Ultrasound-based predictive indicators for treatment outcomes in pediatric vesicoureteral reflux.

PURPOSE: To evaluate the effectiveness of preoperative ultrasound (US) measurements in predicting pediatric vesicoureteral reflux (VUR) treatment outcomes. METHODS: This prospective study enrolled 35 patients (53 renal units) aged 1-16 years who underwent subureteric injection therapy for primary VUR between July 2020 and June 2022. Preoperative ultrasound examinations measured the bladder wall thickness at the ureteral orifice, ureteral submucosal tunnel length, distal ureteral diameter, patient demographics, VUR grade, presenting complaints, bladder-bowel dysfunction, and renal scarring, and the impact of these variables on treatment success was analyzed. RESULTS: Among the patients, 91.4% were female, with a mean age of 6.83 ± 3.84 years. A comparison between the treatment success and failure groups revealed no significant differences in the age, sex, VUR grade, laterality, bilaterality, presenting complaints, bladder-bowel dysfunction, bladder wall thickness, or distal ureteral diameter (p > 0.05). However, renal scarring occurred in 16 (38.1%) patients in the treatment success group and 10 (90.9%) in the treatment failure group (p = 0.002). The treatment failure group had shorter detrusor-to-ureteral orifice distances and smaller detrusor-ureteral orifice distance-to-distal ureteral diameter (D/U) ratios than that of the success group (p = 0.004 and p = 0.006, respectively). Patients with a detrusor-to-ureteral orifice distance < 7.4 mm had an 81.82% likelihood of treatment failure. CONCLUSION: Ultrasound measurements of the detrusor-to-ureteral orifice distance and D/U ratio proved reliable in predicting the success of endoscopic subureteric injection therapy for VUR.

Efficacy of onabotulinum toxin A injection in pediatric patients with non-neurogenic detrusor overactivity.

AIMS: To evaluate the effectiveness and reliability of onabotulinum toxin A (onaBoNT-A) injections in pediatric patients with non-neurogenic detrusor overactivity (NNDO). METHODS: Between January 2010 and February 2016, 39 patients underwent onaBoNT-A injections for NNDO, and were evaluated retrospectively. Three-day voiding diary was filled at baseline, and at the postoperative 9th month. The voiding frequency, incontinence episodes, and the cystometric capacity were noted. Vesicoureteral reflux (VUR) associated with NNDO, and presence of nocturia were recorded. Additional injection requirements were also stated. RESULTS: We reached the data of 33 patients on 9th month. The mean age was determined as 8.75 ± 3.01 (5-16) years. Initially, the mean bladder capacity was calculated as 114.66 ± 35.23 mL on the voiding diary, and 153.15 ± 47.40 mL on the baseline urodynamic study. After the procedures, the mean bladder capacity increased to 140.84 ± 45.61 mL (P = 0.0011), the mean daily voiding frequency decreased from 10.36 ± 1.05 to 7.42 ± 0.83 (P = 0.01), and the mean incontinence episodes decreased from 2.72 ± 1.87 to 1.18 ± 1.13 (P = 0.001), on voiding diary. VUR associated with NNDO was determined in 10 (30.3%) patients. The degree of VUR decreased three in patients, and VUR disappeared in five patients following the injections (P = 0.011). Fourteen (42.4%) patients had nocturia, and after the injections, nocturia disappeared in five (15.15%) patients (P = 0.151). Additional injections were required in 10 (30.3%) patients at the 9th month. CONCLUSIONS: OnaBoNT-A injections can be used in the pediatric patients with NNDO as an effective and reliable procedure by decreasing voiding frequency, incontinence episodes, and increasing bladder capacity, with negligible side effects and complications.

A neural network - based algorithm for predicting stone - free status after ESWL therapy.

OBJECTIVE: The prototype artificial neural network (ANN) model was developed using data from patients with renal stone, in order to predict stone-free status and to help in planning treatment with Extracorporeal Shock Wave Lithotripsy (ESWL) for kidney stones. MATERIALS AND METHODS: Data were collected from the 203 patients including gender, single or multiple nature of the stone, location of the stone, infundibulopelvic angle primary or secondary nature of the stone, status of hydronephrosis, stone size after ESWL, age, size, skin to stone distance, stone density and creatinine, for eleven variables. Regression analysis and the ANN method were applied to predict treatment success using the same series of data. RESULTS: Subsequently, patients were divided into three groups by neural network software, in order to implement the ANN: training group (n=139), validation group (n=32), and the test group (n=32). ANN analysis demonstrated that the prediction accuracy of the stone-free rate was 99.25% in the training group, 85.48% in the validation group, and 88.70% in the test group. CONCLUSIONS: Successful results were obtained to predict the stone-free rate, with the help of the ANN model designed by using a series of data collected from real patients in whom ESWL was implemented to help in planning treatment for kidney stones.

