Introduction and hypothesis
In the current study we hypothesized that total knee arthroplasty might improve the overactive bladder symptoms by providing pain relief and improving physical function.
...Methods
One hundred patients who underwent total knee arthroplasty were preoperatively evaluated for overactive bladder and 47 patients that met inclusion criteria were included in this study. All the patients included in the study were assessed both preoperatively and at the 3rd month postoperatively using the Overactive Bladder-Validated 8 (OAB-V8) questionnaire for overactive bladder symptoms, the Oxford Knee Score (OKS) for pain and physical function, and the International Physical Activity Questionnaire-Short Form (IPAQ-SF) for physical activity.
Results
The mean age of the patients was 65.4 ± 7 (56–83) years. The OAB-V8, OKS and IPAQ-SF scores significantly improved at the 3rd month postoperatively compared with the initial assessment. All the OAB-V8 domains, namely, frequency, urgency, nocturia, and urgency urinary incontinence, significantly improved following total knee arthroplasty.
Conclusions
Our results showed that following total knee arthroplasty, overactive bladder questionnaire scores significantly improved at the 3rd month postoperatively.
Purpose
We aimed to evaluate the impact of previous unsuccessful shock wave lithotripsy (SWL) therapy on ureterorenoscopy (URS) outcomes in proximal ureteral stones and to define whether there is any ...optimal timing for safe URS after SWL.
Methods
The patients who underwent URS for proximal ureteral stones between the years 2015 and 2018 in eight centers were included. Patients were divided into two groups according to previous SWL history; group 1 consisted of patients without SWL before URS for the stone SWL (−) and group 2 consisted of patients with a previous SWL for the stone SWL (+). Demographics, operation outcomes and stone characteristics were compared between these two groups. Regarding the complication and success rates, optimal timing for URS after SWL for the stone was calculated with receiver operator characteristics curve analysis.
Results
Totally 638 patients were included (group 1: 466 patients and group 2: 172 patients). The operation and hospitalization times, rate of ureteral stenting and complications were significantly higher in group 2. Stone free status was similar between the groups. Optimal timing for URS after SWL was calculated as 16.5 days (AUC = 0.657,
p
= 0.012) with a sensitivity of 68% and specificity of 72%, regarding the complication rates. Complication rates were significantly higher in patients who were operated before 16.5 days (27.7% vs 6.5%,
p
< 0.001).
Conclusions
The optimal timing; 2–3 weeks delay of the URS procedure after unsuccessful SWL may decrease complication rates according to our results.
We aimed to evaluate the predictive factors in a holistic manner for ureterorenoscopy (URS) outcomes in proximal ureteral stones by a multicenter study.
The data of patients who underwent URS for ...proximal ureteral stones between the years 2015 and 2018 in eight centers were recorded retrospectively. Patients were divided into two groups according to URS success: Group 1 consisted of patients with successful URS, and Group 2 consisted of patients with unsuccessful URS. The two groups were compared in terms of risk factors, stone, and clinical characteristics of patients.
A total of 638 patients were included in the study. Group 1 consisted of 527 (82.6%) patients, and Group 2 consisted of 111 (17.4%) patients. In multivariate logistic analysis, the key risk factors for URS success was found to be age (OR = 0.980, 95% CI = 0.963-0.996, p = 0.018), stone area (OR = 0.993, 95% CI = 0.989-0.997, p = 0.002), and operation time (OR = 0.981, 95% CI = 0.968-0.994, p = 0.005).
To make the treatment decision of proximal ureteral stones, it is necessary to examine several parameters including available equipment, stone, and patient characteristics. Physicians should keep these risk factors in mind in the decision of treatment options.
Coronavirus disease 2019 (COVID-19) pandemic caused unprecedented restrictions in outpatient services and surgical practices in urology as in other medical branches as well as in all areas of life.
...To investigate whether there have been variations in the presentations of male patients with sexual and reproductive health problems to the outpatient urology clinics during the COVID-19 pandemic and to understand the underlying factors for these variations, if any.
