Objective: Sperm DNA fragmentation and maturation directly interferes with reproductive efficiency. Although there are several methods for assessing sperm DNA integrity, however, many of them are laborious and require high-precision equipment in the clinics. Thus, evaluating economic and reliable methods to prepare suitable sperm for assisted reproductive technologies without DNA damage is critical.
Material and methods: A total of 114 semen samples were collected and analyzed using computer-assisted semen analysis. The DNA fragmentation index (DFI) of all samples was evaluated by two methods of sperm chromatin dispersion (SCD) and sperm chromatin structure assay (SCSA). Besides, chromatin maturation index (CMI) was assessed by three methods including aniline blue (AB)-sperm chromatin maturation assay (SCMA), fl uorescence microscopic chromomycin A3 (fmCMA3), and fl ow cytometric CMA3 (fcCMA3).
Results: The result showed that the DFI had no statistically significant differences (p>0.05) between SCSA (26.98%±1.28%) and SCD (27.88%±1.278%), although SCD demonstrated a strong correlation with DNA maturity (p<0.001), which had not been seen in SCSA. Besides, the CMI demonstrated significant differences (p<0.001) when assessed by AB-SCMA (14.86%±0.65%), fmCMA3 (29.18%±1.01%), and fcCMA3 (22.45%±0.62%). Among these, only the fmCMA3 showed a significant correlation with semen parameters (p<0.01) and embryo development (p<0.001).
Conclusion: It seems that SCD and fmCMA3 were more accessible, affordable, and reliable tests for assessing DFI and CMI. It appeared these two methods may be the best choices for evaluating sperm DNA integrity in clinics.
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Objective: Urothelial carcinoma (UC) is heterogeneous, and variant histologies (VH) are more frequent than initially reported. Reporting VH is recommended by several guidelines because of prognostic and therapeutic implications. We evaluated the concordance of VH between the first transurethral resections of the bladder (TURBs) and the following radical cystectomy (RC). This paper is the first to compare VH with a central pathology review between TURB and RC.
Material and methods: In this retrospective study, we only included those patients who underwent TURB with VH and then RC between 01/2010 and 12/2013 at our institution. The presence of VH in both TURB and RC was assessed and compared according to the 2016 World Health Organization (WHO) classification by a central pathology review.
Results: Among 110 patients who had the initial TURB/RC, 54 (49.1%) were diagnosed with VH, 48 (43%) had a single pattern, and six had (5%) multiple histological patterns. Squamous differentiation was the most common single VH (31%). Twenty patients with UC (18%) showed discordance between TURB and RC, especially in micropapillary versus nested (n=3) cases. Concordant histology between TURB/RC was seen in 82% of the cases.
Conclusion: Discrepancies can be seen between TURB and RC when reporting VH, which can be problematic for selection of therapy and management. TURB alone might be insufficient to evaluate the presence of VH, especially in VH with heavy therapeutic implications, such as micropapillary carcinomas. Nevertheless, concordance with a central review by an experienced uropathologist when applying the WHO 2016 classification is 82%.
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Objective: The prostate-specific antigen density (PSAD) is an accessory tool when suspecting prostate cancer. Multiparametric magnetic resonance imaging (mpMRI) of the prostate has a high rate of false negatives. The aim of this study is to evaluate the sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) when adding the PSAD and negative or equivocal mpMRI.
Material and methods: A retrospective study that included prostate biopsies performed using a transperineal approach and guided by ultrasound between 2015 and 2019 was conducted. Clinically significant prostate cancer (csPCa) was defined as Gleason score ≥3+4. The population was divided into groups according to the PSAD level-≤0.15 and >0.15. Sensitivity, specificity, NPV, and PPV of mpMRI were calculated.
Results: A total of 292 patients were included; 12.1% (4/33 patients) of the negative mpMRI group presented csPCa, and only 7 in the equivocal mpMRI group presented csPCa. NPV and sensitivity were 91.15% and 90.5%, respectively. In the positive mpMRI group, 53.7% (96/179) had csPCa, with a PPV of 53.6% and specificity of 55.3%. Of the patients with PSAD ≤0.15, 23 (16.54%) presented csPCa. All of them presented a positive mpMRI. All patients with a negative or equivocal mpMRI and a PSAD ≤0.15 presented a clinically non-significant tumor or benign result. The addition of this tool to mpMRI resulted in 100% sensitivity, 69% specificity, and 34.8% PPV.
Conclusion: In our series, PSAD ≤0.15 increased the NPV in negative or equivocal mpMRI, and through this unnecessary prostate biopsies could be avoided.
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Objective: Our aim was to report the long-term follow-up for minimally invasive open pyeloplasty in children.
Material and methods: A total of 213 children with a mean age 16.33 months underwent miniature open pyeloplasty for ureteropelvic junction obstruction between January 2010 and May 2016. Anderson–Hynes dismembered pyeloplasty was performed through a subcostal miniature incision. The intraoperative and postoperative parameters including surgical operative time, incision size, intraoperative blood loss volume, postoperative analgesic use, hospital stay, complications, and success rate were documented.
