Objective. To examine the effects of ERAS protocol application on hospital stay, postoperative antibiotic use, and gastrointestinal recovery time in radical cystectomy patients with ileal conduit. Materials and Methods. This retrospective study included 182 patients (112 traditional vs. 72 ERAS) who underwent radical cystectomy (RC) with ileal conduit between November 2017 and December 2020. Patients were compared in terms of time to start enteral feeding (SEF), length of hospital stay (LOS), time to first stool, duration of postoperative intravenous antibiotic use, postoperative ileus rate, and serum albumin levels. Results. The traditional and ERAS groups contained 112 and 72 patients, respectively. LOS (14.79 ± 6.44 vs. 10.44 ± 4.64 days, ), first stool time (4.43 ± 2.39 vs. 2.89 ± 1.81 days, ), and duration of postoperative intravenous antibiotic use (8.79 ± 5.17 vs. 4.61 ± 4.90, ) were to be found significantly shorter in the ERAS group. Conclusion. According to the results of this study, the ERAS protocol shortened the length of hospital stay, duration of antibiotic use, and time of first stool in patients who underwent RC with ileal conduit.

Background: Although open radical prostatectomy has been used in the treatment of localized prostate cancer for a long time, minimally invasive surgical approaches such as laparoscopic radical prostatectomy and robot-assisted radical prostatectomy have recently gained importance in order to improve postoperative results and shorten hospital stay. Although the enhanced recovery after surgery (ERAS) protocol was first defined for gastrointestinal surgeries in 2001, it has now been used in gynecological, orthopedic, thoracic and urological surgeries. In our study, we aimed to compare the results of the ERAS protocol with the conventional approach in patients who underwent laparoscopic radical prostatectomy. Methods: There is a retrospective analysis of 70 patients who underwent laparoscopic radical prostatectomy at Kayseri City Hospital between May 2018 and January 2021. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) for Windows, version 25.0 (IBM SPSS, Armonk, NY, USA). Seventy patients were included in the study. While 48 patients who underwent perioperative care with the traditional approach were included in the conventional group, 22 patients were included in the ERAS group. Age, comorbidities, preoperative PSA level, digital rectal examination findings, preoperative imaging, extra prostatic spread and lymph node involvement, location of tumors, time between biopsy and surgery, lymphadenectomy status, and histopathological findings of transrectal ultrasound biopsy and prostatectomy specimens were recorded for each patient. Initiation of enteral feeding, time to first defecation, duration of antibiotic use, ileus development rate and length of hospital stay (LOS) were compared for both groups. Results: The mean age of 48 patients in the conventional group was 63.37 ± 7.01 years, while the mean age of 22 patients in the ERAS group was 66.36 ± 5.31 years (p = 0.080). Although the first defecation time was shorter in the ERAS group (4.75 ± 3.21 vs. 3.73 ± 2.12 days, p = 0.179), there was no statistically significant difference. Ileus developed in 10 (20.8%) patients in the conventional group and 2 (9.1%) in the ERAS group. Use of antibiotics in the postoperative period in the conventional group (5.83 ± 3.62 vs. 3.18 ± 2.42 days, p = 0.003) and LOS (7.92 ± 3.26 vs. 5.91 ± 2, 15 days, p = 0.011) were statistically significantly longer. Conclusion: In summary, ERAS protocol is associated with short LOS, time to initiation of enteral feeding and duration of antibiotics use. There was no statistically significant difference in the rate of ileus and time to first defecation between the two groups. Randomized prospective studies on heterogeneous and larger patient groups are needed to confirm our findings.

