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The objective of the study was to investigate the precise role of computed tomography (CT) in preoperative radiologic evaluation and surgical planning of kidney stone in children prior to percutaneous nephrolithotomy (PNL). A total of 113 pediatric patients (aged ≤18 years) undergoing PNL for renal stone(s) in three referral hospitals between March 2010 and August 2012 were retrospectively evaluated. Depending on the preoperative radiologic evaluation, patients were divided into two groups. Those evaluated with CT were classified as group-1 (n = 50) and the remaining cases undergoing intravenous urography (IVU) examination were classified as group-2 (n = 63). Patient- and procedure-related variables and perioperative measures were compared between the groups. The mean age, stone size and localization were similar in both groups (p = 0.07, p = 0.57, p = 0.6, respectively). Although the postoperative hemoglobin drop was found to be significantly higher in group-2 (1.5 ± 1.3 vs. 0.9 ± 0.6 g/dL, p = 0.005), the mean operation time, fluoroscopic screening time, access number, overall success and complication rates were comparable (p = 0.06, p = 0.94, p = 0.75, p = 041, and p = 0.41, respectively). However, the mean hospitalization time was significantly prolonged in group-2 than in group-1 (p = 0.03). Our findings clearly demonstrate that, despite the key role of preoperative CT in particular patients with anatomically abnormal kidneys, IVU is a valuable alternative imaging modality with comparable radiation doses in children.

<b><i>Background:</i></b> Although prostate cancer releases more prostate-specific antigen (PSA) per unit of prostate volume (PV), data are limited regarding the association between intravesical prostatic protrusion (IPP) and the PSA level. <b><i>Objectives:</i></b> The study aim was to evaluate the IPP effect in patients with benign prostatic hyperplasia. <b><i>Method:</i></b> This study included patients with (<i>n</i> = 119) and without (<i>n</i> = 121) IPP. The age, International Prostate Symptom Score (IPSS), PSA level, maximum and average flow rates, PV, hematuria, urinary retention, and post-void residual (PVR) volume were compared between the 2 groups. <b><i>Results:</i></b> The mean ages were similar between the 2 groups (66.56 ± 8.67 and 66.92 ± 8.7 years, respectively, <i>p</i> = 0.747), and there were no statistically significant differences in the IPSS, maximum and average flow rates, hematuria, PVR volume, and urinary retention means (<i>p</i> &#x3e; 0.05). However, the IPP patients had lower total PSA (tPSA) and free PSA (fPSA) levels than those without IPP (3.55 [4.18] vs. 5.26 [5.24] ng/mL, <i>p</i> = 0.013 and 0.7 [1.09] vs. 1.05 [1.23] ng/mL, <i>p</i> = 0.029, respectively). Moreover, there were strong positive correlations between the IPP grade and the tPSA and fPSA levels (<i>r</i> = 0.262, <i>p</i> = 0.001 and <i>r</i> = 0.254, <i>p</i> = 0.002 respectively). <b><i>Conclusions:</i></b> This study demonstrated that IPP results in a decreased PSA level, even with a higher PV.

Background Systemic inflammation and oxidative stress increase the possibility of erectile dysfunction (ED) through a coordinated response to vascular endothelial damage. Aim The study aimed to evaluate the status of oxidative stress and systemic inflammation in ED. Methods The analysis was a prospective, cross-sectional, single-center study. The study included non-ED (n = 54) and ED (n = 104) groups. The study analyzed demographics, clinical outputs, oxidative stress (total antioxidant status [TAS], total oxidant status [TOS], oxidative stress index [OSI]), and an inflammatory condition (multi-inflammatory index 1 [MII-1], MII-2). Outcomes Oxidative stress and systemic inflammation were evaluated together in ED, which was evaluated with the help of the International Erectile Function Index (IIEF) scale. Results TAS significantly decreased in the ED group compared with the non-ED group (2.25 ± 0.83 mmol Trolox equivalents/L vs 1.45 ± 0.65 mmol Trolox equivalents/L; P = .001). TOS increased in the ED group (14.1 ± 6.2 μmol H2O2 equivalents/L) compared with non-ED group (11.05 ± 6.8 μmol H2O2 equivalents/L) (P = .002). OSI was as low as 0.74 ± 0.33 in the non-ED group and as high as 2.38 ± 0.85 in the ED group (P = .001). Both MII-1 (273 ± 398 vs 745 ± 1311; P = .012) and MII-2 (4.66 ± 5.02 vs 19.7 ± 29.4; P = .031) increased in the ED group compared with the non-ED group. IIEF was negatively correlated with MII-1 (r = −0.298; P = .009), MII-2 (r = −0.341; P = .006), and OSI (r = −0.387; P &lt; .0001), while TAS had a strong positive correlation with the IIEF (r = 0.549; P = .0001). OSI was correlated with MII-1 (r = 0.304; P = .001) and MII-2 (r = 0.334; P = .001). OSI was the strongest parameter in predicting ED (P = .0001; area under the curve, 0.795; 95% confidence interval, 0.696-0.855). The cutoff was 0.71 at 80.5% sensitivity and 67.2% specificity. Clinical Implications OSI showed diagnostic potential for ED as an oxidative stress indicator, while MII-1 and MII-2 showed the effectiveness. Strengths and Limitations MIIs, a novel indicator of systemic inflammatory condition, were analyzed for the first time in patients with ED. The long-term diagnostic efficacy of these indices was lacking, as all patient data did not include long-term follow-up. Conclusion Considering their low cost and easy applicability compared with OSI, MIIs could be essential parameters in the follow-up for ED for physicians.

