Grand Journal of Urology
ISSN : 2757-7163

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Ekrem Guner
Dear Colleagues, Our journal titled Grand Journal of Urology (Grand J Urol), whose foundation studies were completed by the end of 2020 was published in January 2021 by publishing its first issue and took its place among scientific journals in the field of urology. The journal aims to publish original scientific urological articles. It is an open access, peer-reviewed journal and will be published online three times a year (January, May and September) in English. Our primary goal is to carefully evaluate the works of domestic and foreign authors, to take place in national and international reputable indexes with original and scientific articles, and to announce its name and content on scientific platforms. One of the most important criteria in the long journey to an academic career in our country is the production of scientific articles. I believe that the recently applied associate professorship criteria and the subsequent professorship criteria will increase the production of scientific articles in our country. This increase will increase the demand for distinguished, rigorous and scientific journals. In this process, the Grand Journal of Urology (GJU) will play an important role in delivering written and visual scientific publications to academic platforms and contributing to urology. GJU will add a new impetus to academic activities with its unique style. I am honored to present you the first issue of the Grand Journal of Urology (GJU) journal with the contributions of valuable researchers and scientists in a period when branch activities have decreased considerably due to the COVID-19 pandemic. At the beginning of this journey of our journal, I would like to express my wholehearted gratitude to the very valuable members of the Urology Community, my colleagues, my friends and my dear wife, who always supported us, our authors who contribute to our journal with orginal articles, review articles, case reports, clinical images and letters to the editor, our reviewers who meticulously evaluate the articles and present their support, our designers, and our publisher. January 2021 Editor-in-Chief Assoc. Prof. Ekrem Guner
Ozdem Levent Ozdal, Senol Tonyali, Arslan Ardicoglu
The new coronaviruses outbreak caused by SARS-CoV-2 (COVID-19) originated from the Chinese region of Wuhan in the last quarter of 2019 affected approximately 75 million people all around the world and caused over 1.6 million deaths []. COVID-19 is a highly contagious viral infection and its main routes for transmission are the person to person contact, touch, and aerosol. While it has detrimental effects on respiratory and cardiovascular systems it also can be found in digestive and urinary systems. The frequently experienced symptoms are fever, dry cough, dyspnea, fatigue, and loss of appetite []. With an ongoing effort, several researchers focused on investigating a drug or vaccine to end the pandemic. Currently, despite there is no drug specifically approved for COVID-19 treatment, there has been more than one vaccine from different nations to prevent the virus spread. Prior to the COVID-19 pandemic, virology research constituted less than 2% of all biomedical research. But this rate has been increased to 10-20% which represents the incredible adaptation potential of the research community. By the way, the COVID-19 pandemic led to a massive influx of publication not only by virologists and infectious health specialists but also by almost all medical disciplines. To facilitate early dissemination of knowledge prior to any peer-review, many articles have been uploaded preprint services []. It is not realistic to assume that a qualified and strict peer-review process could compensate for the high number of submissions. Moreover, someone must be aware that those non-peer-reviewed materials could be picked up by the media and spread to the population. Social distancing and transmission issues have also led to travel and social restrictions that resulted in many trials to be suspended or delaying in patient recruitment []. It is wellknown that generally large-scale randomized trials were not set up in time in the previous pandemic. However, the use of modern information technologies in combination with oldfashioned randomization might lead to the rapid gain of viable results nowadays. Countries might be encouraged to establish clinical-trial networks to activate and arrange large multi-center studies []. COVID-19 pandemic deeply affects not only urological patient care but also urology residency education. Work hours modified and residences redeployed to serve in pandemic services in many countries. This situation came along with the problem of interrupted urologic training and unmet minimal case requirements. Generally, online learning curricula have been well-adopted by urologists. However, recent studies have been shown that such changes caused emotionally and physically stressful situations for trainees []. In conclusion, it is obvious that Coronavirus will continue to be in our daily life for a while. Thus, maintaining research and education is vital in all disciplines of medicine. Contributing to the scientific area with respect to essential requirements and ethics will support the development of all humanity in this crisis. Hereby, We would like to congratulate you on the first issue of your journal planned to be released in such a difficult time and wish you to have significant contributions to the field of urology in a strictly scientific manner. Sincerely yours.
