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To compare the long-term outcomes of corporeal plication using absorbable versus nonabsorbable sutures for the treatment of congenital penile curvature in childhood.Forty seven children who underwent congenital penile curvature repair between 11 and 140 months of age were included in the study. All children were operated on using the incisional plication technique and were divided into two groups: Absorbable-polyglactine (PLG, n=23, 48.93%) and nonabsorbable-polypropilen (PP, n=24, 51.06%) according to the suture material used for plication. Surgical outcomes were compared between groups.Mean follow-up period was 19.02±4.66 months. There was no significant difference between the mean age of the children in two groups included in the study (PLG=41.39±34.63 months vs PP=53.66±37.42 months, p=0.250). There was no significant difference in penile straightening degree between the two groups in the postoperative follow-up (PLG=27.39±6.88 vs PP=31.08±6.38, p=0.06). Similarly, there was no significant difference between two groups in terms of postoperative curvature recurrence (p=0.681). However, palpable suture knots in the plication area was significantly higher in the PP group in the postoperative period (25.0% vs 4.3%, p=0.047).The use of absorbable sutures in congenital penile curvature surgery in childhood has similar success rates with the use of nonabsorbable sutures and provides lower complications that are secondary to nonabsorbable sutures.

Amaç: Sünnet sonrası erken dönemde gelişebilen penil kanamaların kontrolünde, non-invaziv yöntem olan hafif-orta baskılı coban bandaj sargısının etkinliğini araştırmak. Hastalar ve Yöntem: Sünnet sonrası, akut dönemde gelişen penil kanama nedeniyle, Mayıs 2012 ile Ocak 2020 tarihleri arasında kliniğimize başvuran 112 çocuğun verileri retrospektif olarak incelenmiştir. Çocuklara, birinci basamak müdahale yöntemi olarak, hafif-orta baskılı coban bandajı uygulanmış ve 2 saatlik takipte kanamanın devam ettiği olgularda cerrahi müdahale yapılmıştır. Müdahale edilen çocuklar, olası cilt enfeksiyonu,cilt nekrozu,akut üriner retansiyon gelişimi ve penil skar gelişimi açısından incelenerek verileri kaydedilmiştir. Bulgular: Hastaların median yaşı 6(1-15) yıl ve median takip süreleri 5(1-12) aydır. Penil kanama nedeniyle, hafif-orta baskılı coban bandajı uygulanan çocuklardan 101(%90.2)’inde kanama tam olarak kontrol edilmişken, 11(% 9.8)’inde kanamanın devam etmesi nedeniyle cerrahi revizyon gerekli olmuştur. Çocukların 8(%7.1)’inde topikal antibiyotik tedavisiyle düzelen yüzeyel cilt enfeksiyonu gelişirken, sadece 6(%5.4)’sında uzun dönemde kozmetik açıdan rahatsız edici cilt skarı geliştiği tesbit edilmiştir. Sonuç: Sünnet sonrası, akut dönemde gelişen penil kanamaların kontrolünde, hafif-orta baskılı coban bandajı cerrahi müdahale gerekliliğini ciddi oranda azaltabilen, etkili, non-invaziv ve poliklinik şartlarında kolay uygulanabilir bir yöntemdir., Objective: To investigate the effectiveness of mild-modarate pressure coban bandage dressing, which is a non-invasive method, in the control of penile bleeding that may develop in the early period after circumcision. Materials and Methods: The data of 112 children who presented to our clinic between May 2012 and January 2020 due to penile bleeding in the acute period after circumcision were retrospectively analyzed. A mild-moderate pressure coban bandage was applied to the children as a first-line intervention method, and surgical intervention was performed in cases where bleeding continued after 2 hours of follow-up. Children were examined for possible skin infection, skin necrosis, development of acute urinary retention and penile scar development, and their data were recorded. Results: The median age of the patients was 6 (1-15) years and the median follow-up period was 5 (1-12) months. While bleeding was fully controlled in 101 (90.2%) of the 112 children who were treated with mild-modarate pressure coban bandage due to penile bleeding, surgical intervention was required in 11 (9.8%) of them because of the continuing bleeding. While superficial skin infection developed in 8 (7.1 %) of the children, which improved with topical antibiotic treatment, it was found that only 6 (5.4%) developed cosmetically disturbing skin scar in the long term. Conclusion: In the control of penile bleeding in the acute period after circumcision, a mild-moderate pressure coban bandage is an effective, non-invasive method that can be applied in polyclinic conditions, which can significantly reduce the need for surgical intervention.

Objective: This study compared the long-term outcomes of polypropylene mesh (PPM) and transobturator rectus fascia (RF) slings in transobturator tape (TOT) surgery in obese women. Materials and Met...

Aim: To evaluate the value of transrectal shear-wave-elastography(SWE) to differentiate benign and malignant tissues in patients with suspected prostate cancer. Materials and methods: Between January and May 2019, the study was designed as a prospective clinical study. The SWE value of 504 cores measured before biopsy and the pathology result of each core were used in the statistical analysis. The SWE values of benign and malignant cores were compared according to pathology results. ROC analysis was used to calculate the best cut-off SWE value for differentiating malignancy from benign tissues. Specificity, sensitivity, negative, and positive predictive values (NPV, PPV) were also calculated for cut-off value. Results: Prostate cancer was detected in 74 (14.7%) of 504 core biopsies. The mean SWE values were found significantly higher in malignant cores (71.1 kPa) than benign cores (42.3 kPa) ( p Conclusions: The malignant tissues have significantly higher SWE values. Also high gleason score was shown to be associated with high SWE values. To predict the prostate cancer, the difference of SWE values of between benign and malignant tissues has high sensitivity. In the near future, to prevent unnecessary prostate biopsies, SWE will be part of the standard protocol for prostate imaging.