Urodynamic outcomes of detethering in children: experience with 46 pediatric patients.

AIM: Tethered cord syndrome (TCS) manifests with neurological and urological complaints. Surgical detethering is the main treatment for TCS. Children with urological symptoms are required objective pre- and postoperative evaluations in order to predict urological outcome. The aims of this study are to investigate the effects of detethering procedure on the urodynamic tests and to determine the relationship between the changes of urodynamic tests and the patients' age and gender. MATERIAL AND METHODS: The data of urodynamic tests in 46 pediatric patients, who underwent surgery for TCS, were retrospectively evaluated. Bladder capacity, post-voiding residual urine volume, maximum intravesical pressure, and bladder compliance of each patient were measured in preoperative period and at the third month after surgery. These parameters were statistically compared, and the correlations of these parameters with age, gender, and etiology of the TCS were also investigated. RESULTS: Bladder capacity and post-voiding residual urine volume were decreased and maximum intravesical pressure and bladder compliance were increased after surgery for TCS. The decrease in bladder capacity was significant in patients older than 10 years (p < 0.05). The increase in maximum intravesical pressure was also positively correlated with age (p < 0.05). But the increase in bladder compliance was negatively correlated with age (p < 0.05). CONCLUSION: Bladder capacity, post-voiding residual urine volume, and bladder compliance are mainly affected by surgery in patients with TCS. From the urological viewpoint, children older than 10 years are most likely to benefit from surgery for TCS.

Transobturator Midurethral Slings versus Single-Incision Slings for Stress Incontinence in Overweight Patients.

PURPOSE: To compare transobturator midurethral sling (TOS) and single-incision sling procedures in terms of their effects on urinary incontinence and the quality of life in overweight (BMI ≥ 25-29.9 kg/m2) female patients using the International Consultation on Incontinence Questionnaire scoring form (ICIQ-SF) and Quality of Life of Persons with Urinary Incontinence scoring form (I-QOL). MATERIALS AND METHODS: In this prospective trial, the patients were divided into two groups consecutively; first 20 overweight female patients underwent the TOS (Unitape T®, Promedon, Cordoba, Argentina) procedure and the subsequent 20 consecutive overweight female patients underwent the single-incision sling [TVT-secur (Ethicon Inc., Sommerville, USA)] procedure. Age, urinary incontinence period, parity and daily pads usage were recorded. No usage of pads was defined as subjective cure rate postoperatively. Before the operation and 6. month after the surgery, the patients completed the ICIQ-SF and I-QOL. RESULTS: There was no significant difference between the two groups in terms of mean age, duration of incontinence, parity, and BMI (p>0.05). ICIQ-SF and I-QOL revealed that the patients in the TOS group showed significantly better improvement (76.20% versus 64.10%, p=0.001, 81.31% versus 69.28%, p=0.001, respectively). In addition, subjective cure rates were found higher in TOS group (75% versus 55%, p=0.190). CONCLUSIONS: The existing data is showed that incontinence symptoms and the quality of life have higher improvement in overweight female patients who underwent the TOS procedure. It is likely that the TOS procedure may provide stronger urethral support and better contributes to continence in this group of patients.

Comparing of different methods for prevention stone migration during ureteroscopic lithotripsy.

