A new protocol for renal collecting system sterilization with antibiotic irrigation during lithotripsy in retrograde intrarenal surgery: a prospective, comparative study

PURPOSE

To present a new protocol using antibiotic irrigation during lithotripsy in retrograde intrarenal surgery (RIRS) to provide sterility of the renal collecting system.

METHODS

This prospective study included 102 patients who underwent RIRS between January 2022 and August 2023. The patients were examined in two groups as those who received antibiotic irrigation (n:51) and standard irrigation (n:51). In the antibiotic irrigation group, 80 mg of gentamicin was dissolved in normal saline in a 3 L irrigation pouch to obtain a 26.7 mg/L concentration. In the standard irrigation group, normal saline was used. Preoperative information, including age, sex, body mass index (BMI), ASA score, stone side, volume, and density, and the Seoul National University Renal Stone Complexity (S-ReSC) score. The groups were compared with respect to postoperative fever (> 38 °C), urinary tract infection (UTI), systemic inflammatory response syndrome (SIRS), infectious complications such as sepsis, and stone-free rate.

RESULTS

No statistically significant difference was determined between the groups with respect to age, sex, BMI, ASA score, stone side, volume and density, and S-ReSC score (p > 0.05 for all). Statistically significant differences were determined between the groups with respect to postoperative fever (p = 0.05), SIRS (p = 0.05), and hospital length of stay (p = 0.05). Sepsis was observed in one patient in the standard irrigation group and in none of the antibiotic irrigation group.

CONCLUSION

The reliability, efficacy, and utility of antibiotic irrigation during lithotripsy in RIRS were presented in this study as a new protocol for sterilization of the renal collecting system which will be able to reduce infectious complications.

A new position utilizing the effect of gravity in proximal ureteral stones, ureteroscopic lithotripsy in the reverse Trendelenburg position: a prospective, randomized, comparative study

PURPOSE

To evaluate the effect of the reverse Trendelenburg position in patients undergoing ureteroscopic lithotripsy for proximal ureteral stones.

METHODS

The study included 167 patients who underwent ureteroscopic lithotripsy for proximal ureter stones between December 2020 and September 2022. The patients were randomly assigned to one of three groups: standard lithotomy (n:55), 10° reverse Trendelenburg (n:55), and 20° reverse Trendelenburg (n:57). Preoperative information, including age, sex, body mass index (BMI), previous shock wave lithotripsy (SWL), stone side, volume, and density, distance to the ureteropelvic junction (UPJ) of the stone, and hydronephrosis degree. Stone-free status was evaluated with computed tomography (CT) at 4 weeks postoperatively. The groups were compared in respect of stone migration, stone-free rate, use of flexible ureterorenoscope, operating time, postoperative length of stay in the hospital, and complications.

RESULTS

No statistically significant difference was determined between the groups with respect to age, sex, BMI, previous SWL, stone side, volume and density, distance to the UPJ of the stone, and hydronephrosis degree (p > 0.05 for all). Statistically significant differences were determined between the groups with respect to stone migration (p = 0.001), stone-free rate (p < 0.001), use of flexible ureterorenoscope (p = 0.01), operating time (p < 0.001), hospital length of stay (p < 0.001), postoperative fever (p = 0.002), and total complications (p = 0.01).

CONCLUSION

A new patient position is presented in this study, which can be used in ureteroscopic lithotripsy performed for proximal ureteral stones. The reverse Trendelenburg position constitutes a surgical method that can be used safely and successfully in the treatment of proximal ureteral stones.

TRIAL REGISTRATION NUMBER

NCT04894058, 05/21/2021, Prospectively registered.

The Value of Prostate-Specific Antigen Density in Combination with Lesion Diameter for the Accuracy of Prostate Cancer Prediction in Prostate Imaging-Reporting and Data System 3 Prostate Lesions

INTRODUCTION

The aim of the study was to investigate the value of prostate-specific antigen density (PSAD) and lesion diameter (LD) combination in prostate cancer (PCa) detection.

METHODS

181 patients who were detected to have prostate imaging-reporting and data system (PI-RADS) 3 lesions in mpMRI and underwent prostate biopsies were included in the study. Demographic, clinical, and pathological data of all patients were evaluated. The patients were divided into four groups according to PSAD and LD status (PSAD <0.15 ng/mL/cc + LD <1 cm, PSAD <0.15 ng/mL/cc + LD ≥1 cm, PSAD ≥0.15 ng/mL/cc + LD <1 cm, and PSAD ≥0.15 ng/mL/cc + LD ≥1 cm). Diagnostic ability for PCa and clinical significant PCa (csPCa) was evaluated by PSAD and LD.

RESULTS

PSAD ≥0.15 ng/mL/cc (OR = 6; 95% Cl = 2.847-12.647; p < 0.001), LD ≥1 cm (OR = 7.341; 95% confidence interval [CI] = 2.91-18.52; p < 0.001), and combination of PSAD ≥0.15 ng/mL/cc and LD ≥1 cm (OR = 10.023; 95% CI = 4.32-23.252; p < 0.001) were associated with PCa detection rates. The most sensitivity, specificity, negative, and positive predictive values were found in PSAD ≥0.15 ng/mL/cc + LD ≥1 cm group for both PCa and csPCa detection (48.8%, 92%, 85.2%, and 65.6% for any PCa detection; 66.7%, 85.2%, 97.3%, and 24.2% for csPCa detection, respectively).

CONCLUSION

The presence of PSAD ≥0.15 ng/mL/cc or LD ≥1 cm in mpMRI of patients with PI-RADS 3 lesions is associated significantly with the finding of PCa and particularly with the detection of csPCa.

A New Scoring System to Differentiate Bladder Cancer from Intravesical Prostatic Protrusion in the Bladder Neck: BCa-IPP Score

OBJECTIVE

The aim of this study was to explore the criteria that can predict bladder cancer among the lesions that could not be differentiated from intravesical prostate protrusion (IPP) and to create a scoring system using these criteria.

METHODS

A retrospective analysis was made of patients with an ultrasound report indicating lesions in the bladder neck, for which differentiation between bladder cancer and IPP could not be determined. A total of 174 patients diagnosed with bladder cancer (n=102) or benign prostate lesion (n=72) according to the biopsy results were enrolled in the study. Hemoglobin, prostate-specific antigen (PSA), prostate volume (PV), bladder wall thickness (BWT), lesion height (LH), and the ratio of lesion width to base (LW/B) were compared between the two groups.

RESULTS

ROC analysis revealed an AUC value >0.7 for all factors, and the best cut-off value was identified for each factor. In the multivariate analysis, by determining a score for each factor according to the ORs, the BCa-IPP scoring system was developed to provide a total score in the range of minimum 0 and maximum 15. In the ROC analysis, the AUC value was 0.954 (95% CI: 0.923-0.986) for the BCa-IPP score. The best cut-off value was found to be 10, with sensitivity of 0.93 and specificity of 0.85.