OBJECTIVES To evaluate whether or not using a ureteral access sheath (UAS) affects the perioperative outcomes after retrograde intrarenal surgery (RIRS) performed in patients with renal stones. MATERIAL AND METHODS An observational study was carried out using data of 60 patients who underwent RIRS with the diagnosis of renal stones

Objective: This study aimed to evaluate the sleep quality and quantity of patients with benign prostate hyperplasia (BPH) and compare them with that of a control group using the Medical Outcomes Study-sleep scale (MOS-SS). Materials and Methods: The study included 114 consecutive men who were recruited between 2014 and 2018. Voiding patterns of patients with BPH were evaluated by free uroflowmetry, and symptom scores were evaluated using the International Prostate Symptom score (IPSS). Sleep quality and quantity of all patients were evaluated using the MOS-SS questionnaire. The participants were divided into two groups: 57 BPH patients (group 1) and 57 healthy individuals (group 2). They were compared statistically in terms of MOS-SS subdomains. The relationship between MOS-SS subdomains and IPSS, free uroflowmetry parameters, and post-voiding residual urine volume (PVR) was evaluated in BPH patients. Factors affecting the MOS-SS subdomains were also investigated. Results: The mean age of group 1 was higher than that of group 2 (67 +/- 9 vs 52 +/- 11 years, p

Background To compare the effectiveness of spinal anesthesia (SA) and the combination of intraurethral topical instillation of 2% lidocaine + intraurethral local visual injection anesthesia (T + LIA) for visual internal urethrotomy (VIU) in the treatment of traumatic posterior urethral strictures and prostatic urethral stenoses. Methods In this study, the results of 178 patients who underwent visual internal urethrotomy for posterior urethral strictures and prostatic urethral stenoses secondary to trauma in our clinic between October 2018 and January 2020 were analyzed retrospectively. Patients were divided into two groups as combined T + LIA (n=146, 82.08%) group and SA (n=32, 17.97%) group according to the type of anesthesia used. The preoperative clinical data and postoperative results of the patients were analyzed and compared between the groups. Results The mean age of the patients was 67.99±10.87 years and the mean follow-up was 5.32±3.27 months. The median age of the patients in the T + LIA group was significantly higher than that of the patients in the SA group (p=0.033). There was no statistically significant difference between the groups regarding preoperative Q-max value (p=0.931). Similarly, the rate of postoperative improvement in the Q-max values of the patients was similar between the groups (p=0.572). The presence of postoperative complications and recurrence rates were similar between the groups (p=0.879 and p=0.904, respectively). Conclusion Compared to spinal anesthesia, T + LIA anesthesia is a safe and effective technique for visual internal urethrotomy in treating traumatic posterior urethral strictures and prostatic urethral stenoses, with a high rate of success and acceptable rate of complications.

To compare the effectiveness and reliability of retrograde intrarenal surgery (RIRS) and micro-percutaneous nephrolithotomy (micro-perc) for the management of kidney stones in pediatric patients.A retrospective analysis was made of pediatric patients aged18 years with kidney stones that ranged from 10 to 20 mm in size, who underwent RIRS (n = 36) or micro-perc (n = 45) in referral centers.In the RIRS group, the mean age of patients was 8.39 ± 4.72 years and in the micro-perc group, it was 5.62 ± 4.50 years (p = 0.01). The mean stone size was 12.80 ± 3.03 mm in the RIRS group and 13.97 ± 3.46 mm in the micro-perc group (p = 0.189). The success rate was 86.2% (n = 31) in the RIRS group and 80.0% (n = 36) in the micro-perc group (p = 0.47). The mean complication rate was 16.6% and 13.3% in the RIRS and micro-perc groups, respectively (p = 0.675). Hospital stay and radiation exposure were significantly lower in the RIRS group (all p 0.001). The mean anesthesia session was 1.94 in the RIRS group and 1.26 in the micro-perc group (p 0.001). The mean hemoglobin drop was 0.53 ± 0.87 g/dL in the micro-perc group, and none of the cases required blood transfusion.The results of this study suggested that micro-perc and RIRS were highly effective methods for the treatment of moderately sized renal stones in children, with comparable success and complication rates. Patients and their parents should be informed about the currently available treatment options, and of their efficacy and safety. However, further clinical trials are needed to support these results.

Fluoroscopy is used for access sheath insertion and postoperative control during retrograde intrarenal surgery (RIRS) operation but with this technique both patient and operation team are exposed to radiation. The use of fluoroscopy is disadvantage for both patient and surgeon. Considering results of recent studies, it is clearly seen that fluoroscopy doesn't affect the success and complication rates of RIRS. In this study, we aimed to compare the results of both fluoroscopy and fluoroscopy-free groups, to show if there is a significant difference.385 patients were included in the study and they were divided into two groups. 284 patients were in Group I where fluoroscopy was used. 101 patients were in Group II and fluoroscopy was not used The success rates of primary operation and final success rates were compared. Data from both groups were evaluated objectively using classification systems and imaging methods.Success rates (primary and final) were higher in Group II, and that can be attributed to experience gained over time. Complication rate was lower and success rate was higher in fluoroscopy-free group. According to multivariate analysis, It is clear that the stone dimension is the foreground of the factors that influence the success, and the effect of the stone location is also observed.When considering the comparison of success and complication rates between two groups, it is clearly understood that the use of fluoroscopy has not a positive effect on results. According to the outcomes of our study, fluoroscopy-free RIRS can be performed with safe and high success rates. This outcome also leads an important point for avoiding unnecessary radiation exposure.

