Erhan Demirelli

Smoking’s Negative Effect on Pathological Grade and Stage in Patients with Primary, Single, < 3cm Bladder Cancer

Article 1 Smoking’s Negative Effect on Pathological Grade and Stage in Patients with Primary, 2 Single, < 3cm Bladder Cancer 3 4 Ercan Öğreden*, Ural Oğuz, Erhan Demirelli, Orhan Yalçın 5 Giresun University, Faculty of Medicine, Department of Urology, Giresun, Turkey 6 *Correspondence: ercanogreden@gmail.com; Tel.: +9 0 505 896 3960 7 Abstract: Introduction: We investigated the potential effect of smoking on pathological 8 staging in clinically low-risk patients. Material-Methods: Data of 59 patients who were 9 diagnosed with a bladder tumor for the first time and had a single lesion radiologically and 10 endoscopically smaller than 3 cm were investigated, retrospectively. A total of 33 patients 11 who currently smoke or smoked were classified as ever smokers group and 26 patients who 12 did not ever smoke were classified as never smokers group. Pathological diagnoses of the 13 patients in both groups were compared. Results: A total of 9 patients (27.3%) in ever smokers 14 group and 18 patients (69.2%) in never smokers group had Ta disease (p<0.05). Morover, 19 15 patients (57.6%) in ever smokers group and 5 patients (19.2%) in never smokers group had T1 16 disease (p<0.05). The number of patients with low grade (LG) tumor were 8 (24.2%) and 19 17 (73.1%) in ever smoking and never smoking groups, respectively (p<0.05). The number of 18 patients with high grade (HG) tumor were 25 (75.8%) and 7 (26.9%) in ever smoking and 19 never smoking groups, respectively (p<0.05). Ta HG was detected in 9 (27.3%) patients in 20 ever smoking group. In contrast, no patients in never smoking group had Ta HG disease 21 (p<0.05). The number of patients with T1 HG was 17 (51.5%) in ever smoking group and 2 22 (7.69%) in never smoking group (p<0.05). Conclusion:Smoking seems to associate with 23 pathologically worse stage and grade in patients with primary, single, < 3cm bladder cancer. 24

Relationship between Response to PDE5 Inhibitors and Penile Duplex Doppler Ultrasound in Erectile Dysfunction

The relationship between the results of penile duplex Doppler ultrasound (PDDU) and response to vardenafil was investigated in patients diagnosed with erectile dysfunction (ED). Data from 148 patients with ED were analyzed retrospectively. Patients who did not respond to therapy were classified in to Group I (n = 32), those who responded partially were classified into Group II (n = 40), and complete responders were classified into Group III (n = 76). Age, comorbidities, and vascular and penile pathologies were compared among the three groups. While diabetes mellitus (DM) and dyslipidemia positivity adversely affected the response to treatment, the presence of hypertension (HT), Peyronie’s disease and priapism increased the therapeutic response to the treatment (p < 0.05). Arterial insufficiency was present in 20 (30.3%), 25 (37.9%) and 21 (31.8%) of the patients in Group I, Group II and Group III, respectively (p = 0.001). Venous insufficiency was observed in three (14.3%) patients in Group I and in eight (85.7%) patients in Group III (p = 0.001). Arterial/venous insufficiency was seen in 9 (30%), 14 (46.7%) and 7 (23.3%) of the patients in Group I, Group II and Group III, respectively (p = 0.001). The response rate to treatment was highest in normal patients according to PDDU, followed by patients with venous insufficiency. In addition, it was found that DM decreased the response to treatment, whereas the response increased in cases with HT, priapism and Peyronie’s disease.

The impact of ureteral Double-J stent insertion following ureterorenoscopy in patients with ureteral stones accompanied by perirenal fat stranding