CONCLUSION

Using simple laboratory and ultrasound findings, the BCa-IPP scoring system was created, which was seen to have high predictive value and can be easily applied in the clinic. The BCa-IPP scoring system is a non-invasive test that can be successfully applied for the differentiation of bladder cancer from benign lesions.

Optimal Dwelling Time for Ureteral Stents Placed for Passive Dilation after Impassable Ureteroscopy

INTRODUCTION

The aim of the study was to determine the correlation between the dwelling time for a ureteral stent placed for passive dilation after impassable ureteroscopy and success and complications.

METHODS

A retrospective evaluation was made of patients who underwent stent placement after impassable ureteroscopy and a repeat ureteroscopy due to kidney stones. A total of 161 patients were included in the study between 2015 and 2022. Demographic, clinical, preoperative, and perioperative data were collected. Logistic regression analyses were performed on the data showing a significant difference in the univariate analyses performed to determine the predictive factors of ureteroscopy after the stent dwelling period in terms of stone-free status and perioperative complications.

RESULTS

Stone-free status was achieved in 110 (68.3%) of 161 patients, and perioperative complications were observed in 41 (25.4%). Factors that affected the stone-free status were determined as the dwelling time and the S-ReSC score, while factors affecting perioperative complications were the stent dwelling time and the operation time. The stone-free rates were observed to increase from 46.4% in the first 2 weeks to 72.9% after the 2nd week, an increase of 1.5-fold. Perioperative complications were determined at the rate of 17.5% during the first 5 weeks and increased 2.1-fold to 37.5% after the 5th week.

CONCLUSION

It can be recommended that great care is taken during the stent dwelling period and ureteroscopy should be performed within 5 weeks (14-35 days) but no earlier than 2 weeks, so as not to affect the success of the procedure.

The protective effect of roflumilast and ibuprofen on testicular ischemia reperfusion injury: An experimental study

BACKGROUND

The aim of the present study is to investigate the efficiency of roflumilast and ibuprofen in an experimental rat testicular ischemia reperfusion injury model in the light of histological and biochemical data.

METHODS

A total of 32 prepubertal male rats were randomly divided into four groups as G1: Control Group (testicular torsion/detorsion + saline (0.9% of 2 ml) was applied). G2: Sham Group only right scrotal incision was performed; G3: Ibuprofen Group (tes-ticular torsion/detorsion + ibuprofen administration); and G4 Roflumilast Group (testicular torsion/detorsion + roflumilast adminis-tration). Oxidative markers such as malondialdehyde (MDA), myeloperoxidase (MPO), total sulfhydryl (TSH), and nitrite (NO) levels as well as histopathological changes were analyzed.

RESULTS

Tissue MPO, MDA, and NO levels were significantly higher and TSH levels significantly lower in control group compared to sham group (p<0.001). The histopathologic scores of drug groups (Groups 3 and 4) were significantly lower than group 1 (p<0.001). In comparison of Group 3 and Group 4 with each other, the mean values of MPO and MDA were statistically significantly lower in Group 4 (p<0.001). A higher mean value of TSH was found in Group 3 without statistically significance (p=0.32). There was also an insignificant decrease in mean NO values of Group 3 compared to Group 4 (p=0.44). In comparison of drug groups, Group 4 had statistically insignificant better scores.

CONCLUSION

Our results indicate that administrating ibuprofen and roflumilast reduced testicular ischemia reperfusion injury in rat testis torsion model. In comparison, roflumilast is found to be more beneficial.

The examination of the nephroprotective effect of montelukast sodium and N-acetylcysteine ın renal ıschemia with dimercaptosuccinic acid imaging in a placebo-controlled rat model

Purpose

To determine the nephroprotective effect of NAC and Montelukast Sodium administration against the development of renal damage associated with long warm renal ischemia.

Methods

Twenty-seven rats were randomly divided into 3 study groups, which received NAC, montelukast and placebo, and 3 rats were included in the sham-treated control group. Medications were given 3 days before the procedure. DMSA renal scintigraphy was performed before and after surgery. The right renal pedicle was occluded for 45 min to induce ischemia and then subjected to reperfusion for 6 h (I/R groups).

Results

On pathological examination, the mean pathological scores of the montelukast and NAC groups were significantly lower than those of the placebo group. (p <0.05). In biochemical examination, significant differences were found in all parameter levels between the placebo group and the montelukast and NAC groups. (p <0.05) When postoperative DMSA renal scintigraphy measurements and renal function levels were compared, significant differences were found between the montelukast and NAC groups and the placebo and sham groups.

Conclusion

The administration of NAC and montelukast sodium was seen to have a nephroprotective effect against the development of renal damage associated with warm renal ischemia.

Effects of cage type on performance, welfare, and microbiological properties of laying hens during the molting period and the second production cycle

As most of the unenriched cages will soon switch to enriched cages, it is important to characterize all the effects in the laying hens for sustainable production. Laying hens can be used in several production periods by applying molting. The aim of this study was to determine the cage type (unenriched and enriched) on performance, welfare, and microbiological properties of laying hens during the molting period and the second production cycle. Overall, 840 brown laying hybrids were used in the experiment. Laying hens were reared on two different cage types (unenriched cage (UEC) and enriched cage (EC)) in the same poultry house. When the hybrids were 75 weeks old, they were subjected to force molting with whole grain barley. Performance, welfare, microbiological, and serological data of laying hens were obtained from 73 to 107 weeks of age. Egg production, egg weight, feed conversion ratio, breaking strength, albumen and yolk index, Haugh unit, feather condition, and breaking force of femur and metatarsus were better in the post-molting period. However, keel bone deformities and Newcastle disease virus antibody titers are the worst in the post-molting period. Stiffness of femur and metatarsus was increased with period. These results indicate that necessary precautions should be taken against the problems that may occur in the direction of bone and health. During the molting period, hens kept in EC had lower egg production but they returned to egg production at a high rate. EC type had a positive effect on egg production, feed conversion ratio, feather and foot condition, and breaking force of metatarsus.

