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Background and Aim: This study aims to establish unilateral intermittent and unintermittent partial nephrectomy-like renal ischemia-reperfusion (I-R) model in rats and to compare the results with biochemical findings. Material and Methods: The study was conducted on 24 adult 8-week-old male Wistar-Albino rats, each weighing s200-250 g. The rats were divided into three groups. In the Sham group (n = 8), the kidney was surgically exposed and closed. We designed experimental I-R models in the second group (n = 8, a total of 30-min ischemia model in the manner of 3 intermittent sets 8 minutes clamping and 2 min unclamping) and in the third group (n = 8, one session of 30-min unintermittent ischemia). In postoperative day 1, the rats were sacrificed, and the effects of I-R models on the renal tissue were comparatively assessed by evaluating serum Neutrophil Gelatinase-Associated Lipocalin (NGAL), serum kidney injury molecule-1 (KIM-1), urinary NGAL, urinary KIM-1, and serum creatinine levels. Results: Urinary NGAL and KIM-1 levels were significantly higher in the continuous ischemia group when compared to those in the sham and intermittent ischemia groups (P < 0.05). In the intermittent ischemia group, urinary NGAL and urinary KIM-1 levels were significantly higher than those in the sham group (P < 0.05). Although the results of serum NGAL, serum KIM-1, and serum creatinine levels seemed to be in parallel to the results of urinary markers, no statistically significant difference was found. Conclusion: Renal injury was significantly less in the intermittent I-R model when compared to that in the unintermittent I-R model in our experimental rat study.

While 68Gallium prostate-specific membrane antigen positron emission tomography/computed tomography (68Ga-PSMA) has demonstrated increasing utility in the evaluation of prostatic carcinoma, it is essential to be aware of false-negative findings. Further subtype analyses of prostate cancer will be helpful in the understanding of the underlying reasons. We herein present a high-grade prostate adenocarcinoma, with metastatic lesions showing high 18F-labeled fluoro-2-deoxyglucose uptake instead of 68Ga-PSMA.

Objective: The aim of this study is to compare the effects of COVID-19 on urology practice using pre- and post-pandemic data of a pandemic hospital. Material and methods: March 11 is considered as the beginning of COVID-19 and, changes in the number of the outpatient clinic examinations, non-surgical procedures, and surgery in the 8-week period before and during the pandemic were evaluated by weeks. Age, gender, and comorbid diseases of the operated patients were compared statistically. The symptoms, complaints, mortality, and morbidity conditions of the patients were recorded by contacting them. Descriptive data and chi-square test were used. Results: The number of COVID-19 cases has been reported as 8,916 for the hospital, 88,412 for the city and 150,593 for the country. The mean age of the operated patients before and after 11 March was 51 and 47, and comorbidities were 79 and 40, respectively, and there was no statistically significant difference(p<0.05). The number of patients examined was 2,309 and 868, the number of operated patients 173 and 94, the number of patients undergoing non-surgical procedures were 371 and 174, respectively. The names and numbers of surgical and non-surgical procedures are listed according to European Association of Urology (EAU) priority classification. In follow-up, no complication because of COVID-19 was observed in any patient. Conclusion: Our study showed that, although the numbers have decreased, similar operations can be performed in daily urology practice without any contamination and mortality during the pandemic compared to the prepandemic period, by taking precautions and following the algorithms.

