Objective: After radical prostatectomy, prostate-specific antigen(PSA) value measuring ≥0.1 ng/mL is defined as persistent PSA(pPSA) and in many studies, it was found to be associated with aggressive disease and poor prognosis. Our aim in this study is to point out the pathological and clinical factors affecting pPSA among the patients who underwent robot-assisted radical prostatectomy(RARP) in an experienced academic centre and to make a useful risk grouping algorithm that can predict pPSA value based on operative data. Methods:We examined records of 1273 patients who underwent RARP retrospectively. Preoperative, operative and postoperative data were collected. Based on the PSA values (ng/mL) measured after 4-to-8 weeks of RARP, patients were divided into two groups as pPSA group (Group1)(n = 97) with PSA values ≥0.1 ng/mL and undetectable PSA group (Group2)(n = 778) with PSA values <0.1 ng/mL. Later on, Group1 was further divided into Group1a (PSA:0.1-0.2 ng/mL) and Group 1b (PSA≥0.2 ng/ mL) to evaluate biochemical recurrence(BCR).Results: Multivariate logistic regression analyses of the collected data revealed that preoperative PSA≥20 ng/mL, operation time, a postoperative international society of urological pathology (ISUP) grade of ≥4, pT 3-4 and pN were independently associated with pPSA. Based on these results, a risk grouping algorithm predicting pPSA was developed. By looking at the risk grouping algorithm pPSA was found in 98.9% of the cases with a preoperative PSA value of ≥20 ng/mL, an operation time of 150 min, a postoperative ISUP grade of 4-5, a positive lymphovascular invasion (LVI) status, pT3-T4, and pN+; while pPSA was found in 25.5% of the cases with a preoperative PSA value of <20 ng/mL, an operation time of 100 min, a postoperative ISUP grade of <4-5, a negative LVI status, pT<3-4 and pN-. The estimated BCR-free survival time was 16.3 months in Group 1a and 57.0 months in Group2 (P < .001). Adjuvant treatment ratio was 64.9% in Group1 and 7.1% in Group2 (P < .001). Conclusion:For the patients who underwent RARP, factors associated with aggressive disease can predict the PSA persistence. To plan our treatment modalities accurately, an applicable risk grouping algorithm in daily practice would be useful. How to cite this article: Micoogullari U, Cakici MC, Kisa E, et al. A risk grouping algorithm for predicting factors of persistently elevated prostate-specific antigen in patients following robot-assisted radical prostatectomy. Int J Clin

Background/aim: In this study, we aimed to compare the results of prone and Barts "flank-free" modified supine percutaneous nephrolithotomy (PCNL) operations in our clinic. Materials and methods:The data from patients that underwent Barts "flank-free" modified supine PCNL (BS-PCNL) (n=52) between June 2018 and July 2020 and prone PCNL (P-PCNL) (n=286) between April 2014 and June 2018 were retrospectively evaluated. Of those 286 patients, 104 patients whose gender, age, body mass index, American Society of Anesthesiology score, stone localization, stone size, and hydronephrosis matched the BS-PCNL group in a 1:2 ratio were included in the study.The groups were compared in terms of intraoperative outcome, complication rates, and stone-free rates. Results:The mean age of all patients (58 females, 98 males) included in the study was 41.8±15.2 years, and the mean body mass index (BMI) was 24.7±2.9 kg/m 2 . The mean operation time was significantly shorter in the BS-PCNL group than in the P-PCNL group (80.2±15.1 min vs. 92.4±22.7 min and p=0.01). There was no significant difference between the two groups in terms of fluoroscopy time, intraoperative complications, postoperative complications, and stone-free rates. Conclusions:Our study shows that BS-PCNL is an effective and safe method that significantly reduces the operation time and should be considered as one of the primary treatment options for patients scheduled for PCNL.

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Introduction: Leiomyomas of the genitourinary tract are rare and their manifestation in the ureter is even rarer. To our knowledge, only 14 cases of leiomyoma of the ureter have been reported worldwide since 1955, therefore this case will be 15th. Case presentation: We present a rare case of primary leiomyoma of the right ureter. Ureteroscopy did not show any abnormal findings in the ureteral mucosa. The primary leiomyoma was resected with distal ureterectomy and partial cystectomy that was followed with ureteroneocystostomy due to extraluminal mass that caused hydronephrosis and back pain. Conclusion: Although rare, we believe that leiomyoma should be considered in the differential diagnoses of well-circumscribed ureteral masses and kidney-sparing surgery should be performed.