Structural changes in gut microbiome after Ramadan fasting: a pilot study

It has been largely accepted that dietary changes have an effect on gut microbial composition. In this pilot study we hypothesised that Ramadan fasting, which can be considered as a type of time-restricted feeding may lead to changes in gut microbial composition and diversity. A total of 9 adult subjects were included in the study. Stool samples were collected before (baseline) and at the end of the Ramadan fasting (after 29 days). Following the construction of an 16S rRNA amplicon library, the V4 region was sequenced using the Illumina Miseq platform. Microbial community analysis was performed using the QIIME program. A total of 27,521 operational taxonomic units (OTUs) with a 97% similarity were determined in all of the samples. Microbial richness was significantly increased after Ramadan according to observed OTU results (P=0.016). No significant difference was found in terms of Shannon index or phylogenetic diversity metrics of alpha diversity. Microbial community structure was significantly different between baseline and after Ramadan samples according to unweighted UniFrac analysis (P=0.025). LEfSe analysis revealed that Butyricicoccus, Bacteroides, Faecalibacterium, Roseburia, Allobaculum, Eubacterium, Dialister and Erysipelotrichi were significantly enriched genera after the end of Ramadan fasting. According to random forest analysis, the bacterial species most affected by the Ramadan fasting was Butyricicoccus pullicaecorum. Despite this is a pilot study with a limited sample size; our results clearly revealed that Ramadan fasting, which represents an intermittent fasting regime, leads to compositional changes in the gut microbiota.

The effect of intraurethral dexpanthenol in hypospadias repair: experimental rabbit study

INTRODUCTION

In this study, the authors aimed to research the histopathologic effects of intraurethral use of dexpanthenol for hypospadias repair. Dexpanthenol is a derivative of pantothenic acid, a B complex vitamin. Pantothenic acid is a molecule contributing in the structure of coenzyme A. It decreases the release of myeloperoxidase from granulocytes and inhibits the formation of free oxygen radicals, and it exhibits an anti-inflammatory effect by increasing mitotic activity.

OBJECTIVE

The objective of this study is to evaluate the use of dexpanthenol after a tubularized incised plate urethroplasty (TIP) on wound healing, inflammation, and fibrosis.

STUDY DESIGN

In this study, 18 healthy male New Zealand white rabbits weighing 2500-3000 g were used. The 18 rabbits were randomly divided into 3 groups. For the hypospadias model, rabbits had a urethral catheter inserted in the urethra and a ventral midline incision was made from the glans tip to the central line of the penis. Afterward, the incision was closed with Vicryl (7/0) using the continuous suture technique, and urethroplasty was completed. For fourteen days, group I had 0.9% saline solution administered intraurethrally twice per day with a 22G catheter sleeve (control group), group II had one dose of 500 mg/kg dexpanthenol (Bepanthene®; Bayer Turk Chemical Industry Limited Company, Turkey) ampoule and one dose of saline solution administered in the same way, and group III had two doses of 500 mg/kg dexpanthenol ampoule administered. On the fifteenth day, the penis was degloved and rabbits had penectomy performed with samples sent to the pathology department for histopathological assessment.

RESULTS

The degree of fibrosis and inflammation in group I (control group) was more severe than groups II and III. The differences between groups I and II were statistically significantly different for both fibrosis and inflammation (P = 0.018 and P = 0.041, respectively). The differences between groups I and III were also statistically significantly different for both fibrosis and inflammation (P = 0.019 and P = 0.011, respectively). Groups II and III were not different significantly for fibrosis and inflammation (P > 0.05).

DISCUSSION

This study shows that intraurethral dexpanthenol application has positive effects on fibrosis and inflammation. The main limitations of the study are that the hypospadias model was created surgically and long-term follow-up for fistula formation was not assessed.

CONCLUSIONS

Administration of intraurethral dexpanthenol after hypospadias repair has positive effects on fibrosis and inflammation.

Comparision of Percutaneous Nephrolithotomy and Retrograde Intrarenal Surgery For The Treatment of Multicalyceal and Multiple Renal Stones

PURPOSE

Comparison of efficiency and reliability of percutaneous nephrolithotomy (PNL) and retrograde intrarenal surgery (RIRS) in treatment of multicalyceal and multiple renal stones in the same renal unit.

MATERIALS AND METHODS

Between 2011 and 2015, records of patients who underwent surgery for renal stone were retrospectively reviewed. Patients who had multiple stones located in different calices in the same renal unit were included. The patients that underwent PNL and RIRS were defined as Group I and Group II, respectively. Patient criteria (age,sex); the stone characteristics; time of procedure, fluoroscopy and hospitalization; stone-free and complication rates of groups were evaluated between the treatment groups.

RESULT

There were no significant differences in terms of age, gender, BMI, laterality, number of stones, number of stone localization, hounsfield units and surface area characteristics of the stone between the PNL (n = 47) and RIRS (n = 35) groups (P = .558, P = .278, P = .375, P = 0.051, P = .053, P = .064, P = .642, P = .080, respectively). Stone free rate was 59.6% (n=28) in PNL, and 88.6% (n=31) in RIRS (P=.004). 1st or 2nd degree complications according to Modified Clavien Classification developed in 10 patients (21.3%) in Group I and 1 patient (2.9%) in Group II (P = .015). The 3A or 3B complications were similar in groups (P = .077). Time of procedure, fluoroscopy and hospitalization were significantly lower in Group II (P < .001, P < .001 and P < .001, respectively).

CONCLUSION

RIRS is more effective and more reliable procedure than PNL with higher stone-free and lower complication rates in treatment of multicalyceal and multiple stone in the same renal unit.

The role of probiotics in women with recurrent urinary tract infections

Urinary tract infections (UTIs) still represent a significant bother for women and result in high costs to the health system. Increasing antimicrobial resistance has stimulated interest in non-antibiotic prophylaxis of recurrent UTIs. Evidence shows that the microorganisms inhabit many sites of the body, including the urinary tract which has long been assumed to be sterile in healthy individuals, might have a role in maintaining urinary health. Studies of the urinary microbiota (UM) have identified remarkable differences between healthy populations and those with urologic diseases. The depletion of these organisms in women susceptible to UTIs raised the question of whether artificial supplementation of these microorganisms as probiotics could lower infection rates. In the literature, probiotic interventions were shown to have some efficacy in the treatment and prevention of urogenital infections. Despite previous controversy regarding the use of probiotics, as treatment for UTIs, there are increasing signs that it may be possible to use them as a first step in regulating the UM so as to reduce the risk of or as a treatment for certain urinary diseases. However, further future clinical trials, involving large numbers of patients, will be mandatory to achieve definite evidence of the preventive and curative role of probiotics in UTIs. Details about correct formulations in terms of amount of bacteria, viability and associated growth factors, will be required in order to standardize the administration schedule and achieve homogeneous and comparable results on selected patients.

The protective effect of Papaverine and Alprostadil in rat testes after ischemia and reperfusion injury

OBJECTIVE

To investigate the effect of papaverine and alprostadil on testicular torsion-detorsion injury in rats.

MATERIALS AND METHODS

A total of 40 male Wistar-Albino rats were used in this study. Four hours of right testicular torsion was applied to each group, excluding sham operated group. The torsion-detorsion (T/D), T/D + papaverine and T/D + alprostadil groups received saline, papaverine and alprostadil at the same time as surgical detorsion, respectively. At 14 days after the surgical detorsion, ischaemic changes and the degree of damage were evaluated with Cosentino scoring and the Johnson tubular biopsy score (JTBS).