Summary Background Several authors have evaluated, in a number of external validation and predominantly adult studies, Guy's stone score (GSS) as a predictive tool for the assessment of stone clearance after percutaneous nephrolithotomy (PCNL). However, there are limited and conflicting data investigating whether GSS could be a potential independent factor associated with residual stone rates and complications of PCNL for children. Objective The aim of the current study was to evaluate the ability of GSS, as an independent factor, to predict residual stone rates and complications in pediatric patients undergoing PCNL. Study design The records of the pediatric patients who had undergone PCNL for stone disease at the current department were retrospectively reviewed. Variables included patient, stone, and treatment parameters. The GSS was used for assessment of stone complexity. Univariate and multivariate analyses were performed to evaluate factors associated with residual stone rates and complications of pediatric PCNL. Results The study group consisted of 114 children (63 boys and 51 girls) with a median (interquartile range) age of 6 (3–11) years and who had undergone 122 PCNLs (eight bilateral). Multivariate logistic regression analysis (Summary Table) demonstrated that the independent risk factors for increased residual stone rate following pediatric PCNL monotherapy were GSS (OR 3.14, 95% CI 1.31–7.49, P = 0.01) and number of calyces involved (OR 4.02, 95% CI 1.11–14.53, P = 0.033). Multivariate logistic regression analysis demonstrated that the independent risk factors for complications following pediatric PCNL were surgical experience (OR 2.72, 95% CI 1.09–6.82, P = 0.032), and operation time (OR 1.01, 95% CI 1.00–1.03, P = 0.040). Discussion A prediction model is needed to pre-operatively counsel patients and evaluate outcomes for measuring treatment success of PCNL. The GSS provides a simple, reliable and reproducible tool for describing the complexity of PCNL while predicting postoperative stone-free status, despite its limitations. However, little research has been conducted on the applicability of GSS in pediatric patients undergoing PCNL. In addition, conflicting results have been reported about its association with complications of pediatric PCNL. Conclusions The current study found that although GSS had a significant predictive ability for residual stone rates after pediatric PCNL revealed by multivariate logistic regression, the results did not conclude that complexity of GSS was directly proportional to complications of pediatric PCNL. The factors, including calyceal involvement and surgeon experience, may need to be incorporated in GSS to further improve its ability to predict outcomes of pediatric PCNL. IRB approved protocol number 1422. Summary Table . Multivariate analyses. Independent factor Odds ratio 95% CI P-value Factors affecting residual stone rate Stone size 1.00 0.99–1.00 0.942 Stone location 2.29 0.49–10.72 0.291 Intercostal access 1.87 0.36–9.69 0.454 Number of calyces involved 4.02 1.11–14.53 0.033 Guy's stone score 3.14 1.31–7.49 0.010 Factors affecting complications Gender 1.84 0.75–4.53 0.180 Stone size 1.00 0.99–1.00 0.622 Stone location 1.40 0.50–3.92 0.515 Number of tracts 1.04 0.23–4.64 0.955 Surgeon experience 2.72 1.09–6.82 0.032 Operation time 1.01 1.00–1.03 0.040 Guy's stone score 1.36 0.71–2.58 0.345

Introduction Urinary incontinence is a severe and common health problem. In this study, we aimed to assess severity of sexual dysfunction and depression in patients with urinary incontinence. Materials and methods The study has been conducted between 2015 and 2017. Age, body mass index, accompanying health problems, Over Active Bladder (OAB) symptom score, Type of urinary incontinence, Beck Depression Scale were assessed for all patients. International Index of Erectile Function-5 (IIEF-5) was used for male patients in order to assess sexual dysfunction. Index of Female Sexual Function (IFSF) and Female Sexual Distress Scale (FSDS) were used in female patients in order to assess sexual dysfunction. Results 33 patients have been included in the study (Male-12: Urge-10/Stress-1/Mixed-1/Female-21: Urge-10/Stress-6/Mixed-5). Mean age of all patients was 47.9 (Male-49.3/Female-47.2). Mean Body Mass Index for all patients was 23.2 (Male-25.9/Female-21.8). Mean OAB score was 24.3 for all patients (Male-27.5: Urge-28.6/Stress-17/Mixed-27/Female-22.5: Urge-24.2/Stress:21.3/Mixed-20.6). Mean Beck Depression Result for all patients was 20.9 (Male-18.5: Urge-20.2/Stress-9/Mixt-11/Female-22.4: Urge-19.1/Stress-20.3/Mixed-31.6). Mean IIEF-5 score for male patients was 39.5 (Urge-41.4/Stress-55/Mixed-5). Mean IFSF score for female patients was 19.9 (Urge-17.9/Stress-21.3/Mixed-22.4) and mean FSDS score for female patients was 22.1 (Urge-22.3/Stress-23.1/Mixed-20.8). Discussion Most of the patients that have been included in the study were diagnosed as urge incontinence. When assessing the OAB scores, they were higher in urge incontinence group. Beck depression results showed higher scores in female patients and it was higher in urge group of male patients and mixt group of female patients. Sexual dysfunction rates were found to be higher for both genders.

