Relationship between psoriasis and urolithiasis

The aim of the present study was to investigate whether patients with psoriasis are prone to urolithiasis. Prospective analysis of 67 patients diagnosed as psoriasis (PS group) and 65 volunteers who had never been diagnosed as psoriasis (NPS group) was performed. The levels of oxalate, citrate, calcium, uric acid, magnesium, creatinine, and sodium were evaluated by analyzing the 24-h urine samples. Stone events were detected in 13 patients (19.4%) in the PS group and in five participants (7.7%) in the NPS group, respectively (P < 0.05). The median value of 24-h citrate was significantly lower in the PS group than in the NPS group (P = 0.029). The median value of 24-h urine uric acid was significantly higher in the PS group than the NPS group (P = 0.005). Hypernatriuria was significantly higher in the PS group (P = 0.027). Hyperuricosuria was detected in the 10.4% and 1.5% of patients who had severe and mild disease, respectively (P = 0.027). Patients with psoriasis are more prone to urolithiasis. Hypocitraturia, hyperuricosuria, and hypernatriuria were the main metabolic abnormalities detected in psoriasis. Hyperuricosuria has been associated with the severity of the disease.

Prospective assessment of VI-RADS score in multiparametric MRI in bladder cancer: Accuracy and the factors affecting the results

PURPOSE

We aimed to investigate the accuracy of Vesical Imaging - Reporting and Data System (VI-RADS) in the detection of muscle-invasive bladder cancer (MIBC) and to determine which factors affect the results of this scoring system.

METHODS

A prospective data analysis of 80 patients who were detected bladder tumor was performed between March 2019 and October 2020. Performed VI-RADS scoring suggest the probability of muscle invasion. Comparison has been made with pathological results to evaluate the accuracy VI-RADS scoring system. Twenty patients were chosen randomly and they were categorized according to VI-RADS for inter-observer agreement statistical assessment by a second experienced radiologist.

RESULTS

According to VI-RADS scoring system, the sensitivity, specificity, positive predictive value and negative predictive value of mpMRI were 87.5%, 87.5%, 63.6% and 96.6%, respectively. The interobserver agreement expressed as the ICC was 0.72 (95% CI: 0.44-0.84, P < 0.001). In addition, flat appearance of the tumor was an important factor affecting the accuracy of the VI-RADS score. (Odds ratio: 5.3 [95% CI: 1.1-27.0] and relative risk: 1.87 [95% CI: 1.24-2.82]) CONCLUSION: The mpMRI, used in conjunction with VI-RADS, has proven to be an effective imaging method for detecting the muscle invasion in cases of bladder cancer. VI-RADS scoring system can distinguish whether there is a muscle invasive and non-muscle invasive bladder cancer with acceptable accuracy. In addition, flat appearance of the tumor is an important entity that can affect the accuracy of the VIRADS scoring system.

Complementary Ureterorenoscopy after extracorporeal Shock Wave Lithotripsy in proximal ureteral stones: success and complications

OBJECTIVE

The aim of this study was to demonstrate the effect of extracorporeal shock wave lithotripsy application on the success and complications of ureteroscopic lithotripsy in proximal ureter stones.

METHODS

The data of 87 patients who did not respond to shock wave lithotripsy and underwent ureteroscopic lithotripsy were retrospectively analyzed and classified as group I, and 99 patients who received ureteroscopic lithotripsy as primary treatment were classified as group II. Demographic features, response to treatment, and preoperative and postoperative complications were compared between the two groups.