Results: The mean surgery time was 65 min (50–85 min), and incision size was 16.99 mm (12–36 mm). None of the patients required blood transfusion or narcotic analgesics in the postoperative period. The mean hospital stay was 21.97 h (10–48 h). Minor side effects included urinary tract infection (3.8%) and urinary leakage in one case (0.004%). Major complications were not observed. The mean antero-posterior pelvic diameter before and after surgery was 28.69 ± 11.54 mm and 15.89 ± 9.29 mm, respectively with a mean difference of 12.78 mm, which shows a signifi cant decrease (P value = 0.001). The success rate was 98.1% with a mean follow-up of 21.43 months (3–56 months). Two of the recurrences occurred in the first postoperative year, another one after 1.5 years, and the last one after 4 years.
Conclusion: Our study confirms minimally invasive open pyeloplasty in children as a safe and efficient procedure with the least complication and hospital stay rate in comparison with other minimally invasive techniques. Moreover, long-term follow-up is a requirement in pyeloplasty surgery.
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Objective: To compare human menopausal gonadotropin (hMG) and recombinant follicle-stimulating hor-mone (rFSH) with respect to successful spermatogenesis and pregnancy outcomes in patients with congeni-tal hypogonadotropic hypogonadism (CHH).Material and methods: This retrospective study included a total of 112 male patients with CHH. Of these, 70 were to receive treatment with hMG and 42 with rFSH following the hCG administration.Results: The average age at diagnosis was 27.9 (range, 15–51) years. The baseline luteinizing hormone (LH), follicle-stimulating hormone (FSH), and testosterone levels were 0.53±0.77 IU/L, 0.63±0.61 IU/L, and 1.10±1.90 ng/dL, respectively. Following the combined hormonal treatment, 85.7% (96/112) of patients had sperm detected in ejaculate samples. In the hMG group, the mean baseline of a testicular size was slightly lower than in the rFSH group (5.0±3.5 mL and 5.3±3.9 mL), whereas these differences were not statistically significant (p=0.364). The mean baseline age, level of FSH, LH, and testosterone also showed no significant difference between the two treatment options. The rate of successful spermatogenesis was similar (85.7%) in both groups, while the pregnancy rates of patients who underwent hMG and rFSH treatments were 38.6% (n=27) and 51.2% (n=21); however, these differences were not statistically significant (p=0.314). No patients developed severe effects during the treatment period.Conclusion: Successful spermatogenesis and pregnancy rates with hMG and rFSH are similar
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Objective: To evaluate the efficacy and complications of mini-percutaneous nephrolithotomy (PCNL) sur-gery using 14-20 Fr access sheaths in pediatric patients, as well as the results of postoperative stone analysis and metabolic urine analysis.Material and methods: We retrospectively evaluated the records of 206 pediatric patients (232 kidney units) who underwent mini-PCNL for kidney stones in our clinic between February 2011 and December 2018. We evaluated the demographic characteristics, complications, stone-free rates, and the results of chemical analysis and urinary metabolic analysis.Results: The age ranged from 9 months to 16 years. The mean age was 5.1±3.9 years, and the median age was 3.5 years. The median stone burden was 200 mm2 (min: 100; max: 1600). Kidney stones were most commonly located in the pelvis in 118 (50.9%) patients, followed by lower calyceal stones in 42 (18.1%) and multiple calyceal stones in 38 (16.4%) patients, respectively. While the success of mini-PCNL was 80.6% after the first session, this rate increased to 87.9% after auxiliary treatments. The total complication rate was 12.9% according to modified Clavien classification. A postoperative stone analysis showed that calcium oxalate had the highest frequency with 61.1% of patients, followed by cystine stone with 21.3% of patients. Metabolic urine analysis revealed no abnormalities in 42.8% of patients. The most common metabolic ab-normality was hyperoxaluria (32%), followed by hypercalcuria (19.6%).Conclusion: Mini-PCNL is a safe and effective procedure with reasonable complications for the treatment of pediatric kidney stones. All kinds of multidisciplinary efforts are required to remove kidney stones com-pletely in pediatric patients.
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During the coronavirus disease 2019 pandemic, there has been a reduction in the provision of all elective services. This poses enormous pressure on urologists as regards to patients with bladder cancer who need intravesical Bacille Calmette Guerin (BCG) treatment. The evolving situation of the pandemic mandates a pragmatic approach in clinical decisions; to date, there are no uniform consensus guidelines about how to manage these patients and the factors affecting our decision for service provision. These concerns need to be addressed not only for the current crisis but also for the upcoming next phase of the pandemic.