Ramazan Azar, Yurdagul Cetin Seker, Kamil Gokhan Seker, et al.
A 36-year-old male patient was admitted to the emergency department with abdominal and left side pain 1.5 hours after an in-vehicle traffic accident. The patient had no history of comorbidity or surgery. The patient did not receive any anticoagulant or antiplatelet therapy prior to the trauma. Vital signs of the patient were stable (Blood pressure 145/100 mmHg, pulse 98 beats/min, and temperature 37.2°C). Physical examination revealed no additional pathology except left side pain and left upper quadrant tenderness in deep palpation. White blood cells were found to be 17.330/mm3, hemoglobin level 17.34 mg/dL, and hematocrit 48.83% in the complete blood count examination. There was no abnormality in the biochemical analysis. An evaluation focused on sonography for trauma (FAST) in the emergency department was negative. Contrast-enhanced thoracoabdominal computed tomography (CT) scan was performed. Abdominal CT revealed a 44x42 mm left central hyperdense and peripheral hypodense adrenal mass (63 hounsfield unit) and periadrenal fat strands. Additionally, a cortical cyst was observed in the upper pole of the left kidney (Figure 1). The lesion was evaluated as an adrenal hematoma. No other injuries were detected, especially no injury to the spleen or kidney. No rib or spine fractures were observed. The patient was treated conservatively with bed rest, parenteral fluid, antibiotherapy, and analgesics. Hemoglobin and biochemical parameters remained constant. Endocrinology consultation was requested for adrenal insufficiency. Endocrinological evaluations revealed no pathology. The control abdominal CT performed 7 days later showed that the hematoma did not progress (40x37 mm, central density is prominent) (Figure 2). The patient was discharged without any problems. An abdominal CT scan was planned to evaluate the resolution of the adrenal hematoma 1 month later. The patient was asymptomatic during the follow-up. No abscess or infection format was observed. Informed written consent was obtained from the patient for this report. Figure 1: A- Left adrenal hematoma 44x42 mm attenuated central hyperdense and peripheral hypodense round mass in the adrenal gland, B- Periadrenal fat stranding, C- Left kidney upper pole simple cortical cyst (Axial view of enhanced abdominal CT scan) Figure 2: Control abdominal CT; regression of hematoma and increased appearance of central hyperdensity (Axial view of enhanced abdominal CT scan) Adrenal gland injury is a rare clinical picture caused by motor vehicle accidents, sports injuries, or blunt abdominal trauma after falling [–]. Isolated adrenal gland injury is rare due to its small size, deep retroperitoneal position on the upper abdomen, and presence of full-fat tissue around it. Most adrenal gland injuries are associated with multiple adjacent skeletal and organ injuries []. Adrenal gland injuries have been reported in approximately 2-3% of all thoracoabdominal injuries []. Unilateral adrenal injuries occur 5 times more on the right side than on the left (77% versus 15%), and bilateral adrenal injuries occur in 8% of cases in trauma []. Being usually silent and self-limiting, it does not require major operative intervention. However, it may be potentially life-threatening in some cases. The most common symptom is pain; other clinical presentations vary greatly, and it does not produce any specific symptoms or biomarkers. Abdominal pain, side pain, nausea, vomiting, hypotension, hypertension, a palpable side mass, agitation, mental status changes, and lowgrade fever may occur []. The emergency physician should be aware of the possibility of organ damage associated with adrenal injury and the potential for adrenal insufficiency especially if an unusual complaint is presented after blunt trauma (unexplained hypotension, electrolyte disorder, and pain that does not go away despite analgesics) []. Although ultrasonography is noninvasive, easily accessible, and inexpensive, it is dependent on the person and can sometimes be inadequate when evaluating retroperitoneal organs. CT is the gold standard for detecting adrenal gland injury as in all trauma cases []. CT scan findings of adrenal gland injury include hyperdensity, periadrenal fat stranding infiltration, and ipsilateral diaphragmatic crural thickening [,]. Furthermore, the need to monitor and rule out an underlying adrenal neoplasm should be taken into account in these patients due to possible bleeding to a pre-existing adrenal mass []. Surgery (adrenalectomy) and interventional radiologic procedures (embolization) may be needed although most adrenal gland injuries are treated conservatively. Treatment depends on the hemodynamic condition of the patient, the severity of the gland damage, bilateral gland involvement, and the extent of bleeding within the gland []. Ethics Committee Approval: N / A. Informed Consent: An informed consent was obtained from the patient. Publication: The results of the study were not published in full or in part in form of abstracts. Peer-review: Externally peer-reviewed. Conflict of Interest: The authors declare that they have no conflict of interest. Financial Disclosure: The authors declare that this study received no financial support.
