PSMA PET/CT is superior to morphological imaging for the detection of metastatic LNs in patients with primary prostate cancer. Surgical dissection remains the gold standard for precise lymphatic staging.

Background and Objectives: Percutaneous nephrolithotomy (PCNL) is a minimally invasive procedure for removing kidney stones, but patients still suffer from moderate postoperative pain. The aim of this study is to evaluate the perioperative analgesic effect of ultrasound-guided subcostal transversus abdominis plane (TAP) block performed before PCNL procedure. Materials and Methods: Patients scheduled for elective PCNL were randomized into two groups: Group TAP and Group IV. General anesthesia was induced with propofol, fentanyl, and rocuronium and maintained with sevoflurane, fentanyl, and rocuronium. Unilateral ultrasound-guided TAP block was performed with total of 30 mL volume of local anesthetic solution (20 mL bupivacaine 0.125% plus 10 mL lidocaine 1%) after intubation but before surgery to the Group TAP patients. Paracetamol 1 g was given to the Group IV. Tramadol 100 mg and morphine IV-patient-controlled analgesia were applied to both groups. Perioperative fentanyl consumption, postoperative verbal analog scale (VAS), morphine consumption, and additional analgesic drug requirement were assessed. Chi square with Yates correction and Mann-Whitney U tests were used for statistical analysis. Results: Eighty patients were assessed for enrollment. One patient developed septicemia at the recovery room so data of 79 patients were collected for statistical analysis. Total morphine consumption at 48th hour after the surgery was lower at Group TAP (p = 0.022). Perioperative fentanyl consumption was lower at Group TAP (p < 0.001). Additional analgesic requirement and VAS were comparable between groups. Conclusions: Preemptive unilateral ultrasound-guided subcostal TAP block decreases perioperative fentanyl and postoperative total morphine consumption in PCNL patients compared to IV analgesic management.

The aim of this review is to update the indications, contraindications, technique, complications, and the tissue engineering approaches of augmentation cystoplasty (AC) in patients with neurogenic bladder. PubMed/MEDLINE was searched for the keywords "augmentation cystoplasty," "neurogenic bladder," and "bladder augmentation." Additional relevant literature was determined by examining the reference lists of articles identified through the search. The update review of of the indications, contraindications, technique, outcome, complications, and tissue engineering approaches of AC in patients with neurogenic bladder is presented. Although some important progress has been made in tissue engineering AC, conventional AC still has an important role in the surgical treatment of refractory neurogenic lower urinary tract dysfunction.

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Objectives:Gallium-68 (Ga-68) prostate specific membrane antigen (PSMA) positron emission tomography (PET) has been shown to be more accurate than multiparametric prostate magnetic resonance imaging (MRI) in detection of primary prostate lesions. Using hybrid PET/MRI we aim to detect the correlation between SUVmax and apparent diffusion coefficient (ADC) in primary prostate lesions and to assess their prognostic value in detection of lymph node (LN) metastasis.Methods:Twenty-six patients, who were diagnosed as having prostate cancer with biopsy and underwent Ga-68 PSMA PET/MRI together with biparametric prostate MRI (bpMRI) were included. SUVmax, SUVmean and ADC were recorded for index lesions drawing a region of interest (ROI) of 1 cm2 around the pixel with the highest SUVmax (ROI-1) and another ROI following borders of prostate tumor detected by bpMRI (ROI-2). Presence of LN metastasis was recorded according to PSMA PET/MRI.Results:SUVmax was inversely correlated with ADC (ROI-1: p=0.010; ROI-2: p=0.017 for b=800). SUVmax and SUVmeans were both higher in patients with LN metastasis and ADC was lower in patients with LN metastasis for ROI-1. SUVmax cut-off value of 19.8 for ROI-1 and 20.9 for ROI-2 had sensitivity and specificity of 77.8% and 76.5%, respectively for detection of LN metastasis, whereas ADC (b=800) cut-off value of 0.92x10-3 mm2/s had sensitivity and specificity of 87.5% and 76.5%, respectively. SUVmax/ADC (b=800) ratio increased the sensitivity and specificity to 100% and 82.4%, respectively.Conclusion:SUV and ADC values are inversely correlated in primary prostate lesions and the combined use of both values increases the diagnostic accuracy of hybrid PET/MRI in the detection of primary prostate lesions.