We investigated possible predictive factors for spontaneous stone passage and the potential role of serum C-reactive protein and white blood count in patients with 4 to 10 mm distal ureteral stones.A total of 251 patients who presented with renal colic secondary to distal ureteral stone were included in study. Patients were grouped according to spontaneous stone passage. Serum C-reactive protein, white blood count and other possible factors were investigated for their potential predictive value for spontaneous stone passage at a followup of 5 weeks. Potential predictive factors for spontaneous stone passage were evaluated with univariate and multivariate analyses. ROC curve analysis was performed to find an optimal cutoff value for serum C-reactive protein according to spontaneous stone passage. Statistical significance was considered at p0.05.Spontaneous stone passage was observed in 135 patients (53.8%) in group 1 while 116 (46.2%) in group 2 did not expel the stone spontaneously. Median stone size was 5.7 mm. Stone size, serum C-reactive protein and white blood count were significantly higher in group 2 than in group 1. The number of patients with hydronephrosis and the number with spontaneous stone passage history were significantly lower in group 2 compared to group 1. The cutoff value of serum C-reactive protein provided by ROC analysis was 0.506 mg/l. Time to spontaneous stone passage was significantly higher in patients with serum C-reactive protein above the threshold and in patients with ureteral stones greater than 6 mm.Stone size, previous spontaneous passage, hydronephrosis, serum C-reactive protein and white blood count can be used to predict spontaneous stone passage in patients with 4 to 10 mm distal ureteral stones. A serum C-reactive protein level of 0.506 mg/l can serve as a cutoff value to predict spontaneous stone passage.

To determine the perioperative risk factors for postoperative infections among patients undergoing flexible uretero-renoscopy with laser lithotripsy (FURSLL). In addition, the resistance patterns of pathogens isolated from positive preoperative urine cultures were investigated.We retrospectively reviewed data from 492 consecutive patients who had undergone FURSLL for stone disease in our department. Postoperative infection was defined as fever (? 38°C) with pyuria (? 10 white blood cells per high power field), or systemic inflammatory response syndrome, or sepsis. Pre-operative and intra-operative characteristics between patients with and without postoperative infectious complications were compared using univariate analyses. Significant variables on univariate analyses were included in a multivariatelogistic regression analysis to evaluate risk factors associated with postoperative infection following FURSLL.42 (8.5%) of 492 patients had postoperative infectious complications after FURSLL. 59 (12%) of 492 patients had a positive preoperative urine culture. 19 (32.2% of 59) patients had multidrug resistance (MDR) isolates recovered from positive preoperative urine cultures. 75% (9/12 cultures) of the positive preoperative urine cultures of patients in whom a postoperative infectious complication developed consisted of gram-negative pathogens. On multivariate analysis positive preoperative MDR urine culture (OR:4.75;95%CI:1.55-14.56; P = .006) was found to be significant with the dependent variable as the postoperative infectious complications despite appropriate preoperative antibiotic therapy.We found that positive preoperative MDR urine culture is a significant risk factor for infectious complications after FURSLL. Our findings point to the need for further research on assessment of risk factors forMDR infections to reduce the rate of postoperative infectious complications.

Purpose: To investigate whether or not the age of spontaneous resolution of monosymptomatic nocturnal enuresis (MNE) was familial. Patients and Methods: A questionnaire was administered to more than 1,500 people, and 100 appropriate participants were identified from four referral hospitals. We included the participants who had MNE and whose parents also had MNE with spontaneous resolution. Then the association between the spontaneous resolution time of MNE in parents and that in their children was investigated. Results: The mean ages of spontaneous resolution were 10.7 (10-30 years), 9.4 (6-17 years) and 10.9 (6-18 years) in participants, their mothers and their fathers, respectively. According to the statistical analysis, there was a positive correlation between participants and both their mothers and fathers (p < 0.05). In addition, it was revealed that familial MNE history based on first- and second-degree relatives, in addition to their parents, was also associated with the increased spontaneous resolution age of MNE (p < 0.05). According to our results, gender and parents' education status were not statistically associated with the spontaneous resolution (p > 0.05). Conclusion: As a conclusion, the age of spontaneous resolution of MNE is familial. Although the exact reasons of spontaneous resolution still remain a mystery; further genetic investigations may be able to resolve this mystery.

To compare the outcomes in patients who have been treated with flexible ureterorenoscopy (f-URS) and percutaneous nephrolithotomy (PNL) in managing stone-bearing caliceal diverticula. Between April 2007 and October 2013, we performed a retrospective analysis of 54 evaluable patients (28 women and 26 men) with symptomatic stone-bearing caliceal diverticula, who underwent PNL (n = 29) or F-URS (n = 25) in four referral hospitals in Turkey. The groups were compared with respect to demographics, stone location/size, success rate, stone-free status, symptom-free status, complication rates, and hospital stay. The average stone burden preoperatively was significantly larger in patients who were treated with PNL, with the average size for f-URS being 154 ± 77 mm2 and that for PNL being 211 ± 97 mm2 (p = 0.023). Symptom-free rates, success rates, stone-free rates and clinically insignificant residual fragments were similar between the groups (p = 0.880 vs. p = 0.537 vs. p = 0.539, and p = 0.877, respectively). There was no statistical difference between the groups for minor complications (p = 0.521) but no major complication (Clavien III–V) occured in the f-URS group; although there were three major complications (10.3 %) (Clavien III) in the PNL group (p