Objective: To investigate the effect of ureterorenoscopic stone removal timing on kidney function in unilateral ureteral stones. Materials and Methods: Hundred and eighty-seven patients included in the study were divided into two groups: 98 patients who underwent surgery ≤14 days after the stone diagnosis constituted the Early Surgery Group and 39 patients who were operated >14 days after the stone diagnosis comprised the Late Surgery Group. Preoperative serum levels of creatinine, blood urea nitrogen (BUN), and glomerular filtration rates (GFR) were recorded for the patients in both groups. In the postoperative first month, serum creatinine, BUN, and GFR were again recorded and compared with the preoperative values. Results: The mean preoperative serum creatinine, GFR, and BUN levels in the Early Surgery Group were 1.25 ± 0.65μmol/L, 80.04 ± 33.6ml/min/1.73m2, and 50 ± 16.6mmol/L, respectively. A decrease was observed in serum creatinine (0.82 ± 0.22μmol/L, p< 0.001) and BUN (14.08 ± 7.25mmol/L, p< 0.001) levels one month after surgery, whereas GFR increased (105.33 ± 21.6ml/min/1.73m2, p< 0.001). In the Late Surgery Group, postoperative levels of serum creatinine (0.94 ± 0.33 vs. 0.95 ± 0.30μmol/L, p= 0.102), and BUN (17.38 ± 9 vs. 17.92 ± 8.8mmol/L, p= 0.283), increased minimally, also a minimal decrease was observed in GFR (95.15 ± 27.3 vs. 93.77 ± 24.3ml/min/1.73m2, p= 0.338) without any statistically significant difference. Conclusion: We believe that surgical treatment should be planned within two weeks at the latest, as prolonged obstruction may result in kidney damage.

Aim: To examine the effect of ureterorenoscopic stone removal timing on kidney function in unilateral ureteral stones. Methods: The 137 patients sampled were divided into two groups: 98 patients who underwent surgery ≤ 14 days after the stone diagnosis (Early Surgery Group) and 39 patients who were operated> 14 days after the stone diagnosis (Late Surgery Group). Preoperative serum creatinine, blood urea nitrogen (BUN), and GFR were recorded for the patients in both groups. In the postoperative first mouth, serum creatinine, BUN, and GFR were again recorded and compared with the preoperative values. Result: The mean preoperative serum creatinine, GFR, and BUN levels for Early Surgery Group were 1.25 ± 0.65µmol/L, 80.04 ± 33.6ml/min/1.73m2, 50 ± 16.6mmol/L, respectively. While a decrease was observed in serum creatinine (0.82 ± 0.22µmol/L, p < 0.001) and BUN (14.08 ± 7.25mmol/L, p < 0.001) levels one month after surgery, the GFR increased (105.33 ± 21.6ml/min/1.73m2, p < 0.001). In Late Surgery Group, postoperative serum creatinine levels increased minimally (0.94 ± 0.33 vs. 0.95 ± 0.30µmol/L, p = 0.102), and GFR decreased (95.15 ± 27.3 vs. 93.77 ± 24.3ml/min/1.73m2, p = 0.338). Although there was an increase in BUN (17.38 ± 9 vs. 17.92 ± 8.8mmol/L, p = 0.283), the statistical difference was not significant. Conclusion: We believe that surgical treatment should be planned within two weeks at the latest, as prolonged obstruction may result in kidney damage