OBJECTIVE To evaluate the impact of ureteral stent insertion following semirigid ureterorenoscopy (URS) in patients with perirenal fat stranding (PFS) due to ureteral stones. MATERIAL AND METHODS Data of 600 patients who underwent URS were analyzed retrospectively. Seventy-two patients detected to have PFS accompanying ureteral stone were included. Patients who did not undergo double J (DJ) stent insertion following semirigid URS were classified as Group I (n: 52), while those who underwent stent insertion were classified as Group II (n: 20). Side distribution; localization of the stones, stone size, presence of fever, urinary tract infection (UTIs) and urosepsis rates were compared in the two groups. RESULTS The average age of the patients was 44.4 (20-71) years. Male/female ratio and side of the stone location showed similar distribution in both groups (p > 0.05). Fever occurred in 23 cases (44.2%) in Group I and in 15 cases (75%) in Group II (p = 0.038). UTIs occurred in 15 cases (28.9%) in Group I and in 12 cases (60%) in Group II (p = 0.03). Urosepsis presented in 3 (5.8%) and 5 (25%) of the patients in Group I and II, respectively (p = 0.033). CONCLUSIONS According to our results, ureteral DJ stent insertion following URS in patients with PFS due to ureteral stone caused an increase on postoperative infection related complications.

The evaluation of the readability of informed consent forms used for urology: Is there a difference between open, endoscopic and laparoscopic surgery?

OBJECTIVE The aim of this study is to evaluate the readability levels of informed consent forms used in Turkey before urological surgery and to compare the readability levels of open, endoscopic, and laparoscopic surgical informed consent forms. MATERIAL AND METHODS A total of 529 informed consent forms used for urological open, endoscopic, and laparoscopic surgical procedures were collected from different hospitals in Turkey. Evaluating informed consent forms that have exactly the same text only once, a total of 69 consent forms were evaluated. The Gunning Fog Index and Flesch-Kincaid test measuring the general readability level were used to calculate the readability level of informed consent forms in addition to the Ateşman and Bezirci-Yılmaz formulas defined to determine the readability level of Turkish texts. Informed consent forms were evaluated and divided into three groups as open, endoscopic, and laparoscopic surgery forms, depending on their content. RESULTS Among 69 informed consent forms evaluated, 35 were open, 19 were endoscopic, and 15 were laparoscopic surgery consent forms. The readability level of all informed consent forms was detected as average according to the Ateşman formula, very difficult according to the Flesch-Kincaid test, difficult according to the Gunning Fog Index, and at the high school education level according to the Bezirci-Yılmaz formula. A statistical evaluation of the three groups did not show a significant difference in the readability level. CONCLUSION In this study, it was detected that the informed consent form readability levels used for urological surgical procedures in our country were rather low. We think that the cooperation of the concerned institutions is required for the revision of the consent information texts available and the improvement of the texts according to the strategies recommended.

Comparison of response to treatment of unilateral and bilateral varicocelectomy

BACKGROUND/AIM We aimed to compare the results of unilateral and bilateral varicocele surgery. MATERIALS AND METHODS In two referral hospitals, the data of 180 patients who were treated with unilateral and bilateral microscopic varicocelectomy were retrospectively analyzed. Sperm parameters and spontaneous pregnancy rates were compared in patients who underwent bilateral and unilateral microscopic varicocelectomy. RESULTS The mean age was 29.6 (17-46) years. While 82 patients underwent unilateral varicocelectomy (Group I), 98 patients underwent bilaterally varicocelectomy (Group II). Forty (48.8%) spontaneous pregnancies occurred in Group I and 59 (60.2%) in Group II. When we analyzed sperm parameters, the rate of increase in the number of sperm in spermiograms was 17% in Group I and 27.5% in Group II. The rate of increase in sperm mobility was 58.5% and 50% in Group I and II, respectively. The improvement rate in sperm morphology was 46.3% in Group I and 56.1% in Group II. There were no significant differences between all these parameters. CONCLUSION In light of our results, although pregnancy rates seemed to be higher in patients who underwent bilateral varicocelectomy, these results were not statistically significant. Improvement rates in sperm parameters were similar between the patients who underwent unilateral and bilateral varicocelectomy.

Categorization of ureteroscopy complications and investigation of associated factors by using the modified Clavien classification system.

BACKGROUND/AIM The purpose of the present study was to review the complications of ureteroscopy (URS) by using the modified Clavien classification system (MCCS) and to investigate the factors associated with complications. MATERIALS AND METHODS Data regarding 811 patients who underwent URS for ureteral calculus were analyzed. Peroperative and postoperative complications were recorded. The patients were divided into seven groups depending on the severity of the complications. The association of sex, stone size, number, and localization with each MCCS grade was also evaluated. RESULTS The average age was 45 years. The success of the procedure after one session was 93.5%. Complications were recorded in 57.9% of the patients. According to the MCCS, grade I, II, IIIa, IIIb, IVa, IVb, and V complications were documented in 29.8%, 7.1%, 8.6%, 11%, 0%, 1.2%, and 0% of the patients, respectively. The factors associated with the complications graded by MCCS were sex, stone size, number of stones, and localization. In addition, in multivariate analysis, history of previous surgeries for urolithiasis, orifice dilatation, and instrument size were associated with complications. CONCLUSION According to MCCS, sex, history of previous surgeries for urolithiasis, orifice dilatation, size of the instrument, stone size, number of stones, and localization are associated with different grades of complications in URS.

