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Butterfly vertebra and block vertebra are usually reported incidental radiological view, which is a rare congenital defect of spine. Butterfly vertebra is a body formation characterized by anterior and median aplasia. The block vertebra is the result of an embryonically incomplete separation of vertebral bodies or arches or both. This rare congenital anomalies butterfly and block vertebra are usually stable and do not cause clinical symptoms.

Objective: The coronavirus disease 2019 (COVID-19) pandemic disrupted all routine health care services and resulted in a significant reconfiguration of urologic cancer services and care pathways across the globe. This study aimed to retrospectively determine the pandemic’s impact on the urologic oncological surgery outcomes at a high-volume referral center.Materials and methods: We compared the number and histopathological outcomes of urologic oncological procedures in a referral center coded during the pandemic and data of the period before the pandemic as control. Data were extracted from patient files and hospital records. The pathological examination included a complete histopathological staging according to TNM stage.Results: A total of 683 patients were included in the study, 424 (62%) of which were operated in the pre-pandemic period. There was a 39% decline in urologic oncological surgical activity in the pandemic, mostly in renal and prostate cancer. The mean tumor size was larger in renal cancer patients who underwent surgery during the pandemic (5.6 cm vs 4.5 cm, p=0.002). During the pandemic, more lymph node involvement was seen after radical cystectomy and prostatectomy (50% vs 27.8%, p=0.024 and 12.5% vs 4.5%, p=0.026, respectively). No differences in terms of main pathologic features were observed in patients undergoing radical orchiectomy.Conclusion: COVID-19 appeared to adversely effect oncologic outcomes in patiens undergone surgery for prostate and bladder cancer. Tumor development induced by a delay in diagnosis may cause severe consequences for patients. Reprioritizion of non-deferrable urologic oncological seems crucial.

Purpose We aimed to examine the expression levels of the genes encoding adenomatous polyposis coli (APC) 1, APC-2, Dickkopf related protein (DKK)-1, DKK-3, secreted frizzled-related protein (SFRP)-2, SFRP-4, and SFRP-5, which play roles in the Wnt signaling pathway, in lung adenocarcinoma and adjacent normal lung tissues and to evaluate their relationships with clinicopathologic factors. Materials and methods The expression levels of genes in formalin-fixed paraffin-embedded samples of tumor tissue and adjacent intact lung tissue from 57 patients who underwent surgery for lung adenocarcinoma between 2011 and 2018 were determined by real-time PCR analysis. Results The expression levels of the DKK-1 in tumor tissue, especially in stage I–II tumor tissue, were significantly suppressed compared to those in normal tissue (p < 0.025). Whereas DKK-1 expression was suppressed in the tumor tissue of patients with early-stage lung adenocarcinoma, expression of the SFRP-5 in these patients was significantly higher in tumor tissue than in normal tissue (p < 0.039). Conclusion In our study, opposing regulation was found between the SFRP-5 and DKK-1, which are known to be extracellular antagonists of the Wnt signaling pathway. The SFRP-5 was found to have an oncogenic role in adenocarcinoma development. Studies of the opposing regulation between these genes in early-stage lung adenocarcinoma may shed light on the mechanisms associated with the development of carcinogenesis. The relationships or interactions of these genes may serve as potential therapeutic targets.

Upper tract urothelial carcinoma (UTUC) is less common than bladder cancer, but its incidence is increasing. Neoadjuvant chemotherapy (NAC) has been the treatment focus for locally invasive and high-grade UTUC. Herein, we aimed to present a case of a locally advanced non-metastatic UTUC, which was thought to be unresectable due to local invasion, but surgically treated successfully after NAC. A 64-year-old male patient was admitted to another hospital because of right flank pain, which was not accompanied by macroscopic haematuria. He did not have comorbidities in his anamnesis, but he had a history of smoking 40 packs/year. A locally invasive right kidney tumour was detected in cross-sectional imaging performed at another hospital. He underwent surgery in that hospital, but radical nephroureterectomy could not be performed because of local invasion. He presented to our urology department. He was subsequently started with cisplatin-based NAC, which led to the resolution of local invasion. After NAC, right radical nephroureterectomy and ipsilateral bladder cuff excision with subcostal and Gibson incisions were performed. No signs of mass invasion or lymph node involvement were detected intraoperatively. He was examined 3 months after surgery. On cystourethroscopy, the bladder was normal and cytology was benign. No recurrence or metastasis was detected on the whole-body computed tomography. NAC is one of the valuable multimodal treatment options, enables surgery in locally invasive UTUC and contributes positively to survival rate. Keywords: Oncology, urooncology, urothelial carcinoma, nephrectomy, nephroureterectomy, neoadjuvant chemotherapy

