Mehmet Fatih Akbulut

Editorial Comment on: Are Infertile Men Less Healthy than Fertile Men? Results of a Prospective Case-Control Survey

There is an increasing emphasis in the literature that infertility and testicular cancer have been linked. Infertile men with abnormal semen analyses have a 20-fold greater increase of testicular cancer compared with the general population [1]. Meanwhile, recent evidence suggests that men with male factor infertility have an increased risk of subsequently being diagnosed with colorectal cancer, melanoma, and prostate cancer [2]. Furthermore, the present study showed that male factor infertility accounts for higher scores on the Charlson Comorbidity Index (CCI), which is used to mirror general health status [3]. Thus, it is rational to consider that all associations point out common etiologic factors such as genetic defects (eg, DNA mismatch repair) that predispose individuals for some cancers and other health problems. Accordingly, identification of these associations and underlying possible mechanisms merit further investigation. Before drawing firm conclusions from the present study [3], some limitations should be noted. First, as the authors mentioned, the power of the study is limited for deriving general conclusions. Large-scale populationbased studies are needed to confirm the outcomes mentioned in the study. Second, the authors used a general definition of infertility and rough data on the infertility of 344 men. Thus, the etiology of infertility such as types of azoospermia, coexistence of varicocele, or hormonal problems is not known. In further studies, the etiology of infertility should be included in the analyzed data and taken into consideration by the authors. This issue is also valid for details of other medical problems such as cardiovascular diseases. Despite these limitations, Salonia et al [3] provided novel evidence that infertile patients may have serious medical problems and that urologists should carefully watch these patients for medical problems other than infertility.

Laparoscopic transperitoneal adrenalectomy: Our initial results.

OBJECTIVE To present the first 24 laparoscopic adrenalectomies performed in our clinic because of an adrenal mass. MATERIAL AND METHODS The medical files of 24 patients who underwent laparoscopic adrenalectomy between December 2008 and March 2013 at Haseki Teaching and Research Hospital were analyzed retrospectively. The demographic characteristics of the patients were recorded. Lateral transperitoneal laparoscopic adrenalectomy was performed in all patients. The operation time was defined as the interval between the first incision of the skin and closure of the skin. Intraoperative complications, estimated blood loss and hospital stays of the patients were evaluated. Final pathologies were recorded. RESULTS The mean age of the patients was 44.2±8.58 years (range: 29-66 years). Nine patients were female and 15 were male. A total of 24 masses were identified in the right (n=11), and left (n=13) adrenal glands masses were identified., Eighteen patients (75%) had no symptoms, and the masses were identified incidentally. The mean operation time was 144±46.1 minutes (range: 90-320 minutes), and the mean blood loss was 74±12.3 mL (range: 50-130 mL). None of the patients required a blood transfusion. In one patient, liver injury was identified intraoperatively due to traction. The mean duration of hospitalization was 2.9±1.1 days (range: 2-5 days). Adrenocortical adenoma and pheochromocytoma were the most common pathologies. CONCLUSION Laparoscopic adrenalectomy is a safe and effective method for the treatment of adrenal masses with low complication rates.

Is standard percutaneous nephrolithotomy still the standard treatment modality for renal stones less than three centimeters