Background and Objectives: Stromal vascular fraction (SVF) is increasingly used for erectile dysfunction (ED), but published human data are very limited and no study has related the cellular composition of the administered product to clinical outcomes. We evaluated the outcomes of SVF added to phosphodiesterase type 5 inhibitors (PDE-5I) in patients unresponsive to PDE-5I alone, and identified factors associated with treatment response. Materials and Methods: Records of 93 consecutive patients with vasculogenic ED who underwent autologous SVF injection in addition to PDE-5I at a single andrology clinic were reviewed retrospectively. Total nucleated cell concentration and viability were measured in every product. International Index of Erectile Function-5 (IIEF-5), Erection Hardness Score (EHS) and penile colour Doppler ultrasonography were assessed at baseline and at 6 and 12 months. The primary outcome was an EHS of 3 or 4 at 6 months. Multivariate logistic regression and receiver operating characteristic (ROC) analysis were used to identify factors associated with response. Results: A total of 66 of 93 patients (71.0%, 95% CI 61.1–79.2) reached an EHS of 3 or 4 at 6 months; no patient had reached this threshold at baseline. Mean IIEF-5 rose from 10.1 at baseline to 16.2 at 6 months and 15.1 at 12 months (p = 0.001); peak systolic velocity and end-diastolic velocity both improved at 6 months (p = 0.001 for both). Non-responders were older (63.8 vs. 52.7 years), had longer ED duration (6.7 vs. 3.0 years), higher HbA1c (6.8 vs. 6.3) and more diabetes (66.7% vs. 42.4%). Product cell concentration (2.5 vs. 1.8) and viability (88.0% vs. 82.5%) were higher in responders (p = 0.001 for both). On multivariate analysis, older age (OR 1.88 per year, 95% CI 1.19–2.96), higher HbA1c (OR 13.23 per unit, 95% CI 1.65–105.87) and lower product cell viability (OR 0.38 per percentage point, 95% CI 0.20–0.73) were independently associated with non-response. On exploratory ROC analysis, cell viability discriminated responders from non-responders with an area under the curve of 0.925 (95% CI 0.872–0.977) at a threshold of 85.3%. Conclusions: In this uncontrolled retrospective series, SVF added to PDE-5I was associated with improved erectile function in approximately seven of ten patients. The cell viability of the administered product was independently associated with outcome, a finding that cannot be attributed to placebo response and that identifies product quality as a modifiable variable. These hypothesis-generating results require confirmation in controlled prospective studies.

Background/Objectives: BK virus-associated haemorrhagic cystitis (BKV-HC) is a severe complication of allogeneic haematopoietic stem cell transplantation (allo-HSCT) for which no standard treatment exists. Intravesical platelet-rich plasma has been proposed, but recipients are profoundly thrombocytopenic, and an autologous product cannot be obtained. We report the outcome of an intravesical allogeneic platelet concentrate (allo-PC) prepared from irradiated single-donor apheresis platelets in patients refractory to all available treatment. Methods: Single-centre retrospective series of 14 consecutive patients with Grade 3–4 BKV-HC treated between January 2018 and June 2021, selected from 84 patients who developed haemorrhagic cystitis during this period. All had failed hyperhydration, forced diuresis, continuous bladder irrigation and cidofovir; 10 had undergone previous cystoscopic cauterisation, 10 had immunosuppression reduction, and 4 had hyperbaric oxygen, all without resolution. The median duration of haematuria before allo-PC was 45.5 days. The primary outcome was resolution of macroscopic haematuria; transfusion requirement, catheter removal and readmission were reported separately. Results: Macroscopic haematuria resolved in 12 of 14 patients (85.7%, 95% CI 60.1–96.0) after a median of 5.5 days (IQR 4.0–12.5). Seven patients (50.0%, 95% CI 26.8–73.2) met all secondary criteria. Product platelet concentration correlated inversely with time to resolution (r_s = −0.917, 95% CI −0.977 to −0.725). Because a fixed 50 mL volume was given, the delivered dose varied 18-fold (0.30–5.62 × 10⁹ platelets/kg). Body weight also correlated with time to resolution (r_s = +0.791), but in partial correlation the association with platelet concentration persisted after adjustment for weight (r_s = −0.783, p = 0.004) and for age (r_s = −0.827, p = 0.002), whereas the association with weight did not persist after adjustment for platelet concentration (r_s = +0.292, p = 0.38). No procedure-related complication exceeded Clavien–Dindo Grade I. Conclusions: In patients who had exhausted all available treatment, intravesical allo-PC was followed by resolution of haematuria in most cases. The association between product platelet content and time to resolution was not explained by body weight or age. These uncontrolled findings are hypothesis-generating.