Male patients aged ≥18 years who presented to the outpatient urology clinics in 12 centers across Turkey from February 1, 2020 to June 1, 2020 were retrospectively evaluated. The patients were divided into 2 groups: those who presented to the outpatient clinic from February 1, 2020 to March 11, 2020 comprised the “pre–COVID-19 pandemic period” group, whereas those who presented to the outpatient clinic from March 12, 2020 to June 1, 2020 comprised the “COVID-19 pandemic period” group and compared with each other.
The main outcome of this study was the number and diagnose of patients presented to urology outpatient clinics.
Andrological problems were detected in 721 of 4,955 male patients included in the study. During the COVID-19 pandemic period, there was a significant increase in andrological diagnosis in these patients compared with the pre–COVID-19 pandemic period (n = 293 17% vs n = 428 13.2%, P < .001, respectively). Similarly, there was a statistically significant increase in the number of patients diagnosed with male reproductive or sexual health problems during the COVID-19 pandemic period (n = 107 6.2% vs n = 149 4.6%, P = .016 and n = 186 10.8% vs n = 279 8.6%, P = .013, respectively). The number of patients diagnosed with erectile dysfunction during the pandemic was also significantly higher than the pre–COVID-19 pandemic period (n = 150 8.7% vs n = 214 6.6%, P = .008).
Presentations to the outpatient urology clinics owing to andrological problems markedly increased during the pandemic period. Although these problems are of multifactorial origin, psychogenic factors are also considered to significantly trigger these problems.
Duran MB, Yildirim O, Kizilkan Y, et al. Variations in the Number of Patients Presenting With Andrological Problems During the Coronavirus Disease 2019 Pandemic and the Possible Reasons for These Variations: A Multicenter Study. Sex Med 2021;9:100292.
Abstract The aim of this study was to explore clinical features of renal infarction (RI) that may have a role in diagnosis and treatment in our patient cohort and provide data on midterm renal ...functions. Medical records of patients with diagnosis of acute RI, established by contrast enhanced computed tomography (CT) and at least 1 year follow-up data, who were hospitalized in our clinic between 1998 and 2012 were retrospectively reviewed; including descriptive data, clinical signs and symptoms, etiologic factors, laboratory findings, and prescribed treatments. Patients with solitary infarct were treated with acetylsalicylic acid (ASA) only, whereas patients with atrial fibrillation (AF) or multiple or global infarct were treated with anticoagulants. Estimated Glomerular Filtration Rate (eGFR) referring to renal functions was determined by the Modification of Diet in Renal Disease (MDRD) formula. Twenty-seven renal units of 23 patients with acute RI were identified. The mean age was 59.7 ± 15.7 years. Fourteen patients (60.8%) with RI had atrial fibrillation (AF) as an etiologic factor of which four had concomitant mesenteric ischemia at diagnosis. At presentation, 20 patients (86.9%) had elevated serum lactate dehydrogenase (LDH), 18 patients (78.2%) had leukocytosis, and 16 patients (69.5%) had microscopic hematuria. Two patients with concomitant mesenteric ischemia and AF passed away during follow up. Mean eGFR was 70.8 ± 23.2 mL/min/1.73 m2 at admission and increased to 82.3 ± 23.4 mL/min/1.73 m2 at 1 year follow up. RI should be considered in patients with persistent flank or abdominal pain, particularly if they are at high risk of thromboembolism. Antiplatelet and/or anticoagulant drugs are both effective treatment options according to the amplitude of the infarct for preserving kidney functions.