Yurdagul Cetin Seker, Emel Sam, Emre Sam, et al.
A 74-year-old male patient was admitted to the emergency department reaching a depth of 1 cm surrounding the penis body, bleeding, and discoloration of the penis skin. It was observed that there were white-yellow rubber bands in the incision area in the examination of the patient (Figure 1). Laboratory examinations revealed no pathology. The patient was consulted at the urology clinic. It was learned that he underwent urethral surgery after trauma and he had continuous urinary incontinence and compressed his penis with these rubber bands to prevent it. 18 Fr urethral Foley catheter was inserted. It was observed in the exploration that the rubber bands lasered the penis skin laterally and dorsally to tunica albuginea, and ventrally to corpus spongiosum and urethra level. Five rubber bands were cut and removed (Figure 2). It was observed that corpus spongiosum-urethra and corpus cavernosa were intact in exploration. The penile skin was left for secondary healing after sterile cleansing of the skin and subcutaneous tissue (Figure 3). Penis was wrapped with a Coban bandage after the medical dressing. The urethral catheter was removed on the first day after the operation. The patient was prescribed broad-spectrum antibiotherapy, analgesic, anti-inflammatory, and duloxetine for continence. Kegel exercises were practically explained. The patient was referred to the psychiatric clinic before discharge. It was observed in the follow-up one week later that the penis healing was good except for mild edema and the wound healed completely (Figure 4). The penis was found to be completely normal except for skin pigment change in several areas a month later (Figure 5). The patient stated that there was intermittent continence. Written informed consent form was obtained from the patient. Figure 1: Preoperative appearance Figure 2: Removed rubber bands Figure 3: Postoperative appearance Figure 4: Control appearance after 1 week Figure 5: Control appearance after 1month Penile strangulation with a foreign material is a rare condition and was first reported by Gauthier in 1755. To date, only a few case series have been published in the literature with fewer than 100 case reports. Penile strangulation is a condition that needs to be intervened urgently, and it can lead to complications such as gangrene and amputation of the penis if not treated as soon as possible [,]. Foreign materials used for strangulation can be classified as soft and hard. In the literature, the most common hard materials for strangulation were metallic rings (49.0%), metallic tubes (14.8%), plastic bottles (12.1%), rings (9.4%) and plastic products (6.7%) and the most common soft materials for strangulation were rubber bands (67.9%), rubber strings (13.2%), threads (13.2%) and vinyl products (1.9%). The most common causes to use foreign material for penile strangulation were pranks, sexual intercourses, treatments of incontinence, and treatments of phimosis []. Complications related to penile strangulation injuries are skin erosion, laceration, infection, urethral transection, penile gangrene, and autoamputation []. Bhat et al. developed a grading system for penile strangulation injuries due to constructive objects around the penis and divided them into five categories from penis edema to gangrene. Grade I causes edema only, whereas Grade II involves penile paresthesia. Grade III includes skin and urethral damage but does not include urethral fistula. Grade IV includes the urethral fistula. It involves Grade V injury, gangrene, necrosis, or complete amputation []. The management of the patients is different according to the type of foreign body and the clinical findings of each case. There is not a standard surgical approach []. The treatment mainly aims to remove the constricting object as soon as possible to restore venous and lymphatic drainage and arterial flow by preserving the anatomy and functionality of the organ []. Thin non-metallic constricting objects are easy to remove in the treatment of penile strangulation. Successful results can be obtained by cutting such objects with simple surgical scissors or a scalpel. Orthopedic surgical instruments or non-medical instruments may be needed in metal objects or in patients with severe edema after penile strangulation []. In addition, psychological and psychosexual evaluation of these patients is a part of the treatment. Ethics Committee Approval: N / A. Informed Consent: An informed consent was obtained from the patient. Publication: The results of the study were not published in full or in part in form of abstracts. Peer-review: Externally peer-reviewed. Conflict of Interest: The authors declare that they have no conflict of interest. Financial Disclosure: The authors declare that this study received no financial support.