RESULTS

JTBS was determined as 8.8±2.7 in the Sham group, 5.08±1.9 in the T/ D+papaverine group, 5.29±2.3 in the T/D +alprostadil group and 2.86±1.9 in the TD group. The JTBS was determined to be statistically significantly high in both the T/D + papaverine group and the T/D + alprostadil group compared to the T/D group (p=0.01, p=0.009). In the T/D + papaverine group, 3 (43 %) testes were classified as Cosentino 2, 3 (43%) as Cosentino 3 and 1 (14 %) as Cosentino 4. In the T/D +alprostadil group, 5 (50 %) testes were classified as Cosentino 2, 3 (30 %) as Cosentino 3 and 2 (20%) as Cosentino 4.

CONCLUSION

The present study indicated that spermatic cord administration of alprostadil and papaverine showed a protective effect against ischemia/reperfusion injury after right-side testes torsion and histological changes were decreased after testicular ischemia reperfusion injury.

Does Preoperative Use of Dutasteride Decrease Bleeding During Open Prostatectomy?

PURPOSE

To investigate whether use of dutasteride, a 5-alpha reductase inhibitor, for at least four weeks preoperatively affected the blood loss during open prostatectomy (OP).

MATERIALS AND METHODS

Retrospective analysis was made of the data of 110 patients who had undergone OP. Group I comprised 50 patients that used dutasteride for 4 weeks preoperatively, and Group II comprised 60 patients that did not use the drug. The groups were compared in respect of age, total prostate specific antigen (TPSA) levels, prostate volumes, preoperative hemoglobin (Hgb) and hematocrit (Hct) levels, postoperative reduction of Hgb and Hct, percentage reduction in Hgb and Hct, and the administration of postoperative blood products.

RESULTS

No differences were determined between the two groups in respect of prostate volumes, TPSA, preoperative Hgb and Hct levels (P = .813, P = .978, P = .422, P =.183, respectively). Postoperative Hgb reduction was 2.19 ± 1.36 g/dL in Group I, and 2.5 ± 1.47 g/dL in Group II (P = .260). Hgb reduction was calculated as 16.4 ± 9.7% in Group I and 17.6 ± 9.7% in Group II (P = .505). Reductions in Hct were 5.8 ± 3.7% in Group I, and 7.3 ± 4.4% in Group II, and percent reductions were 14.8 ± 9.4% in Group I and 17.3 ± 10.2% in Group II (P = .068, P = .182, respectively).

CONCLUSION

The use of dutasteride before OP did not affect blood loss during surgery, therefore surgery should not be delayed for the administration of dutasteride to patients.

Comparison of ultra-mini percutaneous nephrolithotomy and micro-percutaneous nephrolithotomy in moderate-size renal stones

OBJECTIVE

We aimed to compare the success and complications of ultra-mini percutaneous nephrolithotomy and micro-percutaneous nephrolithotomy techniques.

METHODS

We retrospectively analyzed data from 74 patients. Moderate-size stones were included in the study.

RESULTS

Forty-two patients were included in MPNL, and 32 patients were included in UPNL groups. Among our patient cohort, 42 (56.7%)were males, and 32 (43.3%) were females. The mean age of the patients was 40±13.2 years in the MPNL group, and the mean age of the patients was 42±14.1 years in the UPNL group. The mean stone size was 17±3.2 mm in the MPNL group and 16.4±3.7 mm in the UPNL group. The stonefree rates were 88.1% (37/42) and 90.6% (29/32)in the MPNL and UPNL groups, respectively; there was no statically significant difference between the groups. The mean hospital stay was 1.4±0.23 days in the MPNL group and 1.1±0.12 day in the UPNL group.

CONCLUSIONS

Two techniques have similar success and complication rates, and both may be preferred particularly in moderate-size stones. Our experience supports that our UPNL technique is safe and effective using with a standard ureteroscope.

Complications and prostate cancer diagnosis rate of TRUS prostate biopsies using 16 and 18G needles by Clavien scoring

AIM

We aimed to compare the 18 and 16-Gauge (G) needles used in transrectal ultrasonography (TRUS)-guided needle biopsy for cancer detection rates and complications using the Clavien Scoring System.

MATERIALS AND METHODS

The 80 patients who were included in the study were randomized and divided into two groups. Group 1 (n = 36) had a TRUS-guided prostate biopsy with an 18G needle and Group 2 had a 16G needle (n = 44). The hematuria, bleeding assessment, and infection events were evaluated on a daily basis. These complications were graded according to the Clavien Scoring.

RESULTS

In Group 1, only five (13%) patients were diagnosed with prostate cancer, and three patients were reported to have atypical small acinar proliferation (ASAP). In Group 2, 16 (36%) patients were diagnosed with prostate cancer and one patient was reported to have ASAP. The difference in the prostate cancer detection rate between the groups was statistically significant. According to the Clavien grading system, the complications were at the Grade 1 level in 25 people in Group 1 in 29 people in Group 2. Grade 2 level complications were not observed in either group. While one person was Grade 3 in Group 1, two people in Group 2 had this rate. There were no significant differences between the groups.

CONCLUSIONS

We found that cancer detection rate increased by increasing the thickness of the needle used in TRUS-guided prostate biopsy without any increase in the complications.

The Respiratory Induced Kidney Motion: Does It Really Effect the Shock Wave Lithotripsy?

PURPOSE

To investigate the effect of respiratory induced kidney mobility on success of shock wave lithotripsy (SWL) with an electrohydraulic lithotripter.

MATERIALS AND METHODS

Between May 2013 and April 2015, 158 patients underwent SWL treatment for kidney stones with an electrohydraulic lithotripter. The exclusion criteria were presence of a known metabolic disease (such as cystinuria), non-opaque stones, need for focusing with ultrasonography, abnormal habitus, urinary tract abnormalities, and inability to tolerate SWL until the end of the procedure. Stones greater than 20 mm, and lower pole stones were also excluded. The movement of the kidneys were measured with fluoroscopy guidance.

RESULTS

The procedure was successful in 66.7% of the males, and 56.9% of the females. The mean stone size was 11 ± 3 mm in the successful group, and it was 14 ± 4 mm in the unsuccessful group. The mean stone mobility rate was 32 ± 10 in the successful group and 40 ± 11 in the unsuccessful group. Multivariate analysis showed that stone size and kidney mobility affected the success rate significantly, however Hounsfield Unit (HU) did not.

CONCLUSION

The current study shows the significant effect of kidney motion on the success of SWL. Further studies with different lithotripters are needed to determine the significance of kidney mobility.

