Karavaş, Erdal; Gürel, Safiye; Klyan, Aysu; Halicioǧlu, Slddlka; Daǧistan, Emine

Objectives: The aim of this study is to evaluate the effects of performing computed tomography (CT) urogram in the prone position in terms of diagnosis. Methods: CT urograms of 208 patients imaged randomly in the prone and supine positions were included in this study. A total of 199 patients and 370 collecting systems were examined in total. Axial raw data and reconstructed coronal thin and thick MIP images with a slice thickness of 5 mm were evaluated by 2 independent radiologists blinded to the initial diagnosis. Renal collecting system, ureters, and bladder were included in radiological evaluation. Anatomically, the renal collecting system was separated into 7 regions. Filling and dilatation of collecting systems were evaluated via images at urogram phase by scoring. Results: Filling in lower pole infundibulum (p = 0.006), distal ureter (p = 0.006); and highly dilated lower pole calyx (p = 0.020), pelvis (p = 0.006), and bladder (p < 0.001) were determined to be better in images in the prone position compared to the supine position. There were no statistical differences in other regions. Conclusion: Better contrast material filling is achieved in dilated or non-dilated lower pole collecting system, dilated renal pelvis, non-dilated distal ureter of kidney, and in the bladder only by imaging the urogram phase in the prone position compared to the supine position. Additionally, presence of dilatation is a factor that could adversely affect filling. Studies in the future may investigate the contribution of prone positioning to CT urogram with larger series comparing it with other methods and modalities.

Bozkurt, Aliseydi; Karabakan, Mehmet; Keskin, Ercument; Hirik, Erkan; Can Balci, M.B.; Nuhoglu, Baris

Introduction: Prostatic urethral lift (PUL) is a minimally invasive procedure for the treatment of lower urinary tract symptoms (LUTSs) secondary to benign prostatic hyperplasia (BPH). The PUL procedure involves the placement of implants that retract the obstructing prostate lobes. This procedure achieves quantifiable improvements in functional outcomes and quality of life (QoL), while preserving erectile and ejaculatory functions. Methods: Seventeen patients diagnosed with BPH who had undergone the UroLift procedure between March 2011 and June 2015 were retrospectively evaluated. The parameters evaluated in the pre-operative, intra-operative and 1-year post-operative period were demographic data, and pre-operative, intra-operative and 1-year post-operative results were obtained from the International Prostate Symptom Score (IPSS), Uroflowmetry QoL index, International Index of Erectile Function (IIEF) and Male Sexual Health Questionnaire (MSHQ) for ejaculatory function (MSHQ-EjD). Results: The average improvements from baseline to 12 months after intervention were significant for the total IPSS 9.6. There was a 4.2-point increase in Qmax, a 0.9-point improvement in QoL and a 32% decrease in PVR. No statistically significant difference was found in the IIEF and MSHQ-EjD scores when the pre-operative and post-operative 3rd and 12th month scores were evaluated (p > 0.05). Conclusions: PUL offers rapid improvement in voiding and storage symptoms, QoL and flow rate that is durable to 12 months after intervention. PUL is a minimally invasive procedure that has the moderate effect in treating troublesome LUTS secondary to benign prostatic obstruction and preserving total sexual function.

Akin, Yigit; Yucel, Selcuk; Baykara, Mehmet

Paraneoplastic syndromes (PNSs) are rare disorders which are triggered by an altered immune system response to a neoplasm. Although prostate cancer (PCa) is the second most common urological malignancy associated with PNSs, literature is lacking in defining the cases representing different PNSs in PCa. Herein, we present a 50-year-old man with fulminant distal phalangeal necrosis in the lower extremities after a diagnosis of PCa. Additionally, we review the literature in light of this case.

Arslan, Murat; Akin, Yigit; Ates, Mutlu; Degirmenci, Tansu; Kozacioglu, Zafer; Ors, Bumin; Gunlusoy, Bulent

Aim: To evaluate outcomes of laparoscopic adrenalectomy (LA) and laparoendoscopic single-site surgery (LESS) for adrenal masses in the light of changing laparoscopic surgical techniques. Materials and Methods: Seventy-three patients were analyzed retrospectively. There were 2 groups; group 1 included patients who had conventional transperitoneal LA and transperitoneal LESS, and group 2 included patients who had lateral retroperitoneal LA, retroperitoneal LA in prone position, and retroperitoneal LESS. Demographic data, urine 3-methoxy-4-hydroxymandelic acid, normetanephrine, epinephrine, serum cortisol, aldosterone, adrenocorticotropic hormone, American Society of Anesthesiologists score, side and size of mass, conversion to open surgery, complications, estimated blood loss, operation time, pathological results were recorded and analyzed. Results: There was no difference in demographic data and serum parameters between both groups. Tumor size, estimated blood loss, operation time, transfusion rate and hospital stay were less for group 2 (p < 0.05, p = 0.0001). However, the complication rate was similar in both groups; in retroperitoneal prone position, the complication rate was less than for other surgical approaches, but statistically significant results could not be assessed. Conclusions: Even if the diameter of adrenal mass is larger than 6 cm, LA may be considered as the gold standard. The retroperitoneal approach especially in prone position may be a promising treatment method in the near future for adrenalectomy in selected patients.

Akin, Yigit; Celik, Orcun; Ates, Mutlu; Nuhoglu, Baris; Erdogru, Tibet

Aim: To compare the outcomes of laparoscopic (LRCP) and open radical cystoprostatectomy (ORCP) with orthotopic urinary diversion for muscle-invasive organ-confined bladder cancer by a single surgeon. Patients and Methods: Prospectively documented 15 LRCP and 15 ORCP patients, followed for at least 3 years, were included in our study. The demographic parameters of patients, preoperative radiologic staging, previous operations, surgical outcomes, complications, oncologic results and intermediate-term follow-up, postoperative chemotherapy and follow-up periods were recorded and evaluated. Results: The mean oncologic follow-up was 3 years. Transfusion rate, estimated blood loss, oral intake and narcotic analgesic requirement were statistically less in the LRCP group (p < 0.05). However, operation time and hospital stay were similar in both groups. The complication rates were not significantly different between the two groups. The mean number of dissected lymph nodes was 20.0 ± 1.7 in the ORCP and 22.6 ± 2.0 in the LRCP group. One patient in each group had a margin positive for bladder cancer. Conclusions: The laparoscopic approach may be feasible for muscle-invasive organ-confined bladder cancer. Furthermore, LRCP provides less blood loss, early oral intake and postoperative pain management. Additionally, continence and sexual function may be provided by LRCP as with ORCP.