Urinary stone diseaseis less common in pediatric age group and it has anincreasing incidence. In this study, our hypothesis is toevaluate if one of the techniques, PNL or RIRS is superiorthan the other in terms of stone free status (SFR), fluoroscopytime (FT), operation time (OT), complication rate(CR), JJ stent insertion rate, and hospitalization duration(HD) in children.Between 2013 and 2016, 74 patients(under 18 years- old) were operated for the treatmentof renal stones between 1-2cm size. 37 patientswere male (50%) and 37 of them (50%) were female.The study shows the experience of a single center. Dataof the patients who underwent (surgery) were recorded.SFR was not different in both groups in shortand long terms follow up, but hgb drop, FT, OT, andHD were detected to be worse in PNL group. Therewas lower complication rates for RIRS group comparing to PCNL group according to Clavien classification butgrade I complications were higher in RIRS group.Although PNL is a cheaper treatmentmethod, RIRS has less creatinine change, less FT, lessOT, less CR, less HT with similar SFR for 1-2cm renalstones in children. Long term SFR were 83.8% for RIRSand 86.5% for PCNL. RIRS is a treatment of choice inchildren with 1-2 cm renal stones as it has more advantagesbut the costs must be considered.INTRODUCCIÓN: La enfermedad litiásica es menos frecuente en el grupo de edad pediátrica y tiene una incidencia creciente. En este estudio, nuestra hipótesis es evaluar si una de las técnicas, NLP o CIR, es superior a la otra en términos de estatus libre de litiasis,tiempo de fluoroscopia, tiempo quirúrgico, tasa de complicaciones,tasa de inserción de catéter DJ, y duración de la hospitalización en niños.MÉTODOS: Entre 2013 y 2016, 74 pacientes (por debajo de 18 años de edad) fueron intervenidos para tratamiento de litiasis entre 1-2 cm. 37 pacientes eran varones (50%) y 37 mujeres (50%). El estudio muestra la experiencia de un único centro. Se recogieron los datosde los pacientes sometidos a cirugía.RESULTADOS: La tasa de pacientes libres de litiasis no fue diferente entre los grupos a corto y largo plazo, pero el descenso de la hemoglobina, tiempo de fluoroscopia, tiempo operatorio y de hospitalización fueron peores en el grupo de NLP. Hubo una menor tasa de complicaciones en el grupo de CIR en comparación con el de NLP de acuerdo con la clasificación de Clavien, aunque las complicaciones de Grado I fuero mayores en el grupo de CIR.CONCLUSIONES: Aunque la NLP es un tratamiento más barato, la CIR tiene menor cambio de la Creatinina, menor tiempo de fluoroscopia y menor hospitalización con una tasa de libres de litiasis similar paralitiasis de 1-2 cm en niños. Las tasas de libres de litiasis a largo plazo fueron 83,9% para CIR y 86,5% para NLP. La CIR es un tratamiento de elección en niños con litiasis renales de 1-2 cm porque tiene más ventajas, pero deben considerarse los costes.

There are several unusual cases in the literature with foreign bodies in bladder or urethra such as candle, needle, thermometer, animal feather, chicken bone, and wooden stick. Because of these foreign bodies there would be several complications. Pain, infection, urosepsis, and hematuria are the usually seen complications in these cases. Cases with electrical wire cables are also rarely seen. Some of the reasons for inserting foreign bodies are masturbation, feeling or presence of urethral obstruction. In this case, we aimed to present a 21-year-old male patient who was admitted to emergency clinic of Kecioren Research and Training Hospital in September 2014 with a urethral foreign body that was extending into the bladder and was used for masturbation.

To evaluate the treatment alternatives of total avulsion of the ureter from both ends including ureteropelvic junction (UPJ) and ureterovesical junction (UVJ). Total ureteral avulsion on both ends of the ureter was examined in 4 cases performing ureteroscopy. In two male patients of the four cases, avulsion was noticed intraoperatively and ureteral re-anastomosis at UPJ and re-implantation at UVJ were performed immediately. Boari flap was performed for one female patient immediately and for the other female patient who was referred from another hospital after the ureteroscopy, 4 days later. One patient who had ureteral re-implantation was followed with 3-month intervals by ultrasonography and abdominal X-ray. At the end of 1 year, it was determined that kidney parenchyma was normal and the patient had kidney and upper ureteral stones. Percutaneous nephrolithotomy was performed, and the patient was stone-free at the end of the operation. Two years after the surgery, both kidneys were normal. This is the only case who had a successful ureteral re-implantation in literature. The other patient turned up a year later for routine checks after the ureteral stent was removed. Then, hydronephrosis and renal atrophy were detected. The patient did not accept nephrectomy or any other intervention and he was lost to follow-up. Boari flap procedure was performed after UPJ repair for the other two female patients. Their kidneys were both normal 3 months after the operation. In case of ureteral avulsion from both ends of the ureter in the male patients, as bladder capacity is not enough for a Boari flap, proximal anastomosis and distal re-implantation could be a good choice for the management of this untoward event. This new approach also saves time for reconstructive treatments if necessary. If bladder capacity is enough to reach UPJ, Boari flap could be a good choice in female patients.

The purpose of this study is to determine the perioperative risk factors for increased blood loss in children undergoing percutaneous nephrolithotomy (PCNL).We retrospectively reviewed the data on pediatric patients who had undergone PCNL for stone disease in our department. Blood loss estimation was quantified by measuring the changes in hematocrit plus the volume of red blood cells transfused. Univariate and multivariate linear regression analyses were performed to evaluate risk factors associated with increased blood loss after pediatric PCNL. Variables included patient, stone, and treatment parameters. The study group consisted of 105 renal units in 97 children with a median (interquartile range) age of 5 (3-9) years. On univariate linear regression analysis female gender (p = 0.030), absence of hydronephrosis (p = 0.013), increasing stone burden (p = 0.002), staghorn stone type (p = 0.013), multi-tract access (p < 0.001), and prolonged operative time (p < 0.001) were significantly associated with increased blood loss after pediatric PCNL. However, multivariate linear regression analysis demonstrated that the only independent risk factors for increased blood loss following pediatric PCNL were degree of hydronephrosis (B -1.329, 95% CI -2.451 to -0.208, p = 0.021), number of tracts (B 2.545, 95% CI 0.221-4.869, p = 0.032), and operative time (B 0.031, 95% CI 0.008-0.053, p = 0.007). Identifying pediatric patients at increased risk of bleeding following PCNL is crucial to minimize morbidity and hospital stay, and thus, the cost of treatment. Our study demonstrated that degree of hydronephrosis, number of tracts and operative time are important factors in reducing blood loss during pediatric PCNL.