Mehmet Sevim, Baris Sengul, Okan Alkis, et al.
Urinary retention can be described as an inability to urinate, which occurs due to any cause that needs urgent intervention. It is often seen as a result of obstruction due to benign prostatic hyperplasia and urethral stenosis, especially in adult men. Urinary retention is more rare in women and can potentially occur due to anatomical, pharmacological, neurological, infective, myopathic and psychogenic etiologies []. A rare cause of urinary retention is the retroverted uterus, which mechanically obstructs the bladder during pregnancy. Retroverted uterus occurs in approximately 11% of first trimester pregnancies, of which only 1% have urinary retention that requires treatment []. Urinary retention in pregnant women is important to prevent complications by revealing the underlying causes.
Alper Bitkin, Mustafa Aydin, Inci Yavuz, et al.
Retroperitoneal sarcomas represent 10-15% of all soft tissue sarcomas. The most common histological type of sarcomas is liposarcoma, accounting for 20-45% of cases []. Retroperitoneal liposarcoma (RPLS) usually occurs in 40-60 year-old patients, with a male /female ratio of 1:1 []. Because of the largeness of retroperitoneal area, liposarcomas are usually asymptomatic. When initially diagnosed, the sarcoma has reached a large size and often invades adjacent organs []. If needed a negative surgical margin should be provided by resection of adjacent organs to improve survival. However, the 5-year survival rate is 20% in the well-differentiated and 83% in the undifferentiated subtypes []. We report the management of a rare case of a giant 25 cm retroperitoneal liposarcoma.
Didem Karacetin
Prostate cancer is one of the most common cancers in men, and in the treatment of prostate cancer; active surveillance, radical prostatectomy, radiotherapy, hormonotherapy and chemotherapy are the treatment modalities used according to the stage and risk group of the disease. Intensity-modulated radiotherapy (IMRT), Volumetric modulated arc therapy (VMAT), Stereotactic body radiotherapy (SBRT), brachytherapy (BT), proton therapy are used in radiotherapy treatment as a result of developments in recent years []. Among these options, multiple treatment modalities can be equally effective with desirable clinical outcomes [,]. Clinical results obtained with intensive modulated and image-guided radiotherapy (IG-IMRT) used in the treatment of prostate cancer are also being achieved in our clinical practice. The National Comprehensive Cancer Network (NCCN) prostat cancer guidelines include a variety of radiation therapy modalities as part of the standard of care for the definitive treatment of prostat cancer []: Very low risk patients (T1c, Gleason score ≤ 6, PSA
Okan Alkis, Bekir Aras, Mehmet Sevim
The term overactive bladder (OAB) is a symptomatological definition in which urgency is the main complaint and usually presents with symptoms accompanied by increased urination frequency and nocturnal urination and does not have any local pathological or metabolic reason to explain these symptoms []. The incidence of OAB ranges between 12-17% and increases with age []. In the literature, its incidence rates have ranged between 6.5% and 15.8% in men and 9.3-32.6% in women []. Each of the complaints included in the definition of OAB can seriously affect the quality of life. Normal bladder contraction occurs when the muscarinic receptors in the detrusor muscle are stimulated with acetylcholine. Although the pathogenesis of OAB is not fully explained; sensitization of afferent nerves, deactivation of inhibitory mechanisms, and the emergence of contractions similar to primitive voiding reflexes are shown as pathogenetic mechanisms. Another hypothesis is that the number of intercellular connections among detrusor myocytes increase and these cells are spontaneously stimulated []. In addition to the fact that the etiopathogenesis cannot be explained clearly and due to the intense relationship with the autonomic nervous system, undesirable systemic side effects are common in treatments applied []. Although many methods are used in the treatment of OAB, antimuscarinic agents constituted the most commonly used treatment method. In randomized placebo-controlled studies, it was observed that antimuscarinic agents provided an improvement in complaints at a rate of 50-60% []. Therefore, alternative treatment methods to medical treatment have been developed due to its limited effectiveness and highly frequent side effects. Posterior Tibial Nerve