Efficacy of using Zaontz urethral stent in hypospadias repair by the Face, Legs, Activity, Cry, Consolability (FLACC) scale: A prospective study

INTRODUCTION

The developments in hypospadias surgical techniques and materials are intended to improve surgery outcomes and patient comfort. The aim of this study is to determine the effect of the Zaontz urethral stent (ZUS) (Cook Medical) on patient comfort and surgical success rates in children undergoing hypospadias surgery.

METHODS

A feeding tube was used to repair 46 cases of primary distal hypospadias, and ZUS (6F, 8F, and 10F in diameter) was used to repair to 31 cases of primary distal hypospadias between December 2009 and June 2011 in our clinic. ZUS was compared with the feeding tube in terms of surgical success rates and patient comfort in assessments made during postoperative periods.

RESULTS

The patients with ZUS were followed with a stent for seven days postoperatively, as were the patients with the feeding tube. There was no statistical difference between the two groups in terms of fistula formation (p>0.05). Patient comfort was evaluated by the Face, Legs, Activity, Cry, Consolability (FLACC) scale on the first and third postoperative days, and a statistically significant difference was observed in favour of ZUS on the third postoperative day (p<0.05).

CONCLUSIONS

Compared with a feeding tube in hypospadias repair, ZUS does not make any contribution to the urinary fistula rates. However, ZUS may have an advantage in terms of patient comfort in the postoperative followup. On the other hand, the small number of patients and the high price of the ZUS were the most important limitations. Prospective, randomized trials are needed to assess efficacy and cost.

Is a contrast study really necessary prior to ureteroscopy?

This study aimed to evaluate the effect of preoperative imaging techniques on the success and complication rates of ureteroscopy. We performed a retrospective analysis of 736 patients (455 males and 281 females), with a mean age of 45.5±15.2 years (range, 1-88 years), who underwent rigid ureteroscopic procedures for removal of ureteral stones. Patients were divided into 4 groups according to the type of imaging modality used: group I, intravenous urography (n=116); group II, computed tomography (n=381); group III, computed tomography and intravenous urography (n=91), and group IV, ultrasonography and abdominal plain film (n=148). Patients’ demographics, stone size and location, prior shock wave lithotripsy, lithotripsy technique, operation time, success rate, and rate of intraoperative complications were compared among the groups. There were no significant differences in success and complication rates among the groups. The stone-free rate after primary ureteroscopy was 87.1% in group I, 88.2% in group II, 96.7% in group III, and 89.9% in group IV (P=0.093). The overall incidence of intraoperative complications was 11.8%. According to the modified Satava classification system, 6.1% of patients had grade 1, 5.1% had grade 2, and 0.54% had grade 3 complications. Intraoperative complications developed in 12.1% of patients in group I, 12.6% of patients in group II, 7.7% of patients in group III, and 12.2% of patients in group IV (P=0.625). Our findings clearly demonstrate that ureteroscopic treatment of ureteral stones can be safely and effectively performed with no use of contrast study imaging, except in doubtful cases of anatomical abnormalities.

Overview of different scoring systems in Fournier's Gangrene and assessment of prognostic factors

OBJECTIVE

In this study we aimed to evaluate prognostic factors for the survival of patients with Fournier's gangrene (FG), and overview different validated scoring systems for outcome prediction.

MATERIAL AND METHODS

We retrospectively analyzed the data of 39 patients treated for FG in our clinic. Data were collected on medical history, symptoms, physical examination findings, vital signs, laboratory parameters at admission and at the end of treatment, timing and extent of surgical debridement, and the antibiotic treatment used. The Fournier's Gangrene Severity Index (FGSI) and Charlson Comorbidity Index (CCI) were used to predict outcome. The data were analyzed in relation with the survival of the patients. Mann-Whitney U test, chi -square test, Wilcoxon signed rank test, and Cox regression analysis were used for the statistical analysis.

RESULTS

Of 39 patients analyzed, 8 (20.5%) died and 31 (79.5%) survived. The median FGSI score on admission was 2 (0-9) for the survivors and 6 (2-14) for the non-survivors (p=0.004). The median CCI scores of the survivors and non-survivors were 2 (0-10) and 6.5 (5-11), respectively (p=0.001). Except for urea, albumin and hematocrit levels, no significant differences were found between survivors and non-survivors for other laboratory parameters on admission. Lower albumin levels and advanced age were found to be associated with mortality.

CONCLUSION

High blood urea, low albumin, and low hematocrit levels were associated with poor prognosis. High CCI and FGSI scores could be associated with a poor prognosis in patients with FG.

The effect of ureteroscope size in the treatment of ureteral stone: 15-year experience of an endoscopist

OBJECTIVE

We aimed to investigate the ureter stone treatment results performed by using different- caliber semirigid ureteroscopes (URS).

MATERIAL AND METHODS

Adult patients who were treated for ureteral stones by a single endoscopist between January 2000 and March 2015 were analyzed. The patients were divided into 3 groups in accordance with the caliber of the ureteroscope used: 10/10.5 F Storz (Karl Storz, Tuttlingen, Germany) (January 2002-January 2005) URS was used in group 1, 8.9/9.8 F Storz (February 2005-December 2011) URS was used in group 2, and 6/7.5 FWolf (Richard Wolf, Knittlingen, Germany) (January 2012-March 2015) URS was used in group 3. Patients' age and gender, size and site of stones, stone-free rates (SFR), intra- and perioperative complication rates, and durations of surgery were compared among the groups. Intraoperative complications were classified according to modified Satava, and perioperative complications were classified according to modified Clavien classification systems.

RESULTS

A total of 2461 patients treated for ureteral stones were analyzed. There were 583 patients in group 1 (10/10.5 F Storz), 1302 patients in group 2 (8.9/9.8 F Storz), and 576 patients in group 3 (6/7.5 F Wolf). SFR were 83.7%, 87.4%, and 92.2% in groups 1, 2, and 3, respectively (p=0.01). Duration of surgery was 30.34±10.36 min in group 1, 31.61±10.10 min in group 2, and 42.40±7.35 min in group 3 (p=0.01). The overall complication rates classified according to modified Satava classification were 10.8%, 7.6%, and 6.9% (p=0.01) while grade 3 modified Satava complication rates were 1.9%, 1.5%and 0.5% in groups 1, 2, and 3, respectively (p=0.01).

CONCLUSION

In this study, we found that more frequent use of a small- caliber URS resulted in a longer duration of surgery and an increased rate for JJ stent insertion, however it facilitated a safer and more successful ureteroscopy procedure.

Evaluating Ureteral Wall Injuries with Endoscopic Grading System and Analysis of the Predisposing Factors

OBJECTIVE

To analyze the predictive factors for intraoperative ureteral wall injury due to semirigid ureteroscopy (URS) used in the treatment of ureteral calculi.

