Ertugrul Sefik

Objective: This study aimed to investigate the association between the preoperative albumin-to-globulin ratio (AGR) and pathological stage and tumor grade in patients who underwent transurethral resection of bladder tumor (TURBT) for primary bladder tumors.Materials and Methods: A total of 153 patients who underwent transurethral resection of bladder tumor (TURBT) for primary urothelial carcinoma between March 2017 and February 2020 were included in the study. AGR was calculated using preoperative serum albumin and total protein levels. Among the exclusion criteria were active infection, autoimmune disease, hepatic disease, and concomitant malignancy. The optimal AGR cut-off value was determined using receiver operating characteristic (ROC) curve analysis and the Youden index. Independent predictors of pathological stage (NMIBC/MIBC) and tumor grade (low/high Grade) were evaluated using logistic regression analysis.Results: The median age of the patients was 68 years (IQR: 59–75), and 88.9% were male. The pathological stage distribution was Ta in 39.9%, T1 in 39.9%, and T2 in 20.3% of patients, while tumor grade distribution was low Grade in 54.2% and high Grade in 43.1%. The median AGR value of the cohort was 1.32 (IQR: 1.17–1.50). AGR was significantly lower in both the MIBC group (p = 0.003) and the high-grade group (p < 0.001) compared to their respective counterparts. ROC analysis identified an optimal cut-off value of 1.35 for both clinical outcomes (AUC=0.649, 95% CI: 0.542–0.755 for MIBC and AUC=0.656, 95% CI: 0.568–0.744 for high-grade disease). In multivariate logistic regression analysis, AGR was independently associated with both MIBC (OR=0.16, 95% CI: 0.03–0.97; p = 0.046) and high-grade disease (OR=0.18, 95% CI: 0.04–0.74; p = 0.018).Conclusion: Preoperative AGR is independently associated with pathological stage and tumor grade in primary bladder tumors. The ability to calculate this parameter from routine biochemical tests without additional cost makes it clinically valuable for preoperative risk stratification. Further validation of these findings in larger patient cohorts is warranted.

Study demonstrated that antibiotic resistance in the treatment of uncomplicated urinary tract infections varies by geographical region. We believe this comprehensive, national prospective study will provide valuable insights for clinicians planning empirical treatment for uncomplicated urinary tract infections.

Background:This prospective study aims to reveal whether the lesion is a benign pathological process or malignant by measuring ADC values under PI-RADSv2.1 guidance on MpMRI examinations. Additionally, the paper evaluates whether there is a correlation between malignant lesions’ pathological grade and ADC values, and whether ADC values provide noninvasive information about prostate cancer aggressiveness. Purpose:To determine the cut-off ADC values that may exist to identify and distinguish between benign and malignant lesions and also identify cancers with an ISUP score≥2 and cancers with an ISUP score1 defined as silent disease. Methods:This study includes 243 patients and they were diagnosed with TRUS-guided cognitive MRI fusion as tissue diagnosis. MpMRI images were evaluated before biopsy according to PI-RADSv2.1 guideline by a radiologist. Three groups which are benign prostatic tissue, prostatitis, prostate cancer, were obtained according to the histopathological results. Results: When the cut-off value for ADC is 780 x10-3, sensitivity was 80%. When the cut-off value was taken as 668 x10-3, the sensitivity was found to be 72% and specificity 62%. When the cut-off ADC value was taken as 647 x10-3, the sensitivity was 83% and the specificity was 48.5%. ADC values varied significantly according to ISUP groups [p= 0.003]. It was determined that ISUP 1 group was significantly higher than each of the other groups. ADC group mean values did not show a statistically significant difference between Group 2,3,4 and 5. Conclusion:ADC value shows significant potential, and may it improve the diagnostic accuracy.

Purpose Erectile dysfunction (ED) is a worldwide health problem. Oral phosphodiesterase type 5 inhibitors (PDE5I) are used in its first-line treatment. This study aimed to compare the effects of hyperbaric oxygen (HBO) treatment with PDE5I treatment and determine the patient-dependent factors affecting the efficacy of the HBO treatment and duration of action of HBO treatment. Methods Adult male patients who presented to the HBO unit for HBO treatment with non-urological indications and had ED based on the International Index for Erectile Function (IIEF-5) constituted the target population of this study. Participants were given HBO treatment (Group 1), no treatment (Group 2), or daily oral tadalafil 5 mg treatment (Group 3). The treatment duration was 1 month. Patients were assessed by IIEF-5 both initially and after the completion of 1 month. Results There were significant increases in the mean IIEF-5 scores of the patients in Group 1 and Group 3 (p < 0.001, p < 0.001). However, there was no significant improvement in Group 2 (p = 0.496). Also, the post-treatment IIEF-5 scores of Group 1 and Group 3 were significantly higher than Group 2 (p < 0.001). There was no significant difference between the IIEF-5 scores and ∆IIEF-5 values of Group 1 and Group 3 (p = 0.166, p = 0.093). Evaluation regarding comorbidities revealed that patients with the peripheral vascular disease did not improve with HBO treatment (p = 0.285). Conclusion HBO can improve erectile functions, and it can be a reasonable alternative for patients who cannot use PDE5Is due to comorbidities or treatment side effects.

