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Objective: We investigated the use and success rates of subtrigonal injection, which does not have the possible postoperative problems of open surgery, in complicated vesicoureteral reflux (VUR) cases due to anatomical or functional causes. Materials and methods: Endoscopic subtrigonal injection was performed by two experienced pediatric urologists in 64 ureters with complicated VUR for 45 patients (33 girls, 12 boys) with a mean age of 3.1 years (range 1.2-16). All patients were followed up for a mean of 33 (range 9-60) months and underwent voiding cystogram at the postoperative 3rd month. Injection material (dextranomer-hyaluronic acid copolymer) with a mean volume of 1.2 (range 0.7-2.1) mL was injected per ureter. Results: The procedure was successful in 39 of 64 ureters with reflux (61%) regardless of age, gender, and diagnosis. Success rate was 78% after the reenjection in 10 patients. All refluxes except one with paraureteral diverticule in one orifice 'Y/V' duplicated systems were cured after the first or second injection. Endoscopic treatment was performed in 7 ureters for 6 patients with ongoing reflux after extravesical ureteroneocystostomy, and 3 ureters were cured after the first injection and there was no reflux in one ureter after the second injection. In 5 patients in these two groups prophylaxis was stopped, and patients were followed without reimplantation for the decrease in reflux grade and no existing clinical problem. During the follow-up none of the patients demonstrated urinary tract infection. Conclusion: Subtrigonal injection is an acceptable choice of treatment for complicated VUR cases with appropriate injection material and technique in experienced hands. However, reimplantation should not be ignored in the treatment of these patients. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy of anterograde percutaneous nephrolithotomy (PNL) for impacted proximal ureteral stones larger than 15 mm. Materials and methods: We retrospectively evaluated the data of the patients who underwent PNL for impacted proximal ureteral stones between February 2007 and April 2009. Patients, who underwent PNL for a radiopaque stone larger than 15 mm localized between the upper border of the 4th lumbar vertebra and ureteropelvic junction on intravenous pyelography were included. Patients with associated renal stones and a history of previous retroperitoneal surgery were excluded. The demographics, stone-free rates, hospitalization duration, bleeding and complication rates were evaluated. Results: Totally 39 patients underwent PNL for impacted proximal ureteral stones. Eleven patients were excluded due to previous PNL or retroperitonoscopic surgery for renal or ureteral stones. The mean age of the patients was 43.07±15.9 years and stone size was 271±85.43 mm², the male to female ratio was 16:12. Access was achieved to the upper or middle calix through an supracosal entry in 18 (%64) and subcostal entry in 10 (%36) patients. Residual-free treatment was obtained in 27 (%96.4) patients, 2 (%7.1) patients required double J stents due to ureteral perforations, and 2 (%7.1) required post-operative blood transfusion. The mean hemoglobin decrease was 1.92±1.04, hospitalisation time was 48.4±14.6 hours, the need for of analgesic use was 172.4±54.3 mg, and operation time was 78.4±19.3 min. Conclusion: PNL is technique with high success rate in the presence of surgical experience and appropriate equipment for the management of impacted proximal ureteral stones. [ABSTRACT FROM AUTHOR]