OBJECTIVE The aim of study was to compare the efficiency and safety of standard percutaneous nephrolithotomy (sPNL) and miniaturized percutaneous nephrolithotomy (mPNL) in lower calyx and/or pelvic stones smaller than three centimeters. MATERIAL AND METHODS From October 2010 to August 2015, 108 mPNL and 176 sPNL procedures were performed for renal stones smaller than three cm and located in the lower calyx and/or renal pelvis. All patients were evaluated preoperatively with intravenous pyelography and/or computed tomography. Intraoperative parameters, post-operative results and complications were recorded. Postoperative success was defined as complete stone clearance and/or clinically insignificant residual fragments at 3rd month. RESULTS Preoperative characteristics were similar between sPNL and mPNL groups except previous renal stone operation history and gender. The mean operation time was significantly shorter in the sPNL group (p<0.001). The mean hemoglobin drop was significantly less in the mPNL group (p=0.001), we found a 1.27±1.4 and 0.5±1.3 decrease in mean hemoglobin levels (mg/dL) in the sPNL and mPNL groups, respectively. Transfusion rate was 1.9% in mPNL and 5.6% in sPNL groups, and the difference was statistically significant (p=0.048). Only one patient in the sPNL group needed angiography and embolization. Postoperative JJ stent insertion rate was significantly higher in the mPNL group (p=0.03). CONCLUSION Both sPNL and mPNL are safe and effective surgical procedures for lower calyx and/or pelvis stones smaller than 3 cm. However, use of smaller caliber instruments was associated with a lesser hemoglobin drop and need for transfusion.

Bleeding during laparoscopic partial nephrectomy: Can a hemostatic matrix help to improve hemostasis?

OBJECTIVES To evaluate the possible role of an hemostatic matrix on hemostasis, perioperative outcomes and complications in patients who underwent laparoscopic partial nephrectomy (LPN). MATERIALS AND METHODS Patients charts were analyzed retrospectively and their demographic characteristics, operative parameters and follow-up results were recorded. Patients were divided into two groups, according to those who used an hemostatic matrix as Group 1 (n = 41) and those who did not used as Group 2 (n = 44). Demographic characteristics of patients, tumor features, operation time, clamping of the renal vessels, ischemia time, suturing of the collecting system, perioperative hemorrhage and complications were evaluated. Histopathological results, surgical margin status, creatinine level and recurrence at the 3rd month of follow up were analyzed. Statistical analyses were performed with SPSS 17.0 and significance was set at p value of < 0.05. RESULTS The mean RENAL nephrometry score was 5.9 ± 2.0 and the mean tumor size was 35 ± 12 mm. All patients had a single tumor and 44 of them had a tumor in the right kidney. The renal artery was clamped in 79 cases and the mean ischemia time was 20.1 ± 7 minutes. The mean tumor size and the mean RENAL nephrometry score was statistically higher in Group 1 (p: 0.016 and p < 0.001, respectively). Pelvicaliceal repair was more common in Group 1 due to deeper extension of tumors in this group (p: 0.038). In Group 1, less hemorrhage and blood transfusion requirement, with shorter ischemia and operation time was detected. CONCLUSION The outcomes of the recent study showed that adjunctive use of an hemostatic matrix improves hemostasis and decreases hemorrhagic complications during LPN. Further prospective studies are required to assess the potential role of an hemostatic matrix in LPN.

Does body mass index effect the success of percutaneous nephrolithotomy

OBJECTIVE In obese patients, the management of renal calculi presents a number of challenges for urologists. In this study, we aimed to evaluate the efficacy and safety of percutaneous nephrolithotomy (PNL) procedure in obese and morbidly obese patients. MATERIAL AND METHODS We retrospectively reviewed the medical files of 2360 patients treated with PNL between March 2002 and April 2013. The patients were stratified into four groups according to the World Health Organization (WHO) classification of body mass index (BMI): <25 kg/m(2) (average), 25-29.9 kg/m(2) (overweight), 30-39.9 kg/m(2) (obese), and >40 kg/m(2) (morbidly obese). Patients under 18 years of age and those with a body mass index under 18 kg/m(2) were excluded from the study. Intra-, and postoperative outcomes of PNL were compared between groups. RESULTS A total of 2102 patients with a mean age of 43±13.62 years were enrolled in the study. The mean stone size, mean number of stones, staghorn stone rate and history of previous shock wave lithotripsy were similar in all groups. The overall stone-free rate was 82 percent. The mean operation time was longer in the morbidly obese group but it was not significantly different from that in the other groups. No differences were observed in hospital stay, complication or stone-free rate among four study groups. CONCLUSION Percutaneous nephrolithotomy is a safe and effective treatment for renal stone disease. Body mass index does not affect the success or complication rate in PNL.