METHODS

The data of 437 patients who had URS due to ureteral stones were prospectively analyzed. The ureteral wall injuries that occurred during URS were reviewed endoscopically at the end of surgery and divided into two groups as low grade (grades 0 and 1) and high grade (grades 2, 3, and 4) according to classification of ureteral wall injuries. Those two groups were compared for patient and stone characteristics and perioperative findings.

RESULTS

Ureteral wall injury was seen in 133 (30.4%) patients after surgery. According to the endoscopic classification of the lesions after URS, grades 0, 1, 2, and 3 injury were seen in 69.5%, 16.4%, 11.2%, and 2.7% of the patients, respectively. There were no grade 4 injuries in our series. Two groups showed statistically significant differences for the location (prox- vs distal and mid-ureter) and size of the stone (9.9 mm vs 14.03 mm), presence of preoperatively urinary tract infection (UTI) (12% vs 50.8%), needed balloon dilatation (9.8% vs 36.1%), duration of surgery (33.6 min vs 43.3 min), and surgical success rate (90% vs 76%) (p = 0.01, for all). Stone size, location, duration of surgery, and presence of preoperative infection were determined as independent prognostic factors for mucosal injury.

CONCLUSION

The ureteral wall injury grading system may be used for standardized reporting of ureteral lesions after ureteroscopy. Big, proximal ureteral stone, longer operation time, and presence of UTI are the risk factors for ureteral wall injury during URS.

Seasonal preponderance in testicular torsion: is it a myth?

OBJECTIVE

In this study, we aimed to investigate the relation of testicular torsion and weather conditions, and to report results from Turkey, a country located between temperate and sub-tropical climate zones.

METHODS

A total of 56 patients that had surgery with the diagnosis of testicular torsion in Ankara Education and Research Hospital Urology Clinic between 2005 and 2014 were included in the study. Age of the patient, side of torsion, date and time at onset of pain, scrotal exploration time, ischemia duration, degree of cord torsion, the surgical procedure performed, and scrotal Doppler ultrasound (USG) findings at the time of diagnosis and 1 month after surgery were retrospectively analyzed. The web archives of Turkish Republic Meteorology General Directorate was used to determine the seasonal and mean temperatures at the time of diagnosis. The data were analyzed with SPSS v. 16 statistical package program using Chi-square, Mann- Whitney U and Wilcoxon tests.

RESULTS

The mean age of 56 males included in the study was 18.88 ± 0.73 years. Right testicular torsion was seen in 23, and left testicular torsion was seen in 33 patients. Testicular arterial flow was absent in 37, arterial flow was moderately decreased in 12, and significantly decreased in 7 patients on Doppler USG. Detorsion procedure was performed in 46 patients while 10 patients had orchiectomy. Nine patients were admitted in summer, 14 in fall, 15 in winter, and 18 in spring. The mean air temperature at the time of admittance was 9.31 ± 1.05 °C. The prevalence of testicular torsion was not found different among the seasons (p=0.39). The analysis of air temperature at the time of admittance of the patients revealed that it was below 15 °C in 40 patients while it was above 15 °C in 16 patients, with a significant difference in between (p=0.002).

CONCLUSIONS

The prevalence of testicular torsion did not change in relation with the seasons. However, it was determined that its prevalence was directly proportional to the air temperature, and increased particularly below 15 °C.

Core Length: An Alternative Method for Increasing Cancer Detection Rate in Patients with Prostate Cancer

PURPOSE

We determine whether the lengths of benign and malignant cores affect cancer detection rates in patients with prostate cancer (PCa).

MATERIALS AND METHODS

We evaluated retrospectively 512 patients in our clinic who had undergone 12 core transrectal ultrasound (TRUS)-guided prostate biopsies. The cores were divided into two groups: one with cancer (group 1) and one without cancer (group 2). We also classified Gleason scores as poorly differentiated (scores of 7-10) and moderately differentiated (scores of 5-6); these scores were compared with each other in terms of the core length. The core lengths of the groups were compared using a Student's t-test. A P value of less than .05 was considered to be statistically significant.

RESULTS

Of the 512 patients, 76 (15%) had PCa. In total, we evaluated 912 cores of prostate biopsy samples from the 76 patients. Since 92 cores included insufficient tissue and rectal mucosa, we were not able to evaluate them. The remaining 820 cores were divided into two groups. Cancer was detected in 302 cores; 518 cores were benign in nature. The average core length in group 1 was 11.9 ± 4.4 mm, and the average core length in group 2 was 11.1 ± 5.1 mm (P = .015). The core lengths of poorly differentiated and moderately differentiated cancers were similar: 12.3 ± 4.2 mm and 11.7 ± 4.5 mm, respectively (P = .25).

CONCLUSION

Increasing cancer detection rates in cores may be related to core length in TRUS-guided prostate biopsies in PCa patients.

Effectiveness of retrograde intrarenal stone surgery in obese patients

BACKGROUND

A number of comorbid health problems can be found in obese patients. These problems increase the surgical risk in obese patients.

AIMS

To determine the effectiveness of retrograde intrarenal surgery for renal stone treatment in obese patients.

METHODS

We retrospectively reviewed the data of 106 patients who had retrograde intrarenal surgery with the diagnosis of renal stone in our clinic. The patients were divided into three groups regarding their body mass indexes: ≥30 kg/m² being obese (group 1), 25-29.9 kg/m² being overweight (group 2), and <25 kg/m² being normal weight (group 3). The patients were compared for age, gender, and stone characteristics. In addition, the duration of surgery, stone-free rate (SFR), complication rate, and the duration of the hospital stay were compared among the groups.

RESULTS

Twenty eight patients were obese (group 1), 49 patients were overweight (group 2), and 29 patients were normal weight (group 3). The mean ages of groups 1, 2 and 3 were 51.5 (29-84), 47 (30-76) and 35 (19-84) years, respectively (p = 0.001). SFR was 85.7 % in group 1, 89.8 % in group 2, and 75.9 % in group 3 (p = 0.24). The duration of surgery was similar in groups 1, 2, and 3, being 45.5 (25-95), 50 (30-120), and 45.5 (10-100) min, respectively (p = 0.23). None of the patients had major complications.

CONCLUSIONS

Our results indicate that retrograde intrarenal surgery is a safe and efficient surgical method for renal stone treatment in obese and overweight patients.

Ureteroscopy in proximal ureteral stones after shock wave lithotripsy failure: Is it safe and efficient or dangerous?

INTRODUCTION

We assessed the effectiveness of ureteroscopy (URS) in proximal ureteral stones performed after shock wave lithotripsy (SWL) failure, and determined outcomes in terms of success rate, complications, and operation time.