Stimulation (PTNS) Sacral S2-S4 segments, which provide neural control of the bladder, are the segments where the posterior tibial nerve, which is a peripheral nerve, also originates. Through this relationship, it is thought that the posterior tibial nerve is stimulated with electrical stimulation and provides neuromodulation of detrusor innervation. Although the mechanism of action of PTNS is not clear, it is thought that inhibition of preganglionic motor neurons of the bladder is achieved through afferent stimulation of the sacral cord []. In the literature, it was observed that improvement in symptoms of more than 50% in patients with refractory OAB whose complaints do not relieve using antimuscarinic agents and/or beta 3 agonists for at least 8 weeks [–]. Sherif et al. compared PTNS and botulinum toxin A (BoNT/A) in patients with refractory OAB in their study and found that BoNT/A was more effective []. However, they stated that side effects are seen more frequently in BoNT/A. Also, in the review of Tubaro et al., BoNT/A was reported to be more effective than PTNS []. No significant difference was found in studies comparing the effectiveness of PTNS and TTNS [,]. Transcutaneous Tibial Nerve Stimulation (TTNS) TTNS was introduced after PTNS , and found widespread use because it was not invasive and less painful for the patient. Besides, its effectiveness has been demonstrated in many studies in the literature [,–]. The only difference between these procedures having the same mechanism of action is that PTNS uses direct electrical stimulation delivered through transdermal surface electrodes. The procedure has no side effects and the pain is very low. Also, TTNS should not require regular patient visits at clinics and usually is self-administered at home. Studies in the literature have reported that they have similar efficacies with PTNS in refractory OAB [,]. Sacral Neuromodulation (SNM) Sacral neuromodulation is a minimally invasive method involving the implantation of a programmable pulse generator that provides low amplitude electrical current delivered through the S3 foramen. Today, it is also used in interstitial cystitis, chronic pelvic pain syndrome, and neurogenic bladder in addition to refractory OAB [–]. Although it is a minimally invasive method, the disadvantages of the procedure include the difficulty of application, the possibility of infective complications, and the need for replacement dependent on the battery life. There are several studies in the literature comparing SNM with other minimally invasive treatment methods in refractory OAB. Richter et al. revealed that SNM is more effective than BoNT/A []. Amundsen et al. reported that there was no significant difference between efficacies of SNM and BoNT/A []. Again, Al-Azzawi et al. reported that there was no significant difference between efficacies of SNM and BoNT/A []. Bertapelle et al. stated that SNM is a more cost-effective method than BoNT/A []. Intravesical Botulinum Toxin-A (BoNT/A) Intravesical Botulinum toxin-A application is the injection of the toxin of clostridium botulinum, a gram-negative anaerobic bacterium, into the detrusor muscle of the bladder []. BoNT/A acts by inhibiting neuromuscular acetylcholine release. BoNT/A inhibits both afferent and efferent pathways. This method of treatment is usually applied cystoscopically under anesthesia. It is generally applied as 100 units into the detrusor or suburothelial layer [,]. It has been shown in the literature that injection into the detrusor muscle is more effective than suburethral injection [,]. One of the most important advantages of the treatment is that its effect starts within a short time in the postoperative period. Its disadvantage is that its effectiveness last only 6-12 months. In the literature, it has been reported that a reduction in symptoms is achieved by more than 70% of the cases [,]. In this application, which has a high success rate, the complications are less but more than other minimally invasive methods. Major complications have been reported as respiratory depression and death. However, these are extremely rare. More frequently urinary infections and residual urine are seen. If residual urine is excessive, temporary clean intermittent catheterization is recommended []. In comparative studies in the literature, it has been reported that BoNT/A is more effective than PTNS [,]. It has also been reported that SNM and BoNT/A have similar efficiency [,]. However, Richter et al. found that SNM is more effective than BoNT/A [].