The effect of breastfeeding on spontan resolution of monosymptomatic enuresis.

ABSTRACT Purpose The aim of this study was to examine whether the duration of breastfeeding during infancy was associated with the time of spontaneous resolution of monosymptomatic enuresis (SRME). Materials and Methods A total of 1500 people were surveyed at four centers. One hundred and eighty-one people with a history of monosymptomatic enuresis (ME) who received no treatment and had no day time symptoms were included in the study. The relationship between the duration of breastfeeding and SRME was assessed by considering the duration of breastfeeding as both continuous and categorical (cut-off value 5 months) variable. The multivariate general linear model was used to identify independent predictors such as gender, family history, and educational status of parents. Results Pearson correlation analysis of the age of SRME and duration of breastfeeding found no statistically significant relationship. However, there was a significant difference in the age of SRME of those who were breastfed for 5 months or less compared to those who were breastfed for more than 5 months. According to the multivariate analysis, gender and educational status of parents were not effective on the age of SRME. Stepwise linear regression model showed that breastfeeding for five months or less and family history could affect the age of SRME. The regression formula was: age of SRME=9.599 + (3.807×five months or less of breastfeeding) + (1.258×positive family history). Conclusions It was found that when breastfeeding lasted for more than 5 months, there was a positive contribution to SRME.

The effect of the presence of a high-grade tertiary Gleason pattern in radical prostatectomy specimens on histopathological results and failure of biochemical treatment

Objective: The aim of this study was to analyze the effect of a high-grade tertiary pattern in radical prostatectomy (RP) specimens on the histopathological results and PSA progression. Material and methods: In this study, specimens from 71 patients with clinically localized prostate cancer who underwent RP between January 2007 and January 2011 in our department, who regularly attended their follow-up visits and who had a Gleason score of 5-8 (5 and 8 included) were reanalyzed by a single pathologist. The patients were evaluated for the presence of a high-grade tertiary Gleason pattern (Gleason 4 or 5). We investigated the effect of the tertiary pattern on the histopathological results and PSA progression. The patients were followed with testing for the free and total levels of PSA and given a digital rectal examination quarterly for the first two years, semiannually for the next 2 years, and annually for the remaining period. An increase in the serum total PSA count of 0.2 ng/mL or more was considered to represent PSA progression. The statistical analysis in this study was performed with SPSS for Windows Version 15.0 (Inc., Chicago, IL). p<0.05 was accepted as significant. Results: The incidence of a high-grade tertiary pattern in RP specimens was found to be 15.4%. The patients were categorized into groups that were positive or negative for a tertiary pattern. When compared with the other group, the tertiary pattern positive group had higher preoperative PSA levels (p=0.469), more frequent extracapsular extension (p=0.031), more frequent lymph node (p=0.05) and seminal vesicle invasion (p=0.022) and more advanced disease in terms of the pathological stage (p=0.005). The patients were followed up for an average of 36,3 months postoperatively. PSA recurrence was found to be significantly higher in the tertiary pattern positive group (p=0.001), and the PSA progression time was shorter (p=0.001). There was no statistically significant difference between the two groups in terms of preoperative age, clini cal stage, Gleason score and surgical margin positivity. When we investigated the effects of a high-grade tertiary pattern, extracapsular extension, seminal vesicle invasion, surgical margin positivity and Gleason scores on PSA recurrence according to the multivariate Cox regression analysis, only the presence of a highgrade tertiary pattern had a significant effect on PSA recurrence (p=0.034). Conclusion: The presence of a high-grade tertiary pattern in the Gleason scores of RP specimens is associated with poor histopathological results and with postoperative biochemical failure. We believe that prospective studies with a higher number of patients and longer follow-up periods will more distinctly reveal the prognostic value of the tertiary pattern.