WOS: 000410005000014 PubMed: 28861302 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 Jstenting, 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

Objectives: It was the aim of this study to evaluate and compare the outcomes of percutaneous nephrolithotomy (PNL) for the treatment of posterior and anterior caliceal stones. Patients and Methods: We performed a retrospective analysis of 86 patients with isolated caliceal stones who underwent PNL between 2011 and 2012. The patients were classified into two groups according to the localization of the stone, either in the anterior (group 1, n = 41) or posterior (group 2, n = 45) calyx, on axial plane computed tomography. Results: The mean age, male/female ratio and stone size and location were similar in both groups. Fluoroscopy, operation time and duration of hospitalization were also similar between groups. Patients in group 1 had a greater postoperative hemoglobin drop than patients in group 2. Blood transfusion was required for 5 patients in group 1 and for 4 patients in group 2. In addition, open conversion was required for 2 patients in group 1 during the early postoperative period because of extensive bleeding. Hemodynamics were stabilized with angioembolization in 2 patients with prolonged hematuria in group 1. The overall success and complication rates were similar in both groups. Conclusion: Although the postoperative hemoglobin drop did not significantly differ between groups, hemorrhaging was more severe in patients with anterior caliceal stones than in those with posterior caliceal stones.

Aykac, Aykut/0000-0001-7078-0135 WOS: 000380066200022 PubMed: 27286120 Purpose: The aim of this study was to examine whether the duration of breastfeeding during infancy was associated with the time of spontaneous resolution of monosymptomatic enuresis (SRME). Materials and Methods: A total of 1500 people were surveyed at four centers. One hundred and eighty-one people with a history of monosymptomatic enuresis (ME) who received no treatment and had no day time symptoms were included in the study. The relationship between the duration of breastfeeding and SRME was assessed by considering the duration of breastfeeding as both continuous and categorical (cut-off value 5 months) variable. The multivariate general linear model was used to identify independent predictors such as gender, family history, and educational status of parents. Results: Pearson correlation analysis of the age of SRME and duration of breastfeeding found no statistically significant relationship. However, there was a significant difference in the age of SRME of those who were breastfed for 5 months or less compared to those who were breastfed for more than 5 months. According to the multivariate analysis, gender and educational status of parents were not effective on the age of SRME. Stepwise linear regression model showed that breastfeeding for five months or less and family history could affect the age of SRME. The regression formula was: age of SRME= 9.599 + (3.807xfive months or less of breastfeeding) + (1.258xpositive family history). Conclusions: It was found that when breastfeeding lasted for more than 5 months, there was a positive contribution to SRME.

To present our experience with retrograde intrarenal surgery (RIRS) for managing renal stones in patients with spinal deformities.We retrospectively reviewed the records of eight patients with congenital scoliosis (n=6), ankylosing spondylitis (n=1), or spina bifida (n=1) who had undergone RIRS for renal stones. Stone-free status was determined by CT 30 days after the procedure and was defined as the absence of stones in the kidney or residual fragments ≤ 1 mm.Mean patient age was 32.5 years (8-51 years), and mean stone size was 15.8 mm (9-20 mm). The average operative time was 46.5 minutes (25-75 min), and postoperative hospital stay was 1.12 days (1-2 days). A stone-free status was obtained in six (75%) patients, and two patients were considered to have treatment failure. A Double-J stent was placed at the end of the procedure in five (62.5%) patients. Double- J stent discomfort was reported by one (20%) patient who was treated conservatively. No severe complications, either from anesthesia or the surgical procedure, were observed, and no blood transfusion was reported.The good clearance rate with a low incidence of complications shown by the present study has demonstrated that RIRS is a safe and effective procedure for renal stones in patients with spinal deformities.

To compare the outcomes of percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) for 15 to 20 mm lower-pole (LP) renal calculi by evaluating stone-free rates and associated complications.The records of 79 patients who underwent either PCNL (n=42) or RIRS (n=37) by standard techniques for 15 to 20 mm LP renal calculi were reviewed retrospectively.In the PCNL group, the stone-free rate was 92.8% (39/42 patients); this rate increased to 97.6% after a second intervention (shockwave lithotripsy in one and RIRS in one). After a single RIRS procedure, 33 of 37 (89.2%) patients were completely stone free. Two patients needed an additional procedure (rigid ureteroscopy in one and RIRS in one), after which they were all completely stone free, resulting in an overall success rate of 94.6%. Two patients had asymptomatic residual fragments7 mm in the LP of the kidney, and these patients had been followed with ultrasonography of the kidney. For complications, there were minimal differences in both procedures, except for hemorrhage (necessitated transfusion) in three patients who were treated with PCNL. The overall stone-free rates and complication rates for PCNL were higher, but the differences were not statistically significant. Operative time was significantly longer in the RIRS group, and postoperative hospital stay was significantly longer in PCNL group.PCNL and RIRS are safe and effective methods for medium-sized LP calculi. For selected patients, RIRS may represent an alternative therapy to PCNL, with acceptable efficacy and low morbidity.

To evaluate the effectiveness of doxazosin on the rate of spontaneous passage of distal ureteral stones in female patients.A total of 80 patients with stones sized 10 mm or smaller, located in the distal part of the ureter, were included. They were divided into two groups, according to the gender. Patients were followed-up until passage of the stone or for a maximum of 3 weeks. The number of pain episodes, stone expulsion rate and time, and possible side effects of medications were recorded and compared in both groups.All patients completed the study. No statistically significant difference was observed regarding patient age, stone size, and stone location between the groups (P0.05). Stone expulsion occurred in 29 patients (72.5%) in group 1 and in 28 patients (70%) in group 2 (P = 0.35). Mean time to expulsion was 6.5 days (range 3-15 days) in the male arm and 7.5 days (range 4-17 days) in the female arm (P = 0.97). There were no differences between the groups in the number of colic episodes and analgesic use.Medical treatment of distal ureteral stones with doxazosin has similar stone passage rate, expulsion time, and safety in women compared with men.

