Umut Ünal

Purpose: The aim of this study was to evaluate inflammatory parameters to differentiate between testicular torsion (TT) and epididymo-orchitis in patients presenting to the emergency department with acute scrotal pain. Materials and Methods: The study analyzed 241 adult patients who were presented with acute scrotal pain at a tertiary hospital's ED between January 2012 and December 2023. Results: The cohort comprised 137 patients (56.8%) with epididymo-orchitis and 104 (43.2%) with TT. Median symptom duration was 24 hours (24–48 hours) for epididymo-orchitis cases versus 6 hours (4–10 hours) for torsion cases. Laboratory analysis revealed significantly elevated mean values of monocytes, blood urea nitrogen (BUN), BUN/Albumin ratio (BAR), and Monocyte/Lymphocyte Ratio (MLR) in epididymo-orchitis patients compared to torsion cases, while hemoglobin and albumin levels were significantly lower. As a result of the cox regression analysis revealed that albumin, age and body temperature were independent predictors of the diagnosis. A significant and moderately negative correlation was found between symptom duration and albumin levels. The AUC value of albümin was 0.842 and sensitivity was 80.8% and specificity was 71.5% when the cut-off value was taken as 4.05 mg/dl in the power to predict the presence of testiculer torsion. Conclusion: Albumin level, significantly associated with symptom duration, is a valuable predictor in distinguishing testicular torsion from epididymo-orchitis in patients with acute scrotal pain.

Objective: The aim was to evaluate the effect of yellow and red centaury St. John’s Wort (St. JW) oil on inflammation and urethral fibrosis development in a rat urethral trauma model. Methods: A total of 24 male rats were divided into 5 groups. No urethral damage was induced in the sham group. The urethras of all rats in the other groups was traumatized at 6 o’clock with a specially designed urethrotome blade. Group 1 was administered 0.5 cc of St. JW oil once daily for 15 days. Group 2 was administered 0.5 cc of red centaury oil intraurethrally once daily for 15 days. The traumatized rats in Group 3 were not treated (St. JW and red centaury oil were not administered). St. JW oil was administered to 3 rats in the Sham 1 group (Group 4), and red centaury oil was administered to 3 rats in the Sham 2 group (Group 5). A 20-G/32-mm intravenous cannula sheath was used for intraurethral administration. On the 15th day, rats were sacrificed and penectomy was performed for histologic evaluation. Results: Spongiofibrosis, mucosal inflammation, and congestion were significantly decreased in the yellow St. JW oil group when compared with the red centaury oil group and the untreated group (group to which neither St. JW nor red centaury oil was administered). Conclusion: In this study, intraurethral administration of yellow St. JW oil was found to significantly reduce mucosal inflammation, spongiofibrosis, and obstruction after urethral trauma. According to the results of this study, we think that St. JW oil may be a promising option in the treatment of urethral stricture. Cite this article as: Yelsel K, Alma E, Yüceer Ö, et al. The effect of St. John’s Wort oil on urethral stricture: an experimental study in rat model. Urol Res Pract. 2024;50(4):261-266.

Introduction: We aimed to present our single incision two-lobe technique, which we developed in our own clinic and performed by a single surgeon and to compare the results of this technique with the results of Gilling's 3-lobe technique, which we applied before. Material Method: HOLEP was performed in 200 patients with medically resistant lower urinary tract symptoms (LUTS) and BPH, regardless of prostate size, between December 2018 and August 2022 in our urology clinic. All operations in the study were performed by a single surgeon who had completed the HoLEP learning curve, was well versed in endoscopic surgery, and had high experience. The classical Gilling 3-lobe method was preferred in the first hundred cases after the cases in the first fifty cases learning curve (Group 1, n=100). Due to some difficulties in the technique after the experience in the first hundred cases, the single incision two-lobe technique, which was created by referencing and modifying Scoffone's en bloc no touch technique, was used in the next hundred cases (Group 2, n=100). Results: The average age of a total of 54 patients who underwent surgery due to a retroperitoneal mass was 53.8±10.0 years. While 15 (27.8%) of 54 patients with a retroperitoneal mass were diagnosed incidentally, 39 (72.2%) patients were diagnosed symptomatically. The final pathological outcome of all relapsed patients was liposarcoma. The average operation time was 178.7±85.4 minutes. The average length of stay of the patients was 6.2±3.1 days. Additionally, all of these patients had organ resection. In the Kaplan-Meier survival analysis, it was found that surgical margin had a statistically significant effect on average survival (p<0.001). Conclusion: In our modified single-incision two-lobe technique, the eneculation time and probe residence time are shorter than the classical gilling method.

Introduction: The aim of our study is to evaluate the results of patients who underwent surgery due to primary retroperitoneal tumors in order to contribute to the knowledge pool in the literature. Material Method: The data of patients who underwent surgery due to retroperitoneal tumor at Health Sciences University, Adana City Training and Research Hospital between January 2015 and January 2023 were retrospectively scanned. Approximately 54 patients with a clinical diagnosis of PRT were included in the study. Preoperative demographic characteristics of the patients, such as age at diagnosis, gender, number of surgeries for PRT, preoperative biopsy pathology and symptom status, if any, were recorded. All patients underwent computed tomography (CT) imaging with intravenous contrast. The location, size, density and presence of contrast enhancement of PRT in preoperative imaging methods were recorded. Peroperative incision type and duration, need for erythrocyte suspension transfusion, need for organ resection, complications and length of stay in the postoperative period were evaluated. Results: The average age of a total of 54 patients who underwent surgery due to a retroperitoneal mass was 53.8±10.0 years. While 15 (27.8%) of 54 patients with a retroperitoneal mass were diagnosed incidentally, 39 (72.2%) patients were diagnosed symptomatically. The final pathological outcome of all relapsed patients was liposarcoma. The average operation time was 178.7±85.4 minutes. In 12 (22.2%) patients, adjacent organ resection was performed in addition to the mass. The average length of stay of the patients was 6.2±3.1 days. In the postoperative period, one patient required re-operation due to ileus and one patient due to bleeding. Adjuvant therapy was given to 6 (11.1%) patients after surgery. In the final pathology results of the patients, positive surgical margins were detected in 8 (14.3%) patients. Additionally, all of these patients had organ resection. In the Kaplan-Meier survival analysis, it was found that surgical margin had a statistically significant effect on average survival (p<0.001). Conclusion: According to the results of our study, microscopic surgical margin positivity is the main factor affecting survival in PRT treatment and that total organ resection positively affects survival.