Aim Although the management of urinary stones in obese patients is a challenge and the impact of the patient-related parameter has been well studied in adults: No study has evaluated the possible impact of obesity in terms of body mass index related SWL success in pediatric population. In this present study, we aimed to evaluate the safety and efficiency of SWL in obese children in a comparative manner with the cases in normal BMI value limits. Patients and methods A total of 66 children (45 boys and 21 girls, M/F:2.1) with renal calculi were treated with SWL. Depending on the BMI values, the children were divided into two groups as; Group 1 (n:50) children with normal BMI values (mean: 16.1) and Group 2 (n:16) obese children with higher BMI values (mean: 20.3). The success rates, complications, and need for auxiliary procedures after SWL were evaluated between two groups of patients in a comparative manner. While majority of the cases were treated under general anesthesia (n:61), a limited number of cases were treated under neurolept anesthesia with PiezoLith 3000 (Richard Wolf GmbH) lithotripter. Evaluation of efficiency was based on radiological examinations using abdominal radiography, ultrasonography, or CT scan when needed. Results Both the mean age and mean stone size values were similar in both groups. While the mean age was 62 months (24–148) in Group 1, this value was 68 months (24–137) in Group 2. Again mean stone size was 10.26 mm(5–25 mm) in Group 1 and 10.12 mm (6–20 mm) in Group 2. The mean number of SWL sessions and the number of SW’s applied were similar in both groups (2.06 vs. 2.0 and 1975 vs. 1835, respectively). Evaluation of success rates after 3-months again did not show any statistically significant difference with respect to stone-free rates in both groups (47/50–94 %, 16/16–100 %, respectively). However, 3 children in Group 1 did show residual fragments (≤3 mm) which were followed closely with regular visits without any problem. In another 3 cases, again fragments migrated to involved ureter after lithotripsy and these fragments were successfully treated in situ with further SWL. With respect to auxiliary procedures, there was no specific procedure has been done in Group 2, but 3 cases did undergo further SWL for ureteral stones in Group 1. Stone location did not affect the final outcome of the procedure in a significant manner in both groups. Lastly, no serious complication could be demonstrated in both groups either during or after SWL procedures. Conclusions In the light of the successful treatment outcomes with limited need for auxiliary procedures in both groups, we may say that obesity might not be a disadvantage for SWL in children with renal stones.

The purpose of the current study was to evaluate the efficacy and safety of laser prostatectomy by using the latest 180-W XPS GreenLight laser with the new MoXy fiber in the surgical treatment of glands larger than 80 mL in a prospective study. From December 2011 to May 2013, 68 consecutive patients with a mean age of 71.1 ± 9.8 years (range 49 to 85) underwent 180-W XPS laser prostatectomy at our institution. The baseline characteristics, perioperative data, and complications were recorded. Evaluation of outcomes was assessed at 3, 6, and 12 months postoperatively comparing subjective (International Prostate Symptom Score [IPSS], International Index of Erectile Function-5 [IIEF-5]) and objective (Maximal flow rate [Q max ], postvoid residual urine [PVR], transrectal ultrasound [TRUS] volume) parameters to the preoperative data. Mean preoperative prostate volume was 104.3 ± 29.7 mL (range 81 to 185). Mean operation time was 65.5 ± 29.6 min (range 38 to 124), with a mean energy delivery of 398 ± 169 kJ (range 39 to 523). The catheterization time was 20.8 ± 1.9 h (range 6 to 92) and the hospital stay was 27.3 ± 8.7 h (range 12 to 80). No major intraoperative complications were observed. Improvement in IPSS, Q max , and PVR was statistically significant ( p  < 0.001) at 3, 6, and 12 months. Urethral strictures were observed in two patients (2.9 %). No patients required reintervention due to residual adenoma. The average volume reduction was 40.5 % at 12 months. Photoselective vaporization of the prostate (PVP) using the new 180-W XPS GreenLight laser system seems to be a safe and effective procedure and could play an important role in the surgical treatment of symptomatic benign prostatic hyperplasia (BPH) patients with larger prostate volumes.

AimsTo outline and evaluate the incidence, management and follow-up of the residual fragments (RFs) following retrograde intrarenal surgery (RIRS) of renal stones by the Turkish Academy of Urology Prospective Study Group (ACUP Study).MethodsFollowing the ethical committee approval, 15 centers providing data regarding the incidence, management, and follow-up of RFs after RIRS were included and all relevant information was recorded into the same electronic database program (https://acup.uroturk.org.tr/) created by Turkish Urology Academy for Residual Stone Study.ResultsA total of 1112 cases underwent RIRS for renal calculi and RFs were observed in 276 cases (24.8%). Of all the parameters evaluated, our results demonstrated no statistically significant relation between preoperative DJ stenting and the presence of RFs (χ2 (1) = 158.418; p = 0.099). RFs were significantly higher in patients treated with UAS (82 patients, 29.3%) during the procedure compared to the cases who did not receive UAS (194 patients, 23.3%) (χ2 (1) = 3.999; p = 0.046). The mean period for a secondary intervention after RIRS was 28.39 (± 12.52) days. Regarding the procedures applied for RF removal, re-RIRS was the most commonly performed approach (56%).ConclusionsDespite the reported safe and successful outcomes, the incidence of RFs is higher, after the RIRS procedure particularly in cases with relatively larger calculi. Such cases need to be followed in a close manner and although a second flexible ureteroscopy is the treatment of choice for fragment removal in the majority of these patients, shock wave lithotripsy and percutaneous nephrolithotomy may also be preferred in selected cases.

