Keywords: Albumins; Globulins; Carcinoma; Renal Cell

The number of core biopsies required per region of interest (ROI) is controversial, as is the localization of the core to be taken from a lesion. This study aimed to determine the ideal biopsy core number and location in a multiparametric magnetic resonance imaging guided targeted prostate biopsy (TPB), without reducing the clinically significant prostate cancer (csPC) detection rate. Data of patients who had PI-RADS ≥3 lesions on multiparametric magnetic resonance imaging and underwent a TPB in our clinic between October 2020 and January 2022 were reviewed, retrospectively. The first and second cores were taken from the central part of the ROI, whereas the third and fourth cores were taken from the right and left peripheries of the ROI. We compared the csPC detection success of single-, 2-, 3-, and 4-core samplings. Software-based transrectal TPB was performed on 251 ROIs in a total of 167 patients. Internal Society of Urological Pathology Grade Group ≥2 cancer was detected in at least one core in 64 (25.4%) lesions. Moreover, csPC was detected in 42 (65.6%) ROIs in first-core biopsies; in 59 (92.2%) ROIs in first- and second-core biopsies; in 62 (96.9%) ROIs in first-, second-, and third-core biopsies; and in 64 (100%) ROIs in first-, second-, third-, and fourth-core biopsies. Using McNemar's test for comparison, a significant difference was found in terms of csPC detection success between performing first-core and second-core biopsies (65.6 – 92.2%, p < 0.001); by contrast, no significant difference was observed in csPC detection success between 2-core and 3-core biopsies (92.2% - 96.9%, p = 0.24). Furthermore, no significant difference existed between performing second-core and fourth-core biopsies in terms of csPC detection success (92.2%–100%, p = 0.07). We concluded that taking 2-core biopsies from the center of each ROIs during a transrectal TPB is sufficient for diagnosing csPC.

Objective: To determine whether clinical or radiological parameters can predict clinically significant prostate cancer (csPC) in patients with the Prostate Imaging Reporting and Data System (PI-RADS) 3 lesions. Patients and Methods: Data were obtained from 247 patients with PI-RADS 3 lesions on mpMRI and who had received a soft-ware guided transperineal/transrectal MRI/transrectal ultrasonography (MRI/TRUS) fusion prostate biopsy with concomitant standard systematic 12-core biopsy following mpMRI in the prostate cancer and prostate biopsy database of Turkish Uroon-cology Association, between 2016 and 2020. The cut-off values of clinical parameters were determined using receiver operating characteristic (ROC) curve analysis. Simple and multiple logistic regression analyses were performed to determine the clinical parameters in predicting csPC. Results: A total of 56 patients (22.6%) had prostate cancer, 23 (9.3%) of whom had csPC. In the lesion-based analysis, cancer detection rates (CDRs) of each lesion in targeted biopsy were found to be 6% and 5% for ISUP GG 1 and ISUP GG >= 2, respectively. In the patient-based analysis, clinically insignificant CDRs were significantly higher in systematic biopsy compared with targeted biopsy, whereas no significant difference was found in terms of clinically significant CDRs (p = 0.020 and p=0.422, respectively). The cut-off values were determined as 48.3 mL (AUC [95% CI] = 0.68 [0.53-0.82]) for prostate volume, and 0.213 ng/mL/mL (AUC [95% CI] = 0.64 (0.51-0.77]) for PSAD in predicting csPC. In the multiple logistic regression analysis, only PSAD was found to be an independent risk factor in predicting csPC (OR [95% CI]: 3.56 [1.15-10.91], p = 0.024). Conclusion: Since PSAD > 0.20 ng/mL/mL was found to be positive independent risk factor in predicting csPC, in the absence of advanced radiological parameters, PSAD could be used for the biopsy decision in patients with PI-RADS 3 lesions.

Objectives: To evaluate the sexual function of women with urinary incontinence (UI) and double incontinence (DI) comparing with a healthy control group by using the Female Sexual Function Index (FSFI). Methods: This study was designed as a retrospective study consisting of UI, DI, and a control group, each containing age-matched 40 patients. Statistical comparisons were made among the UI, DI, and control groups in terms of the FSFI total score as well as each domain’s score. Results: The FSFI total scores were found to be 22.92, 20.53, and 20.32 for the control, UI, and DI groups, respectively, and no statistically significant difference was found among the groups. A statistically significant difference existed among the groups only in terms of satisfaction and pain. Significantly higher pain was found in the UI and DI groups compared with the control group (p=0.007 and p<0.001). Although there was significantly lower satisfaction in the DI group compared with the control group (p=0.012), no significant difference was found between the UI and control groups. Conclusion: The pain in the UI group and the pain and the low satisfaction in the DI group might be parameters that cause sexual dysfunction.

Background and Objectives: In the surgical treatment of benign prostatic hyperplasia (BPH), laser enucleation of the prostate is recommended as an alternative to transurethral resection (TURP) and open prostatectomy (OP). The thulium fiber laser, with its superficial penetration depth, can offer a rapid learning process by causing less heat injury and capsule damage. This study compares the first 60 cases of an endourologist performing thulium fiber enucleation of the prostate (ThuFLEP) without a mentor to the results of OP and TURP performed by experienced surgeons. It also identifies the case number at which the operation time for ThuFLEP starts to plateau. Materials and Methods: Between 1 November 2021 and 1 November 2023, the initial 60 ThuFLEP cases of an endourologist with no prior enucleation experience were compared with TURP and OP operations performed by experienced surgeons. Since the first 60 ThuFLEP cases involved 80–120 cc prostates, TURP and OP operations within this size range performed during the same period were included in the study. The groups were assessed for age, preoperative and postoperative prostate volume, PSA levels, the IPSS, the IPSS Quality of Life (QoL), and maximum urinary flow (Q_max). The 60 consecutive ThuFLEP cases were divided into three groups of 20 (Groups 1, 2, and 3) and compared for operation time, IPSS, and Q_max. Results: The operation time for TURP was shorter than for ThuFLEP and OP (p < 0.001). There was no significant difference between ThuFLEP and OP in postoperative Q_max and IPSS, while TURP had lower values than the other two methods. For ThuFLEP, the operation time was longer in the first 20 cases but plateaued in groups 2 and 3 (p < 0.001). Postoperative Q_max and IPSS values showed no significant differences among the three ThuFLEP groups (p > 0.05). Conclusions: For large prostates, ThuFLEP provides better postoperative results than TURP and offers shorter catheterization and hospital stay times than OP. Its short learning curve makes it a preferable method for treating BPH compared to other laser techniques.