AIM: To compare the effectiveness of Stone Cone™, PercSys and lidocaine jelly instillation to prevent stone migration during ureterorenoscopy (URS). MATERIALS AND METHODS: One hundred patients who underwent URS for proximal ureteral stones between 2007 and 2012 were evaluated prospectively. The patients were divided into four groups consecutively. The control group (Group I) consisted of the 25 consecutive patients, in whom no device or method was used to prevent stone migration. Group II consisted of 25 patients treated with the Stone Cone, group III consisted of 25 patients treated with PercSys, and group IV consisted of 25 patients treated with lidocaine jelly instillation. RESULTS: The migration rates were 4.5% in group II, 8.7% in group III, 21.7% in group IV, and 31.8% in group I. The migration rate was found to be statistically significantly lower in the groups treated with the Stone Cone and PercSys compared to the control group (p = 0.014, p = 0.048). However, there was no statistically significant difference between the lidocaine jelly group and the control group in terms of migration rates (p = 0.444). CONCLUSIONS: Our results suggested that the Stone Cone and PercSys were the most successful methods with significantly low migration rates (4.5 and 8.7%, respectively).

Factors effecting the success of retrograde intrarenal surgery in pediatric patients with renal stones: The experience of two tertiary centres with 368 renal units.

INTRODUCTION AND OBJECTIVES: Currently, in the field of pediatric urology, the primary aim of surgical approaches for the treatment of renal stone disease is to provide a stoneless state through minimally invasive methods, and to prevent the damage that such stones may cause in the urinary system and stone recurrence. The aim of this study was to evaluate the efficacy and safety of RIRS and the factors affecting its success in the surgical treatment of renal stones in pediatric patients. METHODS: Data from 357 pediatric and 368 renal units were collected retrospectively. The recorded parameters were age, gender, location and burden of the stone, and presence of postoperative residual stones. RESULTS: The stone location was the upper pole in 28 (7.6 %) patients, the middle pole in 44 (12 %), the pelvis in 98 (26.6 %), the lower pole in 139 (37.8 %), and multiple locations in 59 (16 %) patients. A stoneless state was achieved in 277 (75.3 %) units, while 91 units (24.7 %) had residual stones at the end of the first month. In the multivariate analysis, the development of residual stones was found to be significantly associated with age (odds ratio [OR], 1.123; p = 0.012) and stone location (OR, 3.142; p = 0.018). DISCUSSION: RIRS is an endourological procedure with a high success rate in the achievement of a stoneless state in both pediatric and adult age groups, with an 82-100 % success rate reported in various studies. A full stoneless state was achieved in 277 (75.3 %) units after the initial RIRS in the present study, and full stone clearance was achieved in 304 units after the second RIRS session, with a success rate of 82.6 %. A limitation of our study is that it was not performed by a single surgeon, and stone samples could not be taken from all patients for stone analysis. CONCLUSION: RIRS has also been associated with a high success rate in the endoscopic treatment of renal stones and is an efficient and safe method with a minimal rate of complications, especially in the pediatric age group.

Correlation of Postoperative Outcomes According to the Amount of Prostatic Tissue Removed in Patients Undergoing Transurethral Resection of the Prostate.

OBJECTIVE: The present study assesses the effect of the proportion of tissue resected during transurethral resections of the prostate (TUR-P) on lower urinary tract symptoms (LUTS) and other parameters in patients with a benign prostatic obstruction (BPO). MATERIALS AND METHODS: Forty-three patients who underwent TUR-P between 2018 and 2021 were assessed prospectively. The patients were divided into two groups according to the percentage of tissue removed (group 1 <30%, group 2 >30% resection). Age, prostate volume, amount of resected tissue, operative time, length of hospital stay, duration of catheterization, International Prostate Symptom Score (IPSS), quality of life score (QoL), maximum urinary flow rate (Qmax), and serum prostate-specific antigen (PSA) (ng/dl) at preoperative and postoperative three months were recorded. RESULTS: The percentage of tissue removed was 22.2% vs. 48.4% (p = 0.001), IPSS reduction was 77.7% vs. 83.3% (p = 0.048), QoL improvement was 77.2% vs. 84.8% (p = 0.133), Qmax increase was 171.3% vs. 193.5% (p = 0.032), and serum PSA decrease was 56.4% vs. 69.2% (p = 0.049) in groups 1 and 2, respectively. In addition, the operative time was 38.5 vs. 53.6 min (p = 0.001), the length of hospital stay was 2.0 vs. 2.4 days (p = 0.001), and the duration of catheterization average was 4.1 vs. 4.9 days (p = 0.002). CONCLUSION: Resections of at least 30% of prostatic tissue can provide a significant improvement in the symptoms and parameters related to benign prostatic obstruction, while resections of less than 30% of prostatic tissue can effectively reduce urinary symptoms and improve the quality of life in older adult patients with comorbidities who require shorter operating times.