Premature ejaculation (PE) is common, but its true pathophysiology is not clear, and treatments are limited. We aimed to investigate the effect of neuromuscular electrical stimulation applied in ...different modes and frequencies to the bulbospongiosus muscle on ejaculation parameters. In this study, 24 male Wistar albino rats were used. The rats were equally divided into three groups: control, high-frequency burst (HFB) and low-frequency (LF) (n = 8 each). Neuromuscular electrical stimulation was applied to the rats for 30 min. In the HFB group, this stimulation was applied in the burst mode at 80 Hz frequency using 200 microseconds (µs) transition time. In the LF group, manual stimulation was applied using a 2 Hz frequency and 200 µs transition time. Following the intraperitoneal administration of para-chloroamphetamine at a dose of 5 mg/kg, ejaculation time, increase in basal seminal vesicle pressure, seminal vesicle maximum pressure, number and interval time of seminal vesicle contractions and bulbospongiosus muscle electromyography activities were evaluated over 30 min. There was a significant difference between the groups in terms of ejaculation time (p = 0.002). The ejaculation times of the LF, HFB and control groups were 1344.71 ± 105.9, 908 ± 62 and 672 ± 149.7 s, respectively. The post hoc analysis revealed that the ejaculation time of the LF group was significantly longer than that of the HFB and control groups (p = 0.033 and p = 0.001, respectively). The remaining parameters did not differ significantly between the groups. The results showed that low-frequency (2 Hz) electrical stimulation applied to the male rats significantly prolonged the ejaculation time. It is thus considered that applying neuromuscular electrical stimulation before planned sexual activity can prevent the rhythmic contractions necessary for completing the ejaculatory process by maintaining subtetanic continuous contraction and prolonging the ejaculation time in patients with premature ejaculation complaints.
Objective: To investigate the relationship of spontaneous ureteral stone passage with stone size (width-length) and area. Materials and Methods: Patients who presented to the urology outpatient ...clinic with acute renal colic between January and December 2016 and were found to have a distal ureteral stone of 10 mm or smaller on unenhanced computed tomography (CT) were retrospectively evaluated. Using the CT images, the size of the stones was measured and the data of the patients were compared in terms of spontaneous passage status. Results: A total of 245 patients were included in the study. The mean stone size on the axial plane and coronal plane was 4.72+ or -1.55 mm and 4.75+ or -1.84 mm, respectively and the spontaneous passage rate was 77.6%. In logistic regression analysis, the most important factor in predicting spontaneous passage was the stone size on coronal measurement (p=0.020). The spontaneous passage rate was 70.8% in cases where the stone size on the axial plane was the same as or larger than on the coronal plane, 56.2% when the size on the the coronal plane was 1 mm greater than on the axial plane, and 34.7% when the stone size on the the coronal plane was 2 mm or more than 2 mm greater than on the axial size. Chi-square analysis revealed that the difference between spontaneous passage rates was statistically significant (p=0.001). Conclusion: When planning treatment for ureteral stones, the length of the stone in coronal measurement should be considered as a priority. It should be remembered that the probability of spontaneous passage is significantly low, especially if the length of the stone is 2 mm or more than 2 mm greater than its width. Keywords: Spontaneous passage, Computerized tomography, Ureteral stone Amac: Distal ureter taslarinin spontan pasaji ile tas boyut olcumleri (en-boy) ve tas alani arasindaki iliskiyi arastirmayi amacladik. Gerec ve Yontem: Ocak 2016 ile Aralik 2016 tarihleri arasinda akut renal kolik ile uroloji polikligine basvuran ve kontrastsiz bilgisayarli tomografide (BT) 10 mm ve daha kucuk distal ureter tasi saptanan hastalarin bilgileri retrospektif olarak degerlendirildi. BT goruntuleri kullanilarak tas boyutlari hesaplanarak spontan pasaj durumuna gore hastalarin verileri karsilastirildi. Bulgular: Calismaya 245 hasta alindi. Hastalarin aksiyal tas boyutu ortalamasi 4,72+ or -1,55 mm, koronal tas boyutu ortalamasi 4,75+ or -1,84 mm olarak olculdu. Hastalarin en buyuk tas boyutu ortalamalari ise 5,2+ or -1,73 mm