RESULTS

There was no difference between the two groups in terms of gender, operation times, stone sizes, and ureteroscope diameters. (p>0.05). Infective complications such as postoperative fever, pyelonephritis, and urosepsis were similar in both groups (p=0.142, p=0.291, and p=0.948). Stone migration was observed in 10 (11.5%) and 6 (6.1%) patients in groups I and II, respectively (p=0.291). Impacted stone was seen in 47 (54%) patients in group I and in 15 (15.2%) patients in group II (p<0.0001). Mucosal laceration occurred in 11 (12.6%) and 3 (3%) patients in groups I and II, respectively (p=0.028). Ureteral perforation was detected in 3 (3.4%) patients in group I and 1 (1%) patient in group II, whereas ureteral avulsion was not observed in either group (p=0.524).

CONCLUSIONS

It was concluded that the application of shock wave lithotripsy before ureteroscopic lithotripsy in proximal ureter stones did not affect the success. Although the results are similar in terms of postoperative infection, shock wave lithotripsy application has been found to increase the risk of stone impaction into the mucosa and ureteral laceration.

The effect of perirenal fat stranding on infectious complications after ureterorenoscopy in patients with ureteral calculi

Objective

Perirenal fat stranding (PFS) is linear areas of soft-tissue attenuation in the perirenal space on non-contrast computed tomography. The present study aimed to investigate whether PFS is associated with infectious complications after ureterorenoscopy (URS) in patients with ureteral calculi in any location.

Methods

The data of 602 patients with ureteral stones who underwent URS were analyzed retrospectively. The patients were divided into two groups as Group 1 (PFS not detected) and Group 2 (PFS detected). Gender, and age of patients, size, side, and location of the stone, operation time, double-J stent insertion status, perioperative ureter injury, postoperative infection after URS and related complications, and duration of hospital stay were compared.

Results

While PFS was not detected in 530 patients, PFS was detected in 72 patients. The mean age, male/female ratio, side and localization of the stones, operation time, and perioperative insertion of the double-J after lithotripsy were statistically similar (p>0.05). The median stone diameter was smaller in Group 2 (9 mm vs. 8 mm) (p=0.033). Fever was observed in 30 and 38 patients in Group 1 and Group 2, respectively (p=0.0001). Urinary tract infection was detected in 24 and 27 patients in Group 1 and Group 2, respectively (p=0.0001). The urosepsis did not occur in any patients in Group 1, whereas 8 (11.1%) patients in Group 2 experienced urosepsis (p=0.0001).

Conclusion

According to the results of the present study, patients with ureteral stones accompanied by PFS are much more prone to ureteral injuries and infectious complications such as urinary tract infection, fever, and sepsis after URS.

The impact of Coronavirus Disease 2019 (COVID-19) on urinalysis parameters

BACKGROUND

Creatinine elevation and changes in urinalyse parameters may be seen due to acute kidney injury during COVID-19. In the present study, we aimed to investigate the changes in urinalysis of COVID-19 patients with normal kidney function.

METHODS

The data of COVID-19 patients with normal renal functions were retrospectively analyzed. Urinalysis parameters of these patients were recorded. The patients were divided into three groups as mild, moderate and severe with respect to the clinical course of the disease. It was examined whether the urine analysis values in the groups were different from normal reference values and whether these values were different between the groups. In addition, possible relationship between the urinalysis parameters and the clinical severity of the disease was investigated.

RESULTS

There are three groups; mild (n:40), moderate (n:38) and severe (n:42). Mean age were significantly higher in the severe group, while gender distribution of the groups was similar. (p=0.033) (p=0.091) Creatinine values of all patients were normal. There were 6.7% glucose positivity, 13.4% protein positivity, 5.8% urobilinogen positivity and 7.5% ketone positivity in urine dipstick analysis and these changes were all significantly higher than the reference values. (p=0.008, p<0.0001, p=0.016, p=0.016) Pyuria and hematuria were detected in 8.3% and 9.2%, respectively. The urinalysis parameters and urine microscopy findings were not affected by the severity of the disease.

CONCLUSIONS

Glycosuria, proteinuria, pyuria and hematuria may occur during COVID-19 disease, regardless of comorbidity and renal dysfunction. However, these urine parameters were not correlated with the severity of the disease.