Introduction and hypothesis We aimed to compare on-demand and continuous use of fesoterodine 4 mg concerning efficacy and adverse effects. Methods A total of 100 patients who were diagnosed with non-neurogenic overactive bladder (OAB) syndrome were included in the study. All patients were evaluated with MMSE, ICIQ-SF, SEAPI quality of health and OAB-V8 questionnaires, at the beginning, 1st month and 4th month. Fesoterodine 4 mg was started for treatment. At the end of the 1st month, patients who obtained benefit from the treatment were 1:1 randomized into two groups. In group 1, fesoterodine 4 mg was given 1 × 1 in a standard manner whereas in group 2 patients took the pills on demand. Both groups were evaluated for efficacy and adverse events at 4 months. Results Final analyses included 69 patients. At 4-month follow-up, OAB-V8 scores were significantly improved compared to 1 month in both groups. Again at h months, no difference was detected between the two groups for MMSE, ICIQ-SF and SEAPI scores. In continuous usage group, 4th month MMSE scores were significantly lower than 1st month scores. At 4 months, dry mouth and constipation were lower in the on-demand group compared to continuous usage group. Conclusions Compared to standard continuous usage, on-demand usage of fesoterodine showed similar efficacy with fewer adverse events.

Background: To classify intraoperative and postoperative complications using the modified Clavien classification system(MCCS) and modified Satava classification system(SCS) and to evaluate the parameters associated with complications in patients undergoing retrograde intrarenal surgery(RIRS) for renal and proximal ureteral stones. Materials and Methods: We performed a retrospective analysis of 949 patients who underwent RIRS for renal stones and proximal ureteral stones at two institutions between March 2015 and June 2020. Intraoperative complications were assessed using SCS and postoperative complications were graded according to MCCS. Univariate and multivariate analyses were undertaken to determine predictive factors affecting complication rates. Results: The median stone size was determined as 13 mm (range 10-20 mm). The stone-free rate was 83.6% after the first intervention. Reprocedure was applied to 89 of the patients with residual stones and the final stone-free rate was 94.4% after reprocedure. According to SCS, the number of intraoperative events and complication incidences was 153(16.1%). MCCS revealed postoperative complications in 121(12.8%) patients. Major complications were observed in 18(1.9%) patients. The rate of complications was higher in patients with renal anomalies (9.9% vs 3.4%, p=0.001). Stone location, stone size, stone burden, stone number, stone density and residual fragments were determined to be associated with the development of complications (p<0.001,p<0.001,p<0.001, p<0.001,p=0.002 and p<0.001 respectively). In addition, the multivariate analysis revealed that only presence of residual fragments was a significant predictor of complication development for the patients with Grade≥3 complications according to MCCS (p=0.032). However, significant predictors were stone burden (p<0.001), stone density (p=0.002) and fluoroscopy time (p<0.001) for those with Grade≥2b complications according to SCS. Conclusion: This study showed that abnormal kidney anatomy, operation time, stone burden and residual fragments were reliable predictors of complication development during and after RIRS. Appropriate preoperative management should be planned according to these predictors to prevent intraoperative and postoperative complications.

Purpose: To evaluate the correlation between PI-RADSv2.1 and International Society of Urologic Pathologists (ISUP) score for patients who underwent multiparametric-MRI(MpMRI) prior to transrectal ultrasound (TRUS) guided cognitive fusion biopsy (CF-Bx). And to investigate inter-observer agreement of PI-RADSv2.1. Methods: Patients who underwent MpMRI of prostate prior to first TRUS-guided CF-Bx, were included in this prospective study. MpMRI examinations were evaluated by two radiologists before biopsy according to the PI-RADSv2.1. Interobserver agreement was recorded and the final PI-RADS categorization was performed by consensus. Correlation of histopathological results with PI-RADSv2.1 score was evaluated. Lesions with Gleason Score(GS)≥6 were considered as prostate cancer (PCa). Results: A total of 84 patients with 106 lesions were included in the study. The ratio of PCa in the PI-RADS groups 1,2,3,4,5 was 0%, 0%, 22.2%, 56%, 94.45%, respectively. There was a positive correlation with a value of 0.814 between the PI-RADSv2.1 and the ISUP score. When PI-RADS≥3 is accepted as the cut-off value in peripheral zone(PZ) and the whole gland, the NPV for malignancy was 100.00%. For PI-RADS ≥4, it was 76.47% for PZ, and 80.65% for the whole gland. For the whole gland; sensitivity, specificity, and PPV of the PI-RADS≥3 were 100%, 12.9%, and 44.33%, respectively; for PI-RADS≥4, these values were 72.09%, 80.65%, and 72.09% respectively. Without applying cut-off values, the interobserver agreement for PI-RADS score was κappa:0.562. Conclusions: PI-RADSv2.1 was created in the framework of v2 to facilitate to evaluate MpMRI and to increase interobserver agreement. We believe that further studies will be necessary.