METHODS

We analyzed data of patients with previous unsuccessful SWL (Group I) and the ones that did not have SWL or URS before (Group II) for proximal ureteral stones between December 2007 and August 2014. Group I included 346 patients who underwent complementary URS and Group II 209 patients who underwent primary URS. Success rates, operation time and complications were compared between groups.

RESULTS

Success rates of complementary and primary URS were 78.9% and 80.9%, respectively. The difference in success rates was not statistically significant between groups (p = 0.57). The complication rates of complementary URS was 12.1%, and 9.5% in primary URS (p = 0.49). No statistically significant differences were noted in terms of gender, age, stone size and side, or lithotripter type between groups. The mean operation time and need for balloon dilatation were higher in complementary URS group compared to the primary URS group, and the difference was statistically significant (p < 0.05).

CONCLUSIONS

Complementary URS may be used safely after SWL failure in proximal ureteral stones. Its success rate and morbidities are similar to primary URS, except for longer operation time and an increased need for balloon dilatation.

The effect of music therapy during shockwave lithotripsy on patient relaxation, anxiety, and pain perception

OBJECTIVES

To research the effect of listening to music during shock wave lithotripsy (SWL) on the patient's pain control, anxiety levels, and satisfaction.

PATIENTS AND METHODS

The study comprised 400 patients from three hospitals. Half of patients listened to music during their first SWL session but not during their second session. The other half had no music for the first session but the second session was accompanied by music. During all sessions, with and without music, pulse rates, blood pressure, State-Trait Anxiety Inventory-State Anxiety scores (STAI-SA), Visual Analog Scale (VAS scores for pain), willingness to repeat procedure (0 = never to 4 happily), and patient satisfaction rates (0 = poor to 4 = excellent) were assessed.

RESULTS

There was no statistical difference between the two groups in terms of blood pressure and pulse rates. In both groups, the STAI-SA and VAS pain scores were lower in the session when music was listened to (p < 0.001). The patients requested more SWL treatment be completed while listening to music and their satisfaction was greater.

CONCLUSION

Music lowered the anxiety and pain scores of patients during SWL and provided greater satisfaction with treatment. Completing this procedure while the patient listens to music increases patient compliance greatly and reduces analgesic requirements.

A Giant Female Urethral Stone: An Unusual Complication after MidUrethral Sling Operation

Primary giant urethral stones are extremely rare in females, and they usually appear in the case of congenital diverticula, not as complications of surgery. Herein, we report a 54-year-old woman with a giant female urethral stone developed after tension-free obturator tape procedure. To our knowledge, this is the first late complication reported in the literature after midurethral sling procedure.

The Effect of Testicular Cryoablation on Testosterone Level in Rats: An Experimental Model of Histopathological Orchiectomy

PURPOSE

To determine whether testicular cryoablation caused histopathological orchiectomy, and to show its effects on serum total testosterone (t-testosterone) levels in rats.

MATERIALS AND METHODS

A total of 12 Wistar albino male rats were used in this study. The animals were divided into two groups, as cryoablation (9 rats) and control (3 rats) groups. Bilateral cryoablation was performed in the cryoablation group. T-testosterone levels were measured in both groups before scrotal exploration. Bilateral or­chiectomy was performed in both groups 10 days after the cryoablation procedure. T-testosterone was measured immediately before orchiectomy. Mann-Whitney U test was used for intergroup comparisons.

RESULTS

Baseline t-testosterone levels were 1.31 (0.78-2.45) ng/mL and 0.98 (0.91-2.05) ng/mL in the cryoab­lation and the control groups, respectively (P = .92). T-testosterone levels were 0.23 (0.07-1.12) ng/mL and 2.87 (0.63-3.06) ng/mL in the cryoablation and the control groups, respectively, in the blood samples obtained at the time of orchiectomy (P = .03). Histopathological examination of rat testes revealed varying degrees of paratestic­ular inflammation and necrosis in 13 of 18 testes in the cryoablation group. None of 6 testes showed necrosis in the control group.

CONCLUSION

Our study showed that histopathological orchiectomy could be obtained by cryoablation in rat testes.

Impact of cadaveric surgical anatomy training on urology residents knowledge: a preliminary study

OBJECTIVE

Cadaveric dissection is used as a major tool for anatomy education at the medical school. In this study we aimed to determine how a uro-anatomy cadaveric dissection course would impact urology residents knowledge.

MATERIALS AND METHODS

A three days course was given to 50 urology residents by experienced trainers in 1-3 June 2012 at Ege University Medical School's Anatomy Department, İzmir, Turkey. Efficacy of the course was assessed using a multiple choice questionnaire of 20 questions given before and after the course.

RESULTS

Completed questionnaires before and after the course were available for 25 residents (50%) that were included. Residents answered correctly to 11.7 out of 20 questions (59%) before the course and 13.0 out of 20 (65%) after (p<0.05). In individuals analysis, 16 residents (64%) increased their scores, 4 (16%) had similar scores and 5 (20%) had lower scores. The number of correct answers for 6 out of the 20 questions was lower following the course.

CONCLUSION

This cadaveric surgical anatomy course was effective in improving surgical anatomy knowledge for most urology residents but not all and helped to identify ways to improve the course in the future.

Evaluation of Tl-201 SPECT imaging findings in prostate cancer

Objectives: To compare with histopathological findings the findings of prostate cancer imaging by SPECT method using Tl-201 as a tumor seeking agent. <br />Methods: The study comprised 59 patients (age range 51-79 years, mean age 65.3 ± 6.8 years) who were planned to have transrectal ultrasonography (TRUS)-guided biopsies due to suspicion of prostate cancer between April 2011 and September 2011. Early planar, late planar and SPECT images were obtained for all patients. Scintigraphic evaluation was made in relation to uptake presence and patterns in the visual assessment and to Tumor/Background (T/Bg) ratios for both planar and SPECT images in the quantitative assessment. Histopathological findings were compatible with benign etiology in 36 (61%) patients and malign etiology in 23 (39%) patients. Additionally, comparisons were made to evaluate the relationships between uptake patterns,total PSA values and Gleason scores. <br />Results: A statistically significant difference was found between the benign and malignant groups in terms of uptake in planar and SPECT images and T/Bg ratios and PSA values. No statistically significant difference was found between uptake patterns of planar and SPECT images and Gleason scores in the malignant group. <br />Conclusions: SPECT images were superior to planar images in the comparative assessment. Tl-201 SPECT imaging can provide an additional contribution to clinical practice in the diagnosis of prostate cancer and it can be used in selected patients.