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ÖZETAmaç: Laparoskopik cerrahiyi kursiyer düzeyinde öğrenen, kliniğinde laparoskopi deneyimi olmayan bir üroloğun ilk dört yıllık sütür gerektiren operasyonlarını retrospektif olarak inceleyerek yıllık dilimler şeklinde sonuçlarını karşılaştırmayı amaçladık.Yöntemler: Laparoskopik cerrahi uygulanan 160 hasta 2008-2012 yılları arasında incelendi. Operasyonların sayısı, açığa geçme oranı, süresi, hastaların hastanede kalma süresi yıllık dilimler şeklinde dörde bölünerek karşılaştırıldı.Bulgular: Laparoskopik üreterolitotomi yapılan 12 operasyonun tamamı laparoskopik tamamlandı. Ortalama operasyon süresi 145,4±42,4 dakika, hastanede kalma süresi 2,4±0,7 gün olarak bulundu. Optimum parametreye 2. yıl ulaşıldı. Laparoskopik piyeloplasti yapılan 9 operasyonun tamamı laparoskopik tamamlandı. Ortalama operasyon süresi 226,6±63,8 dakika, hastanede kalma süresi 6,2±2,5 gün olarak bulundu. Optimum parametreye 4. yıl ulaşıldı. Laparoskopik parsiyel nefrektomi yapılan 6 operasyonun tamamı laparoskopik tamamlandı. Ortalama operasyon süresi 195±31,4 dakika, hastanede kalma süresi 6,3±3,6 gün, ortanca iskemi süresi 26,5±8,3 dakika olarak bulundu. Optimum parametreye 4. yıl ulaşıldı. Laparoskopik radikal prostatektomi yapılan 32 operasyonun 25'i laparoskopik tamamlandı. Ortalama operasyon süresi 300±103,9 dakika olup, hastanede kalma süresi 8,1±5,7 gün bulundu. Optimum parametreye 4. yıl ulaşıldı.Sonuç: Laparoskopide sütür atma beceri gerektiren bir işlemdir. Laparoskopiye kursiyer düzeyinde başlayan bir ürolog 1 yıl sonra üreterolitotomi, 2 yıl sonra piyeloplasti, 3 yıl sonra parsiyel nefrektomi ve radikal prostatektomi yapacak beceriye ulaşabilir. (JAREM 2013; 3: 8-13) Anahtar Sözcükler: Laparoskopi, sütür, öğrenim körvü ABSTRACT Objective: We aimed to retrospectively compare the first four years outcome of a novice laparoscopic surgeon in suture-requiring laparoscopic procedures annual section.Methods: Between 2008-2012, a total of 160 laparoscopic suture-requiring procedures were retrospectively evaluated with conversions, operative times and hospital stay, and optimum time-interval to reach surgical competency.Results: All 12 ureterolithotomies were completed laparoscopically, 3 transperitoneal and 9 retroperitoneal approaches, witha mean operative time of 145.4±42.4 mins. and mean 2.4±0.7 days of hospital stay. Optimum experience was accomplished within 2 nd years. All laparoscopic pyeloplasties were successfully completed with a mean operative time of 226.6±63.8 mins and mean 6.2±2.5 days of hospital stay. Optimum experience was accomplished within 4 th years. All 6 partial nephrectomies were completed laparoscopically with a mean operative time of 195±31.4 mins, with 6.3±3.6 days hospital stay and without blood transfusion. The optimum experience was accomplished within 4 th years in laparoscopic partial nephrectomy. Among 32 radical prostatectomies, 25 were completed with laparoscopy and 7 with open conversion. The mean operative time was 300±103.9 mins and hospital stay of 8.1±5.7 days. The optimum experience was ga...