Is there a difference in the number of interstitial cells, neurons, presence of fibrosis and inflammation in ureteropelvic junction tissues of patients with ureteropelvic junction obstruction with and without crossing vessels?

OBJECTIVE

We compared the number of interstitial cells (ICs), nerves, presence of fibrosis and inflammation at the level of full-thickness human ureteropelvic junction (UPJ) tissues obtained from normal subjects, and patients with UPJ obstruction with and without crossing vessels.

MATERIAL AND METHODS

Normal UPJ tissues (n=12) histopathologically confirmed to be without tumor involvement were obtained from subjects who underwent radical nephrectomy for kidney mass. Additional UPJ tissues were obtained from patients who underwent pyeloplasty due to UPJ obstruction. Crossing vessel was identified in 17 patients. In 57 patients, no crossing-vessel was noted. ICs were stained immunohistochemically with anti-human CD117 (c-kit) antibody. Neural tissue was stained with S-100. The numbers of ICs and neurons were compared between the groups: controls with normal UPJ (Group I), Ureteropelvic junction obtruction (UPJO) with crossing vessel (Group II) and UPJ obstruction without crossing vessel (Group III). Groups were also compared in terms of the presence of fibrosis and inflammation.

RESULTS

The mean age of total population included in the study was 30.5±18.5 years. No significant differences were detected between the three groups regarding mean and median numbers of ICs at the level of UPJ (lamina propria and muscle layer) and mean and median numbers of neurons at the level of lamina propria (p>0.05). Likewise, no significant differences were detected between the three groups regarding the presence of fibrosis and inflammation (p>0.05).

CONCLUSION

Number of ICs, neurons, presence of fibrosis and inflammation seem to be similar in the intact UPJ and UPJ with obstruction with and without crossing vessel. Cellular function rather than the number ICs might play a role that warrants further research.

Factors associated with postoperative pain after retrograde intrarenal surgery for kidney stones

OBJECTIVE

We aimed to investigate factors related to early postoperative pain after retrograde intrarenal surgery (RIRS).

MATERIAL AND METHODS

A prospective data analysis of 250 patients who underwent RIRS due to kidney stones was performed. Postoperative pain was evaluated in all patients by using visual analogue scale (VAS). Patients with severe pain (VAS score ≥7) were separated and included in Group I (n=46). While patients without pain or with insignificant pain were included in Group II (n=204). The impact of patient-related (age, gender, renal anomalies, shock wave lithotripsy history, preoperative hydronephrosis) stone-related (stone number, side, size, location and opacity) and operation-related (preoperative and postoperative ureteral J-stenting, ureteral injury, postoperative bleeding and fever, stone-free rates, size of access sheath, and sheath indwelling time) factors on early stage postoperative pain (if any) were investigated.

RESULTS

Female gender increased the risk for pain 3.6-fold (p<0.05). One millimeter increase in stone diameter increased the risk for postoperative pain 1.15-fold. Prolonged sheath time was another important factor which increased the risk for pain (p<0.05). Patients with high residual fragments were also prone to early postoperative pain.

CONCLUSION

According to our results, patient-, stone-and operation-related factors associated with postoperative pain after RIRS were female gender, stone size and sheath time.

Comparison of response to treatment of unilateral and bilateral varicocelectomy

BACKGROUND/AIM

We aimed to compare the results of unilateral and bilateral varicocele surgery.

MATERIALS AND METHODS

In two referral hospitals, the data of 180 patients who were treated with unilateral and bilateral microscopic varicocelectomy were retrospectively analyzed. Sperm parameters and spontaneous pregnancy rates were compared in patients who underwent bilateral and unilateral microscopic varicocelectomy.