Early postoperative effects of ureterorenoscopy on morbidity and renal functions in ureteral stone patients with nondialysis-requiring renal insufficiency

In this study, we aimed to investigate the effects of ureterorenoscopy (URS) on morbidity and renal functions in patients with ureteral stones and nondialysis-requiring renal insufficiency. The data of 3200 patients who had ureterorenoscopic lithotripsy and diagnostic URS were analyzed retrospectively. Age, urea and creatinine levels in the preoperative period and 4 h after surgery, the size of the stone, duration of surgery, percentage change in urea and creatinine levels [(last level-first level/first level) × 100] and postoperative complications were noted. Student's t-test was used for the intergroup analysis of continuous variables. p < 0.05 was considered as statistically significant. There were 90 patients in nondialysis-requiring renal insufficiency group (group 1) and 101 patients in the control group (group 2). Percentage changes of urea and creatinine levels in the renal insufficiency and the control groups were found as -0.3% ± 3.3, 0.67% ± 3.9 and 2.3% ± 23.2, 2.5% ± 31.6 (p = 0.24 and p = 0.56), respectively. In group 1, three (3.3%) patients had postoperative febrile urinary infection, however febrile infections were not seen in any of the patients in group 2 (p = 0.06). Our results indicated that URS might be used safely in ureteral stones of the patients with nondialysis-requiring renal insufficiency.

Accuracy of Unenhanced Computerized Tomography Interpretation by Urologists in Patients with Acute Flank Pain

<b><i>Purpose:</i></b> The aim was to compare the findings of non-contrast computerized tomography (NCCT) evaluated by urology specialists with the findings of experienced radiologists, who are accepted as a standard reference for patients who present with acute flank pain. <b><i>Materials and Methods:</i></b> Five hundred patients evaluated with NCCT were included in the study. The NCCT images of these patients were evaluated by both radiologists and urology specialists in terms of the presence of calculus, size of calculus, the location of calculus, the presence of hydronephrosis, and pathologies other than calculus, and the results were compared. <b><i>Results:</i></b> The evaluations of urology specialists and standard reference radiology specialists are consistent with each other in terms of the presence of calculus (kappa [&#954;]: 0.904), categorical stone size (&#954;: 0.81), the location of calculus (&#954;: 0.88), and hydronephrosis (&#954;: 0.94). However, the evaluations of urology specialists in detecting pathologies other than calculus, which may cause acute flank pain or accompany renal colic, were found to be inadequate (&#954;: 0.37). The false-negative rate of detecting pathologies outside of the urinary system by the urology specialists is calculated as 0.86. <b><i>Conclusion:</i></b> Although the urology specialists can evaluate the findings related to calculus sufficiently with NCCT, they may not discover pathologies outside of the urinary system.

Intraperitoneal stone migration during percutaneos nephrolithotomy

Percutaneos nephrolithotomy (PNL) is the standard care for renal stones larger than 2 cm. The procedure has some major and minor complications. Renal pelvis laceration and stone migration to the retroperitoneum is one of the rare condition. We report the first case of intraperitoneal stone migration during PNL.

How many times should the uroflowmetry be repeated before making a treatment decision in the elderly males?

OBJECTIVE

To investigate the effect of repeating uroflowmetry test on results of patients with or without lower urinary tract symptoms.

METHODS

The prospective study was conducted at the Department of Urology, Ankara Training and Research Hospital, Turkey, from August to December 2012, and comprised 79 consecutive male patients with or without infravesical obstruction symptoms. All patients underwent uroflowmetry testing thrice on different occasions. The urinary maximum flow rate, average flow rate, voided volume (> or = 150 ml), voiding time, flow time and time to void values were evaluated. SPSS 16 was used for statistical analysis.

RESULTS

The overall mean of maximum flow rate was 11.4 +/- 1.69, 12.4 +/- 1.47 and 13.7 +/- 1.44 ml/sec at the first, second and third repetition respectively (p > 0.05). The mean percentage difference in maximum flow was +8% higher between the first and second attempt, and +4% higher between the second and third attempt. The mean average flow rate, the mean voiding time and the mean flow time values were also found to have insignificantly improved. The mean voided volumes of the patients were 201 +/- 48, 209 +/- 57 and 248 +/- 61 ml, respectively (p > 0.05). The time to void decreased significantly in the second and third attempts (p < 0.01).

CONCLUSION

Repeating uroflowmetry exhibits a minor improvement in maximum and average flow rates, and voided values in men, while a significant decrease was noted in time to void.

Comparison of ultrasonic and pneumatic intracorporeal lithotripsy techniques during percutaneous nephrolithotomy

OBJECTIVES

To compare the effectiveness and safety of ultrasonic and pneumatic lithotripters in the treatment of renal stone disease.

MATERIALS AND METHODS

A total of 227 consecutive percutaneous nephrolithotomy procedures for renal calculi were performed. In 107 patients ultrasonic lithotriptors were used (group I) and in 83 patients pneumatic lithotriptors were used (group II). In the remaining 37 patients, stones were managed with both pneumatic and ultrasonic lithotripters. Follow-up studies included intravenous urography (IVU) and/or computed tomography (CT).

RESULTS

The mean operative time and duration of hospitalization were similar between the groups. In the ultrasonic treatment group, 100 (96.9%) patients were stone-free on postoperative day 1 and 5 (4.6%) went on to undergo an additional treatment modality, resulting in a total stone-free rate of 97.2%. In the pneumatic lithotripsy group, 68 (81.9%) patients were stone-free after the primary procedure on the first day and 15 (18.1%) went on to undergo an additional treatment modality, resulting in a stone-free rate of 91.5%. The final stone-free rates at 3 months postoperatively in groups I, II, and III were 97.2%, 91.5%, and 87.9%, respectively (P = 0.826).

CONCLUSIONS

We conclude that both ultrasonic and pneumatic lithotripters are effective and safe for intracorporeal lithotripsy. However, the ultrasonic lithotripter provides higher stone-free rates with similar morbidity compared with pneumatic devices.

Biodegradable stents for caustic esophageal strictures: a new therapeutic approach

The treatment of caustic esophageal strictures is a challenging topic. Although traditional therapies have limited efficacy, most of these patients eventually require surgery. Biodegradable (BD) stents are newly designed stents for benign conditions. This is a retrospective case series of seven patients with caustic esophageal stricture. BD esophageal stents were inserted for palliation of dysphagia. The position of the stent was checked at 1, 4, 8, 12 16, 20, and 24 weeks and at the end of follow-up period. The follow-up period was 60 ± 23 (36-102) weeks. Complete dissolution of the stent occurred at 16 ± 4 (12-20) weeks. Three patients had partial/complete relief of dysphagia. The remaining four patients experienced tissue hyperplasia at the edges of the stent and required serial dilations. At the end of follow-up, all patients had partial or complete relief of dysphagia. Although BD stents have some efficiency, tissue hyperplasia is the main limiting factor. Further randomized trials are needed to determine efficiency of BD stents for caustic damage.