Purpose: The aim was to investigate the difference in Ureteral Stent-Related Symptom Questionnaire (USSQ) scores with the use of different stent diameters (4.0 Fr versus 4.8 Fr). Materials and methods: Between August 2022 and January 2023, patients with double J stent insertion after endoscopic ureteral stone and retrograde intrarenal surgery in two different centers were included in the study. The patients were divided into two groups according to stent size of 4.0 Fr and 4.8 Fr. All of the patients were called for check-up in the 2nd week after discharge and were questioned using the USSQ. Results: A total of 228 patients, 112 in the 4.0 Fr group and 116 in the 4.8 Fr group, were included in the study. At the 2nd week visit, the total USSQ scale scores were 73.9 ± 8.9, and 80.0 ± 9.8 for the 4.0 Fr and 4.8 Fr groups, respectively (p< 0.001). Stent dislocation was detected in 10 (8.1%) patients in the 4.0 Fr group and in 3 patients (2.5%) in the 4.8 Fr group (p=0.049). The symptom score scale was analyzed separately based on subdomains. The mean value for the urinary index score was 24.5 ± 3.6 for the 4.0 Fr group and 27.6 ± 3.4 for the 4.8 Fr group (p< 0.001). Body pain index score was 16.4±3.8 and 18.6±3.8 for the 4.0 Fr and 4.8 Fr groups, respectively (p

Uzun zamandır üzerinde çalıştığımız ‘’Ürolojik Vakalar, Tedaviler Ve Literatürde Yaklaşım’’ kitabını sizlere sunmaktan gurur duymaktayız. Mesleğimiz gereği, her üroloji uzmanı günlük pratikte zorlu vakalarla, nadir görülen vakalarla karşılaşmaktadır. Bu kitap içinde de bölüm yazarlarının günlük pratikte karşılaştıkları vakaları, vakaya yaklaşımlarını ve en güncel bilgiler ışığında ilgili konu başlığında literatür bilgileri sunulmaktadır. Dolayısı ile bu kitap meslektaşlarımıza benzer konular hakkında hızlı ve kolay bilgiye ulaşımı sağlamaktadır.

Purpose This study aimed to compare the results of ultramini percutaneous nephrolithotomy (UMP), shock wave lithotripsy (SWL) and retrograde intrarenal surgery (RIRS) in pediatric patients with kidney stones 10–20 mm size. Methods The files of 159 pediatric patients (36 RIRS, 39 SWL, 84 UMP) with kidney stones were reviewed retrospectively. Preoperative age, sex, stone size and location were evaluated. The three methods were compared in terms of operation and fluoroscopy duration, complications with the modified Clavien grading system, and stone-free rate (SFR) in the postoperative first month. Results The stone burdens of the groups were similar (P = 0.102). At the end of the first month, SFR was higher in the RIRS and UMP groups compared to the SWL group (88.9%, 92.9% and 69.2%, respectively, P = 0.002). UMP had higher SFR for lower pole stones than the other two methods (P = 0.042). There was no difference in complications between the three methods (P = 0.758). Conclusion SFR was similar for all three methods in all localizations, apart from lower pole stones. UMP had higher SFR for lower pole stones than the other two methods. There was no difference in terms of complications between the three methods.

Aim: The aim of this study was to reveal the effect of manual detorsion on testicular salvage rates and the factors affecting the success of manual detorsion in adult testicular torsion. Material and Methods: The records of patients who applied to the emergency department with pre-diagnosis of acute scrotum were examined. A total of 62 adult patients diagnosed with testicular torsion were included in the study. Manual detorsion was attempted in all patients before surgery. Demographic characteristics of the patients, time from onset of scrotal pain to hospital admission (24 hours), physical examination and ultrasonography findings, type of surgery performed, and long-term results were evaluated. The data were statistically compared between patients with manual detorsion considered successful and unsuccessful. Results: Manual detorsion was considered successful in 36 (58.1%) patients and unsuccessful in 26 (41.9%) patients. Orchiopexy was performed in 35 (97.2%) of the successful patients and in 11 (42.3%) of the unsuccessful patients (p<0.001). When subgroup analysis was performed, although there was no significant difference in pain duration between patients with and without successful manual detorsion for patients with pain duration of less than 24 hours (p=0.648), there was a statistically significant difference in testicular salvage rates. While the rate of orchiectomy was 1/35 (2.9%) in patients with successful manual detorsion, this rate was 8/19 (42.1%) in unsuccessful patients (p<0.001). Conclusion: Manual detorsion increases testicular salvage rates in adult patients diagnosed with testicular torsion, and it should be attempted especially in patients with pain duration less than 24 hours.