WOS: 000440260100015 PubMed: 25847901 Objectives: To investigate the situations in which ureteral double-J stent should be used after retrograde intrarenal surgery (RIRS). Patients and Methods: Patients with no ureteral double-J stent after RIRS constituted Group 1, and those with double-J stent after RIRS constituted Group 2. Patients' age and gender, renal stone characteristics (location and dimension), stone-free status, VAS score 8 hours after surgery, post-procedural renal colic attacks, length of hospitalization, requirement for re-hospitalization, time to rehospitalization and secondary procedure requirements were analyzed. Results: RIRS was performed on 162 renal units. Double-J stent was used in 121 (74.6%) of these after RIRS, but not in the other 41 (25.4%). At radiological monitoring at the first month postoperatively after RIRS, complete stone-free status was determined in 122 (75.3%) renal units, while residual stone was present in 40 (24.6%). No significant differences were observed between the groups in terms of duration of fluoroscopy (p = 0.142), operation (p = 0.108) or hospitalization times (p = 0.798). VAS values determined routinely on the evening of surgery were significantly higher in Group 1 than in Group 2 (p = 0.025). Twenty-eight (17.2%) presentations were made to the emergency clinic due to renal colic within 1 month after surgery. Double-J catheter was present in 24 (85.7%) of these patients. Conclusions: Routine double-J stent insertion after RIRS is not essential since it increases costs, morbidity and operation time.

Objective To present the outcomes of flexible ureterorenoscopy (F-URS) and laser lithotripsy for the treatment of calculi within pelvic ectopic kidney (PEK). Patients and Methods We retrospectively reviewed the medical records of 26 patients with calculi in PEK treated with F-URS in 5 referral hospitals between 2010 and 2013. Patient demographics and stone characteristics (age, sex, body mass index, stone size, location, history of shock wave lithotripsy or kidney surgery), and perioperative measures (duration of operation, fluoroscopic imaging, and hospitalization and success and complication rates) were reviewed. Results A total of 26 patients with mean age of 41.1 ± 15.8 years (7-72 years) were included in the study. The mean stone size was 17.0 ± 5.1 mm (10-28 mm). The mean procedure and fluoroscopy times were calculated as 52.1 ± 27.7 minutes (30-120 minutes) and 54.8 ± 48.9 seconds (10-180 seconds), respectively. The mean length of hospital stay was 2.7 ± 1.8 days (1-9 days). Treatment was deemed successful in 22 patients (84.6%). Ureteroscopy failed in 4 patients (15.4%) due to impaired passage of fragments (n = 3) or inability to reach the stone secondary to the location in an isolated lower calyx (n = 1). Minor postoperative complications were observed in 5 patients (19.2%; persistent hematuria [n = 1], fever [n = 1], renal colic [n = 2], and urinary tract infection [n = 1]). No severe complications or mortality occurred. Conclusion Our results suggest that F-URS is a safe and effective minimally invasive treatment modality for small- and medium-sized stones in PEK.

Urethral prolapse is frequently reported in girls; however, the clinical condition is frequently encountered in postmenopausal women by urologists and gynecologists. The treatment of urethral prolapse is controversial. Information regarding the treatment and pathophysiology of this clinical entity in postmenopausal women is sparse in the published literature. We report a case of strangulated urethral prolapse that was successfully treated by surgical excision under local anaesthesia.

Purpose: To review our intraoperative complications of retrograde intrarenal surgery (RIRS) for kidney calculi and stratify these complications according to the modified Satava classification system (SCS). Patients and Methods: 230 patients (119 males, 111 females) who underwent RIRS because of kidney calculi were analyzed. We documented and stratified the intraoperative complications according to the modified SCS. There are four grades for this classification: grade 1 complications include events without consequences for patients; grade 2a complications include events that could be treated with endoscopic surgery intraoperatively; grade 2b complications include events which were treated with endoscopic treatment in another session, and grade 3 describes the events requiring laparoscopic or open surgery. Results: Mean age was 39.1 years (range 1-78). The stone-free rate after one session was 81%. Intraoperative complications were recorded in 30.4% of the patients. According to the modified SCS, grade 1 complications were documented in 15.9%, grade 2a complications were documented in 5.6%, and grade 2b complications were documented in 8.9% of the patients. Grade 3 complications were not detected in any of the patients. Conclusion: In our opinion, the modified SCS can facilitate patients to understand the safety of this surgery and can make it easier to compare the results of different institutes and surgeons.

Objective To assess the analgesic efficacy of bupivacaine infiltrations into the nephrostomy tract in tubeless and standard percutaneous nephrolithotomy (PCNL). Methods This prospective, randomized controlled study enrolled 121 patients. Patients were randomized to receive a 20-mL infiltration of 0.25% bupivacaine into the nephrostomy tract after PCNL. Patients were divided into 2 groups. The group 1 patients received bupivacaine infiltrations, whereas group 2 did not. Patients' visual analog scale (VAS) pain scores were evaluated at 6, 12, and 24 hours postoperatively. Pain in the postoperative period was managed with intramuscular diclofenac sodium (75 mg) or meperidine (pethidine) hydrochloride (50 mg), as requested by the patients. Results The patients were a mean age of 43.2 ± 12.7 years (range, 18-74 years). The VAS pain scores at 6, 12, and 24 hours postoperatively and the amount of diclofenac sodium needed were significantly less in the group with bupivacaine infiltration than in those that did not receive the infiltration (P

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.