Aykut Baser, Muhammet Ihsan Ozturk, Mucahit Dogan, et al.
The World Health Organization (WHO) defines infertility as the inability of a sexually active couple to have spontaneous pregnancy despite unprotected sexual intercourse in the last 1 year []. Infertility affects approximately 15% of all couples. In previous studies on the male and female factors, mostly the female factor was prioritized. Although it is stated that 50% of infertility is caused by the female factor and 50% by the male factor, in fact many couples have male and female infertility factors in combination. In the evaluation of male infertility semen analysis plays an important role. Azoospermia, defined as the absence of sperm cells in semen analysis, is responsible for approximately 10-15% of cases with male infertility. Approximately 60% of azoospermic patients have non-obstructive azoospermia (NOA). A disorder in the stages of spermatogenesis of these patients is thought to constitute the underlying pathology []. Testicular sperm extraction (TESE) is the possible procedure to offer genetic parenting to men with nonobstructive azoospermia (NOA) []. Spermatozoa can be taken directly from the testis in TESE and used for intracytoplasmic sperm injection (ICSI). The first successful fertilization and pregnancy by obtaining spermatozoa from the testis were reported in 1993 []. Looking at the current literature, TESE achieves success rates of 100% for men with obstructive azoospermia (OA) and 56% for men with NOA [–]. Many predictive factors have been identified that affect the success rates of TESE, such as levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), testicular volume, and the application of microscopic TESE (micro-TESE) []. Our aim in this study is to present our clinical experiences that affect the success rates of sperm retrieval in men with NOA in the light of the literature.
Mehmet Yilmaz, Mustafa Karaaslan, Cavit Ceylan, et al.
Varicocele is a disease characterized by abnormal enlargements in the testicular vein and pampiniform plexus caused by various factors []. Varicocele is found in about 15% of men and represents the primary cause of male infertility in 35% of cases []. The etiology of varicocele is multifactorial and the pathogenic mechanisms of varicocele are unclear, but varicocele may lead to increased venous pressure, high testicular temperature, oxidative stress, hypoxia and ultimately testicular damage []. According to previous studies, it is known that oxidative stress enhances vascular inflammation, which plays an important role in the progression of atherosclerotic disease []. Varicocele is a vascular disease and causes local and / or systemic inflammation []. In addition, a systemic vascular varicosity was positively correlated with varicocele []. Changes in platelet function caused by vascular damage can be associated with varicocele []. In this study, we aimed to determine if complete blood count (CBC) parameters especially platelet count and volume indices could be a practical tool in the diagnosis and follow-up of varicocele.
Deniz Noyan Ozlu, Kamil Gokhan Seker, Emre Sam, et al.