RESULTS

The mean age was 29.6 (17-46) years. While 82 patients underwent unilateral varicocelectomy (Group I), 98 patients underwent bilaterally varicocelectomy (Group II). Forty (48.8%) spontaneous pregnancies occurred in Group I and 59 (60.2%) in Group II. When we analyzed sperm parameters, the rate of increase in the number of sperm in spermiograms was 17% in Group I and 27.5% in Group II. The rate of increase in sperm mobility was 58.5% and 50% in Group I and II, respectively. The improvement rate in sperm morphology was 46.3% in Group I and 56.1% in Group II. There were no significant differences between all these parameters.

CONCLUSION

In light of our results, although pregnancy rates seemed to be higher in patients who underwent bilateral varicocelectomy, these results were not statistically significant. Improvement rates in sperm parameters were similar between the patients who underwent unilateral and bilateral varicocelectomy.

Family compliance with the use of alarm devices in the treatment of monosymptomatic nocturnal enuresis

OBJECTIVE

In the treatment of monosymptomatic nocturnal enuresis (MNE), enuretic alarm devices (EADs) are the first recommended treatment option. This study aimed to evaluate parental and child compliance with EAD treatment.

MATERIAL AND METHODS

Fifty patients for whom EAD therapy was recommended were included in this study. The mean age of the patients was 10.4 years (5-16). All the patients were nursery or school children. Patients who did not return for their follow-up visits were called by phone, and verbal information were gathered about the use and performance success of the device. We documented the patients who used, and did not use the EAD with their reasons.

RESULTS

Nineteen (36%) patients were able to use the EAD without any problems. Eight of the remaining 31 patients didn't return for control, and they could not be get in touch with, either. Of the 23 (46%) families whom we could get a contact, 4 families did not purchase EAD due to a decrease in the number of wet nights, 4 families due to compensatory payment, and 3 families due to reluctance of one of the parents. One family reported that they gave up the EAD treatment because of the disturbing loud volume of the device. Four families reported that their children refused to use the EAD. Four families said that they could not use the EAD regularly because the device frequently did not work properly. In this study, we could not keep in touch with 16% of the patients, and 46% of the patients stopped using or did not receive this therapy.

CONCLUSION

Although EAD has been the priorly recommended alternative with its relatively higher success, and lower recurrence rates, our study demonstrated that the compliance of families with this treatment is below the expected level.

Cytological Diagnosis of Small Cell Carcinoma of Urinary Bladder in a Patient with CLL

Small cell carcinoma of the urinary bladder (SCCUB) is an extremely rare bladder malignancy characterized by an aggressive clinical behavior. So, it is important to diagnose this high grade disease by urinary cytology. We report a case of SCCUB in an old man with chronic lymphocytic leukemia (CLL) in remission, while bladder tumor was diagnosed by cytology. With this article, we aimed to review and to update the literature concerning this tumor.

Retrograde intrarenal surgery in patients with isolated anomaly of kidney rotation

The purpose of the study was to investigate feasibility of retrograde intrarenal surgery (RIRS) in patients with isolated anomaly of kidney rotation with kidney stones. We retrospectively reviewed the medical records of patients who underwent RIRS due to kidney stones in three referral hospitals. Twenty-four patients who had kidney rotation were included in this study. The patients with horseshoe kidney or pelvic kidney were not included in the study. The patients were evaluated for final success 1 month after surgery. Success was defined as stone-free or fragment smaller than 3 mm. Mean age of patients was 39.5 years (1-71 years) and male/female ratio was 3:1. Mean stone size was 13.46 mm (5-30 mm). Twelve (50 %) patients had the operation on the right side and other 12 (50 %) patients had on the left side. Eighteen (75 %) patients were stone-free after single procedure. And stone-free rate increased to 83.3 % after additional treatment procedures. When we compared the successful and failed procedures, gender, stone side and size, preoperative hydronephrosis, access sheet usage, ureteral double-J stent insertion were not statistically significant in two groups. We did not confront major complication. RIRS seems to be an effective and safe treatment option for renal stones in patients with isolated anomaly of kidney rotation.