manual detorsion was considered successful in 36 (58.1%) patients and unsuccessful in 26 (41.9%) patients. Orchiopexy was performed in 35 (97.2%) of the successful patients and in 11 (42.3%) of the unsuccessful patients (p<0.001). When subgroup analysis was performed, although there was no significant difference in pain duration between patients with and without successful manual detorsion for patients with pain duration of less than 24 hours (p=0.648), there was a statistically significant difference in testicular salvage rates. While the rate of orchiectomy was 1/35 (2.9%) in patients with successful manual detorsion, this rate was 8/19 (42.1%) in unsuccessful patients (p<0.001). Conclusion: Manual detorsion increases testicular salvage rates in adult patients diagnosed with testicular torsion, and it should be attempted especially in patients with pain duration less than 24 hours.

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Introduction: Computed tomography (CT) or ultrasonography (USG)-guided renal access for percutaneous nephrolithotomy (PNL) is not suitable in all cases with retro-renal colon (RRC) due to anatomical and technical restrictions. We would like to describe our novel technique that permits standard subcostal renal access with a small incision for these patients. Methods: This method was performed on adult patients with severe RRC and complex renal stones who were not suitable for renal access with CT or USG guidance. Time from skin incision to puncture needle insertion, incision length, stone-free rate (SFR), and complications were evaluated. Surgical Technique: The appropriate renal calyx for renal access was identified with retrograde pyelography. The skin closest to the identified calyx was incised and retroperitoneum visualized. The RRC was swept laterally by blunt dissection to obtain a safe puncture line. The retractors were placed to keep the colon away from the incision. Then, the puncture needle was placed over Gerota’s fascia. After this, the puncture needle was inserted into the targeted calyx under fluoroscopic guidance. The insertion of guidewire and the rest of the procedure such as dilatation and insertion of Amplatz sheath were performed under same maneuver. Results: A total of 1,348 patients were treated with PNL between January 2016 and November 2019. Our group consisted of 16 adult patients with a median age of 44.8 years (7 females and 9 males) who underwent PNL with our new access technique. SFR and clinically insignificant residual fragment (CIRF) rate were 72.5 and 14.2%, respectively. The median access time was 22.2 min (range: 15–30 min). The median skin incision length was 3.7 (range: 3.0–4.5) cm. The average skin incision length was 3.7 cm. The SFR and CIRF rate were 72.5 and 14.2%, respectively. We did not observe any complication related to our access technique. Conclusion: Our novel access technique created a safe anatomical route for standard subcostal renal access with acceptable incision length and very low complication rate.

Amaç: Zorluk; prostat büyük olduğunda gri bölgede başlar. Avrupa Üroloji Kılavuzları, 80 ml'den küçük prostatlar için transüretral prostat rezeksiyonu (TURp) ve 80-100 ml'den büyük olanlar için açık prostatektomi (OP) operasyonunu önermektedir. Bu çalışmada, büyük (80-100 ml) prostatların tedavisinde bipolar TURp ve OP tedavi seçeneklerinin güvenilirliğini ve etkinliğini karşılaştırmayı amaçladık. Yöntem: Alt üriner sistem semptomları (AÜSS) ile kliniğimize başvuran ve bipolar (Plazma Kinetik) OP (Grup 1) ve TURp (Grup 2) ile tedavi edilen hastalar çalışmaya dahil edildi. Hasta yaşı, (toplam ve serbest) prostat spesifik antijen (PSA), prostat hacmi, semptom skorları (ameliyat öncesi ve sonrası) (IPSS), dijital rektal muayene, prostat hacmi, üroflovmetri, ameliyat süresi, işeme sonrası rezidüel hacim (PVR), ameliyat öncesi ve sonrası hematokrit ve komplikasyonlar değerlendirildi. Bulgular: Gruplar karşılaştırıldığında ortalama hasta yaşı, prostat hacmi, PSA düzeyleri preoperatif hematokrit düzeyleri, IPSS, Qmax ve PVR benzerdi. Operasyonlardan sonra IPSS, Qmax ve PVR farkı Grup 1 lehine anlamlı derecede daha iyi idi (sırasıyla p = 0.000, p = 0.000 ve 0.05). Ancak hastanede yatış ve hematokrit düşmesi Grup 2 lehine anlamlı olarak daha iyi idi (p = 0.000 ve p = 0.018). Sonuç: OP için birçok alternatif olmasına rağmen ve modası geçmiş olduğu düşünülse de, gelişmekte olan ülkelerde OP, büyük prostat bezlerinin tedavisinde TURp' den daha uygun olabilir. Bulgularımızı doğrulamak için daha büyük kohortlar üzerinde prospektif randomize çalışmalar yapılmalıdır.