PurposeWhite light (WL) is the traditional imaging modality for transurethral resection of bladder tumour (TURBT). IMAGE1S is a likely addition. We compare 18-mo recurrence rates following TURBT using IMAGE1S versus WL guidance.MethodsTwelve international centers conducted a single-blinded randomized controlled trial. Patients with primary and recurrent non-muscle-invasive bladder cancer (NMIBC) were randomly assigned 1:1 to TURBT guided by IMAGE1S or WL. Eighteen-month recurrence rates and subanalysis for primary/recurrent and risk groups were planned and compared by chi-square tests and survival analyses.Results689 patients were randomized for WL-assisted (n = 354) or IMAGE1S-assisted (n = 335) TURBT. Of these, 64.7% had a primary tumor, 35.3% a recurrent tumor, and 4.8%, 69.2% and 26.0% a low-, intermediate-, and high-risk tumor, respectively. Overall, 60 and 65 patients, respectively, completed 18-mo follow-up, with recurrence rates of 31.0% and 25.4%, respectively (p = 0.199). In patients with primary, low-/intermediate-risk tumors, recurrence rates at 18-mo were significantly higher in the WL group compared with the IMAGE1S group (31.9% and 22.3%, respectively: p 0.035). Frequency and severity of adverse events were comparable in both treatment groups. Immediate and adjuvant intravesical instillation therapy did not differ between the groups. Potential limitations included lack of uniformity of surgical resection, central pathology review, and missing data.ConclusionThere was not difference in the overall recurrence rates between IMAGE1S and WL assistance 18-mo after TURBT in patients with NMIBC. However, IMAGE1S-assisted TURBT considerably reduced the likelihood of disease recurrence in primary, low/intermediate risk patients.RegistrationClinicalTrials.gov Identifier NCT02252549 (30-09-2014).

PurposeIt is reported that surgical procedures performed during the COVID-19 pandemic are accompanied by high complications and risks. In this study, the urological interventions applied with appropriate infrastructure and protocols during the pandemic in the pandemic hospital that is carrying out the COVID-19 struggle are analyzed.MethodsUrological interventions were reviewed in the 5-week period between March 11 and April 16. The distribution of outpatient and interventional procedures was determined by weeks concurrently along with the COVID-19 patient workload, and data in the country, subgroups were further analyzed. Patients intervened were divided into four groups as Emergency, High, Intermediate, and Low Priority cases according to the EAU recommendations. The COVID-19-related findings were recorded; staff and patient effects were reported.ResultsOf the 160 interventions, 65 were minimally invasive or open surgical intervention, 95 were non-surgical outpatient intervention, and the outpatient admission was 777. According to the priority level, 33 cases had emergency and high priority, 32 intermediate and low priority. COVID-19 quarantine and follow-up were performed at least 1 week in 22 (33.8%) operated patients at the last week, 43 (66.2%) patients who were operated in the previous 4 weeks followed up at least 2 weeks. No postoperative complications were encountered in any patient due to COVID-19 during the postoperative period.ConclusionIn the COVID-19 pandemic, precautions, isolation, and algorithms are required to avoid disruption in the intervention and follow-up of urology patients; priority urological interventions should not be disrupted in the presence of necessary experience and infrastructure.

ObjectivesVasectomy is a popular and effective male surgical contraceptive method. Different techniques have been proposed to reduce failure rates and complications. In this study, we sought to compare vas deferens occlusion rates using both standard occlusion techniques and LigaSure (LSVS) for vasectomy.Material and methodsA total of nine patients underwent open radical retropubic prostatectomy at our institution. During the procedure, a total of 125 fresh vas deferens samples were obtained and divided into four groups as follows: Group 1: ligation (n = 22), Group 2; ligation and electrocauterization (n = 18), Group 3; 5 mm LSVS (n = 44), Group 4; 10 mm LSVS (n = 41). All specimens were harvested during surgery and subsequent histopathological assessments were performed to assess the luminal status of the vas deferens.ResultsHistopathological evaluation revealed that the majority of vas lumens with LSVS (79.5% of Group 3 and 89.4% of Group 4) were totally occluded. With standard techniques, however, the majority of vas lumens (86.4 and 77.8% of Groups 1 and 2, respectively) maintained a tiny patency.ConclusionsOn histopathological review, the application of LSVS resulted in better occlusion rates, compared to standard ligation methods. These findings suggest a higher occlusive role for LSVS for vasectomy. Further clinical studies are needed to confirm the clinical efficacy and safety of this technique.