A true penile fracture is the occurrence of a tunical tear as a result of blunt trauma to the penis, usually during sexual intercourse or masturbation. It is an emergency that requires timely repair of the tear in the tunica albuginea. Otherwise, there may be consequences such as erectile dysfunction, chronic pain, corporal fibrosis and penile curvature in the long term [] In some patients, no tear is observed in the tunica albuginea during surgery. There may be penile ecchymosis or hematoma secondary to the rupture of the superficial veins of the penis. This condition is called a false penile fracture and amounts to 5-52% of clinically diagnosed penile fractures []. The characteristic symptoms of a penile fracture include ecchymosis and swelling of the penile body following a cracking sound, penile pain, and immediate detumescence []. However, history and physical examination can be inaccurate in 15% of patients with suspected penile fracture []. Preoperative detection of false penile fracture cases bears great importance. In these cases, morbidity can be avoided by refraining from performing unnecessary surgical interventions, and successful results can be obtained conservatively. In this study, in the light of the literature, it was aimed to present the clinical and operative results of 8 patients who were operated on with a prediagnosis of penile fracture and then diagnosed with a false penile fracture in the light of the literature.
Gulcin Sahingoz Erdal, Feyzi Sinan Erdal
Urinary incontinence (UI) is a common symptom of varying severity that can affect women of all ages. Although urinary incontinence is not directly life threatening, it can seriously disrupt the physical, psychological and social life of individuals []. Unless UI is considered and questioned by patients as a natural consequence of aging, it is often shamed and hidden. Therefore, patients consult the doctor late and the existing discomfort becomes more severe []. One study showed that women with diabetes complain less about urinary incontinence to doctors []. Geriatric syndromes are clinical conditions common in older adults who share underlying causal factors that involve more than one system. These include a range of clinical conditions that do not fit into a separate disease category. Examples of geriatric syndromes are incontinence, cognitive impairment, delirium, falls, pressure ulcer, pain, weight loss, anorexia, functional decline, and depression []. UI affects quality of life and fragility in geriatric patients. With aging, the number of comorbid diseases increase and the number of drugs used causes polypharmacy. Polypharmacy results in many side effects and a decrease in quality of life in the geriatric population []. Polypharmacy and urinary incontinence are common in the geriatric population. Adverse drug effects are a concern in geriatric patients and should be considered in patients with urinary incontinence. Drug treatments may cause the emergence or aggravation of lower urinary tract symptoms. This should be kept in mind when there is a newly emerging UI []. Drugs that can cause or contribute to urinary incontinence in the elderly were presented by the 4th International Incontinence Consultation in 2009 []. There are many drugs that cause UI symptoms, and drugs used to treat heart failure may be associated with UI. For example, in the use of ACE inhibitors, drug-induced cough stress can cause UI. Diuretics frequently used by geriatric patients may cause incontinence due to higher urine volüme []. Increased body mass index (BMI) has been associated with many chronic diseases, including cancer. Incidence of UI also increases in obese patients []. In our study, we aimed to investigate the relationship between the incidence of UI with polypharmacy and BMI in diabetic geriatric patient population.
Joshgun Huseynov, Nadir Kalfazade, Ekrem Guner
Urolithiasis is a major health problem all around the world with an estimated incidence of 11.1 % in Turkey []. Urinary stone disease is related to many factors such as genetics, dietary habits, body mass index, fluid intake, occupation, geography and climate []. Management of stone disease includes medical treatment, minimal invasive treatment modalities such as extracorporeal shock wave lithotripsy and surgical treatment like ureterorenoscopy (URS), retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PNL) []. PNL has been utilized more than 30 years in renal stone disease treatment. Parallel to the developments in technology and refinement of endourological equipment's several modifications of PNL such as supine or prone, mini or micro has been offered during the recent years. PNL is also not without complications. Perioperative bleeding is one of the main complications of PNL, and it is not always possible to achieve stone-free status after PNL. Several factors have been proposed to effect surgical outcomes of PNL. In this study, we aimed to compare outcomes of PNL surgery in patients who had , and had not undergone prior renal stone surgery before PNL and who did not have.

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