Objectives. To determine when emergent intervention for bleeding after percutaneous nephrolithotomy (PCNL) is required. Methods. We reviewed analysis data of 850 patients who had undergone PCNL in our center. Blood transfusion was needed for 60 (7%) patients during and/or after surgery. We routinely performed followup of the urine output per hour, blood pressure, and hemoglobin levels after PCNL. Five (0.6%) of them had severe bleeding that emergent intervention was needed. Results. The mean age of the 5 patients who had emergent surgery due to severe bleeding was 42.2 (19–56) years. Mean duration of surgery was 44.75 (25–65) minutes. Mean stone size was 27 (15–38) mm. Mean decrease of hemoglobin was 4.8 (3.4–5.8) ng/dL, and unit of transfused blood was 4.4 (3–6). Mean blood pH was 7.21. There were metabolic acidosis and anuria/oliguria in all these patients. One of 5 patients suffered from cardiopulmonary arrest because of massive bleeding four hours after the PCNL, and despite cardiac resuscitation, he died. Hemorrhaging was controlled by open surgery in the other 4 patients. Two patients experienced cardiac arrest during the open surgery but they responded to cardiac resuscitation. There were no metabolic asidosis and anuria/oliguria, and bleeding was managed only with blood transfusion for the other 55 patients. Conclusion. Severe bleeding after PCNL is rare and can be mortal. If metabolic asidosis and anuria/oliguria accompanied the drop of hemoglobin, emergent surgical intervention should be performed because vascular collapse may follow, and it may be too difficult to stabilise the patient.

The aim of this study was to determine the relationship between urinary incontinence (UI) and parameters such as pregnancy, mode of delivery and other factors.The study was based on a questionnaire administered to 761 patients. After their age, menopausal status, number of pregnancies, number of deliveries and history of connective tissue disease (CTD) were recorded, the data were analyzed using a chi2 test.In patients who are post-menopausal and over 40, both stress incontinence (SI) and urge incontinence (URI) were found to be significantly higher. It was also established that both SI and URI increased with the number of pregnancies. As the number of normal vaginal deliveries increased, the rate of both SI and URI increased, while increases in the number of cesarean sections affected neither SI nor URI. Among women who had had abortions, the rate of SI was higher, and it increased as the number of abortions increase. Neither the occurrence of abortions nor increased numbers of abortions influenced the rate of URI. In patients with CTD, both SI and URI increase.Urinary incontinence in women seems to be influenced by the mode of delivery, menopause, age and CTD.

The aim of this study was to compare the outcomes of retrograde intrarenal surgery (RIRS) and miniaturized percutaneous nephrolithotomy (mini-PNL) in management of lower-pole renal stones with a diameter smaller than 15 mm. Between December 2009 and July 2012, the patients with the diagnosis of lower-pole stones were evaluated by ultrasonography, intravenous pyelography and computed tomography. The records of 73 evaluable patients who underwent mini-PNL (n = 37) or RIRS (n = 36) for lower-pole (LP) stones with diameter smaller than 15 mm were reviewed retrospectively. Of the 73 patients, 37 underwent mini-PNL and 36 underwent RIRS. The stone-free rates were 89.1 and 88.8 % for mini-PNL and RIRS groups, respectively. The mean operation time was 53.7 +/- A 14.5 in the mini-PNL group but 66.4 +/- A 15.8 in the RIRS group (P = 0.01). The mean fluoroscopy times and hospitalization times were significantly higher in the mini-PNL group. There was no major complication in any patient. RIRS and mini-PNL are safe and effective methods for treatment of LP calculi with a diameter smaller than 15 mm. RIRS is a non-invasive and feasible treatment option, and has also short hospitalization time, low morbidity and complication rate. It may be an alternative of mini-PNL in the treatment LP calculi with smaller than 15 mm.

To compare the outcomes of shock wave lithotripsy (SWL), percutaneous nephrolithotomy (PNL), and retrograde intrarenal surgery (RIRS) for 10–20 mm radiolucent renal calculi by evaluating stone-free rates and associated complications. A total of 437 patients at 7 institutions who underwent SWL (n = 251), PNL (n = 140), or RIRS (n = 46) were enrolled in our study. Clinical success was defined as stone-free status or asymptomatic insignificant residual fragments

Objective To determine whether Charlson comorbidity index (CCI) predicts the postoperative complications after percutaneous nephrolithotomy (PCNL) and could be a plausible option to avoid surgery and its potential risks in elderly patients with significant comorbidites. Methods The data from 283 elderly patients (age ≥60 years) who underwent PCNL in 4 large referral hospitals were reviewed in the present multicenter study. For each patient, we evaluated pre-existing comorbidities and calculated the CCI score. The patients were classified to 3 CCI score categories (0, 1, ≥2) and compared regarding the stone-free and complications rates. Results The mean patient age was 64.7, 65.6, and 67.7 years in the 3 groups. The stone-free rate after primary PCNL was 85.7% in group 1, 86.1% in group 2, and 75.0% in group 3. These rates increased to 90.8%, 95.4%, and 83.9% after a second intervention (P = .049). The overall postoperative complication rate was 38.8%. The most common complication was hemorrhage necessitating blood transfusion in 34 patients (12%), and we found an increased risk of hemorrhage associated with the CCI score (P = .011). Life-threatening medical complications developed in 7.6% of the patients in group 1, 12% of the patients in group 2, and 28.6% of the patients in group 3 (P = .001). A multivariate logistic regression analysis showed that a high CCI score, bleeding, and operative time had significant influence on the postoperative medical complication in this population. Conclusion Conservative management of asymptomatic large kidney stones appears to be a safe alternative to PCNL in elderly patients with significant comorbidites.