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YASEMİN YUYUCU KARABULUT ,
Emre Çağatay KÖSE ,
Murat BOZLU ,
Ferah TUNCEL ,
Gül EMEK YÜKSEK ,
Demet ETİT ,
HAVVA SERAP TORU ,
Bahar AKKAYA ,
Zeliha Esin ÇELİK ,
MELTEM ÖZNUR ,
Gülhan Orekici TEMEL ,
Erdem AKBAY
Objective: The COL6A1 is a gene encoding the alpha 1 polypeptide subunit of collagen 6 (COL6A1), an extracellular matrix protein subunit. Programmed cell death receptor-1 (PD-1) and its ligand, programmed cell death receptor ligand-1 (PD-L1) have been shown to have a prognostic significance in clear cell renal cell carcinomas (RCCs). In this study, we evaluated the expressions of COL6A1 and PD-1 in four different RCC subtypes. Materials and methods: A total of 161 radical nephrectomy and nephron-sparing surgery cases with RCCs from five different health care centers were included in this study. Clinical data of the cases were taken from electronic records of the institutions. The pathological data were collected by an expert uropathologist and re-evaluated with slides obtained from paraffin blocks of the cases. The correlation of COL6A1 and PD-1 expression with sex, age, tumor type, lymphovascular invasion (LVI), World Health Organization/International Society of Urological Pathology (WHO/ISUP) grade, and tumor stage (pT) was analyzed with the Pearson chi-squared test. Results: Patients with sarcomatoid RCC and clear cell RCC had significantly higher COL6A1 scores and intensities than in other types of RCC (p=0.004 and p=0.002, respectively). WHO/ISUP grade and, COL6A1 and PD-1 staining scores also showed positive correlation (r=0.230, p=0.004 and r=0.277, p=0.001, respectively for COL6A1 and r=0.191, p=0.018 and r=0.166, p=0.041, respectively for PD-1). The staining scores and intensities of COL6A1 and PD-1 were not different between the patients with positive and negative LVI (p>0.05). Conclusion: In high-grade RCCs, we found the relationship between immunohistochemical staining scores of COL6A1 and PD-1 proteins and clinical, demographic, and histopathological parameters. Our results proved that COL6A1 and PD-1 are really promising proteins as prognostic parameters and for targeted immunotherapy.
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Objective: To report the outcomes of robot-assisted radical cystectomy (RARC) and extended pelvic lymph node dissection (ePLND) series for bladder cancer. Material and methods: Between October 2016 and June 2019, overall 57 patients (50 men, 7 women) were included in the study. Patient demographics, operative data, and postoperative pathological outcomes were evaluated. Patients who had a history of pelvic or intraabdominal surgery due to other concurrent malignancy, radiation therapy, or lacked data were excluded from the study. Results: The mean age of the patients was 64.72±9.09 years. The mean operation time, intraoperative estimated blood loss, and hospitalization time were 418.58±85.66 minutes, 313.00±79.16 mL, and 13.44±5.25 days, respectively. The postoperative pathological stages were reported as pT0 (n=8), pTis (n=4), pT1 (n=4), pT2 (n=22), pT3a (n=11), pT3b (n=2), pT4a (n=4), pT4b (n =1), and other (n=1). The mean lymph node (LN) yield was 23.45±9.43. Positive LNs were found in 16 (28.1%) patients. Surgical margins were positive in 3 (5.26%) patients. The mean follow-up period was 15.42±8.31 months. According to the modified Clavien-Dindo system, minor (Clavien 1-2) and major (Clavien 3-5) complications occurred in 18 (31.58%) and 9 (15.78%) patients during the early (0-30 days) period and in 4 (7.02%) and 5 (8.77%) patients in the late (31-90 days) period. Conclusion: RARC and ePLND are complex but safe procedures with acceptable morbidity and excellent surgical and oncologic outcomes in muscle-invasive or high-risk bladder tumors.
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Objective: To investigate the effects of flexible ureteroscopy (F-URS) on the operated side of a kidney by assessing the renal damage markers, urine neutrophil gelatinase-related lipocalin (NGAL) and serum cystatin-C (Cys-C), and overall kidney function with the measurements of standard serum creatinine and urine albumin and protein levels. Material and methods: A total of 30 patients who underwent F-URS for treatment of upper urinary stone disease were prospectively evaluated. Preoperative serum urea, creatinine, and Cys-C levels were noted. Levels of urine albumin, protein, creatinine, and NGAL in spot urine samples from the operated side of a kidney obtained through the access sheath preoperatively and through the ureteral catheter 1 and 24 hours postoperatively were also measured. Preoperative and postoperative parameter levels were statistically compared. Results: The patients’ mean age was 46.6±15.9 years. The mean operative and fluoroscopy times were 90.67±32.5 and 3.15±1.43 minutes, respectively. The urine creatinine, albumin, protein, albumin/creatinine, and protein/creatinine levels were similar in preoperative and postoperative periods. Postoperative serum urea, creatinine, and Cys-C levels and urine NGAL and NGAL/creatinine levels were not also found with remarkable changes from the baseline levels. Conclusion: F-URS is a safe therapeutic intervention in the treatment of urolithiasis, especially regarding renal damage, and functional outcomes.
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