idi. Hastalarin takiplerinde %77,6'sinin (156) tasini dusurdugu saptandi. Yapilan logistik regresyon analizinde spontan pasaji ongormede en etkili faktorun tasin koronal olcumunun oldugu saptanmistir (p=0,020). Hastalarin spontan pasaj oranlari aksiyal boyutun koronal boyut ile ayni veya daha buyuk oldugu durumlarda %70,8 olarak saptandi. Koronal boyut ile aksiyal boyuttan 1 mm daha buyuk oldugu durumlarda spontan pasaj %56,2, 2 mm ve daha buyuk oldugu durumlarda ise %34,7 olarak bulundu. Yapilan ki-kare analizinde spontan pasaj oranlari arasindaki farkin istatistiksel olarak anlamli oldugu saptandi (p=0,001). Sonuc: Ureter taslarinda tedavi plani yapilirken tasin koronal olcumdeki boyu (uzunlugu) oncelikli olarak dikkate alinmalidir. Ozellikle tasi boyu eninden 2 mm ve daha fazla ise spontan pasaj olasiginin ciddi oranda dusuk oldugu akilda bulundurulmalidir. Anahtar Kelimeler: Spontan pasaj, Bilgisayarli tomografi, Ureter tasi
Objective To contribute to the diagnosis and treatment of ureteral stones by investigating the relationship between the ureteral jet flow measurements of patients with ureteral stones and the size of ...the stones and the patients' pain scores. Materials and Methods The sample consisted of patients who presented acute renal colic between December 2014 and 2015 and from a noncontrast computed tomography were found to have a urinary stone. The ureteral jet flow velocities were determined using Doppler ultrasonography. The patients were all assessed in terms of stone size, localization and area, anteroposterior pelvis (AP) diameter, and visual analogue scale (VAS) scores. Results A total of 102 patients were included in the study. As the VAS score decreased, the peak jet flow velocity on the stone side increased, whereas the flow velocity on the other side, AP diameter, and stone area were reduced ( P < .05). As the stone size increased, the peak jet flow velocity was reduced and the AP diameter increased significantly ( P < .05). Ureteral jet flow was not observed in 17 patients on the stone side. A statistically significant difference was found between these patients and the remaining patients in terms of all parameters ( P < .05). Conclusion For patients, in whom the peak flow velocity of ureteral jet is low and with a severe level of pain or the peak flow velocity of ureteral jet cannot be measured, there is a low possibility of spontaneous passage and a high possibility of a large stone, and therefore the treatment should be started immediately.
The effects of hormone levels on ejaculation are known. In addition to thyroid hormone levels, testosterone levels are also associated with ejaculation, but no consensus has been reached on this ...issue. Thus, we investigated the effect of decreased testosterone levels due to bilateral orchiectomy on the chemical stimulation-induced ejaculation phases in rats. Twenty-one male Wistar rats were randomized into the orchiectomy, sham, and control groups, with seven rats in each group. Bilateral orchiectomy was performed. The ejaculation parameters were evaluated 5 days after the sham and bilateral orchiectomy operations and the waiting period in the control group. The seminal vesicle (SV) phasic contraction number and increase in basal pressure amplitude were significantly lower in the orchiectomy group (6.9 ± 3.3 and 0.6 ± 0.3 mmHg) than in the sham and control groups (11.2 ± 1.7 and 1.0 ± 0.4 mmHg, and 14.5 ± 6.6 and 1.1 ± 0.2 mmHg, respectively; p = 0.016 and p = 0.03, respectively). The interval between the SV contractions was significantly longer in the orchiectomy group (166.2 ± 104.3 s) than in the sham and control groups (76.0 ± 15.5 s and 63.1 ± 31.1 s, respectively; p = 0.014 (between groups), orchiectomy vs sham p = 0.040 and orchiectomy vs control p = 0.018). The SV weights of the rats were significantly lower in the orchiectomy group (0.14 ± 0.01 g) than in the sham and control groups (0.37 ± 0.05 g and 0.48 ± 0.03 g respectively; p < 0.0001 (between groups), orchiectomy vs sham p < 0.0001 and orchiectomy vs control p < 0.0001). The groups showed no significant differences in ejaculation time, SV basal pressure, SV maximum amplitude, and bulbospongiosus muscle contraction electromyographic activity. Our results partially clarified the relationship between decreased testosterone levels and ejaculation. Decreased testosterone levels caused statistically significant changes in SV functions and affected the ejaculation emission phase.
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