Objective: There is no clear consensus on which patients and how many of microscopic testicular sperm extraction (mTESE) procedures will be successful. In this study, we aimed to evaluate the sperm retrieval rates and factors affecting these rates in men who underwent repeat mTESEs. Material and methods: A total of 346 patients who underwent mTESE for sperm retrieval were included in the study. Patients were divided into groups according to the number of mTESE operations. Patients’ karyotype, follicle-stimulating hormone (FSH) and testosterone levels, varicocele presence, and testis volumes were recorded from patient files. The sperm retrieval rates were compared between groups, and predicting factors for successful sperm retrieval were evaluated. Results: Microscopic TESE was applied for the first time in 244 patients, 1-2 times in 73 patients, and 3-4 times in 29 patients. There was a significant difference between groups in preoperative FSH values and postoperative testicular histopathology (p=0.004 and p<0.001). The sperm retrieval rate in the group of patients who had not undergone previous TESE was higher than the group of patients that had undergone TESE for 1-2 times and 3-4 times (p=0.028). In addition, testicular volume, histology, karyotype, and Y-chromosome microdeletion were predicting factors for successful sperm retrieval (p=0.011, p=0.039, p=0.002, and p<0.001, respectively). Conclusion: Our results confirm the necessity for repeat mTESE operations to be performed by experienced surgeons in reference centers to optimize the chance of reduced sperm retrieval rates with recurrent biopsies. Cite this article as: Kızılay F, Semerci B, Şimşir A, Kalemci S, Altay B. Analysis of factors affecting repeat microdissection testicular sperm extraction outcomes in infertile men. Turk J Urol 2019; 45(Supp. 1): S1-S6

Objective: To compare the abdominal and transvaginal techniques in the surgical treatment of vesicovaginal fistula (VVF) and analyze the factors affecting its recurrence rate. Materials and Methods: Patients were divided into two groups according to the operation technique used (abdominal-transvaginal) and the recurrence status (recurrent and non-recurrent). The primary endpoint of the study was the comparison of the factors related to fistula and surgical techniques. Results: The number of cases with radiotherapy history was found to be higher in the recurrent group (68.2% vs 11.5%, p<0.001). Although fistulas were more subtrigonally located in the transvaginal repair group, the supratrigonal localization was more frequent in those operated with abdominal technique (p=0.019). While the rates of first and second recurrences were more in the cases managed by the transvaginal technique (p=0.041), the length of hospitalization and the mean operation time were longer in women managed by abdominal technique (p=0.025 and p=0.019, respectively). Conclusion: The abdominal technique provides more favorable outcomes by allowing extensive tissue exposure and omental tissue flep in the surgical treatment of VVF. Patients with a history of radiotherapy are more likely to have a recurrence after the surgery and repetitive treatment may be needed.

Paraneoplastic syndromes are systemic disorders developing in response to any neoplasm and may have various clinical symptoms depending on the affected organ system. Hypercalcemia, one of the renal cell carcinoma (RCC) - Related Paraneoplastic syndromes, occurs in approximately 20% of patients with RCC. Although clinical conditions such as paraneoplastic hypercalcemia and polycythemia are more common complications of RCC, there are rarer paraneoplastic syndromes such as hepatic dysfunction, galactorrhea and Cushing’s syndrome. It has been reported that RCC accounted for 2% of all cancers responsible for for Cushing’s syndrome and the symptoms associated with Cushing’s syndrome remited after surgical treatment. In our patient, although serum isolated adrenocorticotropic hormone, aldosterone and cortisol levels were normal, there was treatment resistant hypokalemic metabolic alkalosis and this was not related to Cushing’s syndrome. Complete normalization of the clinical picture and laboratory values after radical nephrectomy suggests that hypokalemic metabolic alkalosis may be a Paraneoplastic syndrome associated with RCC.