Clinical Outcomes of Prostatic Artery Embolization in Patients with Benign Prostatic Hyperplasia: A Prospective Clinical Study.

OBJECTIVE: To determine the clinical outcomes of prostatic artery embolization applied to patients with Material and methods: The study includes 30 patients diagnosed with benign prostatic hyperplasia in the urology clinic between 2012 and 2016, for whom anesthesia was contraindicated due to advanced age and comorbidities and who underwent prostatic artery embolization. These patients were evaluated before the procedure and in the 1st, 3rd, 6th, and 12th months after the procedure. RESULTS: The mean prostate volume of the patients was 68 cm3 before the procedure and 45 cm3 12 monthsafter the procedure. A statistically significant decrease was observed (P = .001). The mean prostate-specific antigen value was 4.9 ng/dL before the procedure and 2.8 ng/dL 12 months after the procedure (P = .008). The mean Qmax value was 0 mL/s before the procedure and 12 mL/s 12 months after the procedure (P = .001). The mean international prostatic symptom scores value was 35 before and 16 twelve months after the proce-dure (P = .001). While the international index of erectile function value was 8.25 before the procedure, it was8.46 12 months after the procedure (P = .32). The quality of life index value was measured as 3.02 before theprocedure and 3.09 twelve months after the procedure; a statistically significant difference was determined (P = .027). CONCLUSION: Prostatic artery embolization, which is a minimally invasive procedure, can be applied as a safe and effective method to patients with benign prostatic hyperplasia who cannot tolerate anesthesia due to advanced age and comorbidities.

Comparison of the micro-percutaneous neprhrolithotomy results between adult and pediatric cases: Is it safe and effective for pediatric cases?

OBJECTIVE: To compare the safety and effectivity of micro percutaneous nephrolithotomy (MicroPNL) in adults and children. MATERIAL AND METHODS: Twenty children and twenty adult patients underwent MicroPNL were evaluated prospective consecutively,between June 2016 and December 2017,who were not suitable for retrograde intrarenal surgery (RIRS).Demographic data,stone free rates,length of hospitalization,duration of the operation,fluoroscopy time,transfusion rates,requirement of double J (D-J) catheter implantation and complications were examined. RESULTS: Seventeen patients with complete data in each group were evaluated within the scope of the study. Mean age was 40.76±14.96 (18-67) years in adults and 5.38±3.84 (10 months-14 years) years in children.There were no differences found between two groups for the mean operation time, fluoroscopy time,and length of hospitalization.Total success rate was noted 94.11% in each group (p=1).While no complications were seen in adults, three complications developed in the pediatric group (p=0.07). One patient in children group had steinstrasse.In addition,intraperitoneal fluid extravasation occurred in one pediatric patient during the operation.After paracentesis,postoperative period was observed uneventful.Also,one pediatric patient had high fever due to urinary tract infection.While there was no need for perioperative D-J catheter implantation in adults,D-J catheter was implanted in 6 (35.29%) pediatric patients, due to fragmented stone burden (p= 0.007) (Table 1). CONCLUSION: According to our results, micaroPNL is safe and effective treatment option in symptomatic renal stones smaller than 2 cm, especially in adults. Unfortunately,it needs more attention due to the risk of complications in pediatric population.

Evaluation of the results of laser endopyelotomy with two different technique in ureteropelvic junction obstruction.

INTRODUCTION: Failed pyeloplasty procedures are caused by large amounts of scarring, and peripelvic fibrosis. This finding has been associated with urinary extravasations to the operation, urosepsis or an excessive tissue reaction. The treatment options for secondary UPJO (Ureteropelvic Junction Obstruction) are the same with the options for primary procedures: in cases of very poor renal function, various pyeloplasty forms (open and laparoscopic), and ureterocalicostomy or sometimes nephrectomy may be considered in severe renal function loss. Whereas, endoscopic treatment can be considered in elective cases. STUDY DESIGN: A total of 46 young patients who underwent endopyelotomy due to secondary ureteropelvic obstruction between January 2013 and September 2018 were included in the study. Patients underwent semirigid URS (Ureterorenoscopy) guided laser endopyelotomy until July 2015, and the patients had flexible URS guided laser endopyelotomy since July 2015. RESULTS: The mean age of the patients was found as 17.7 ± 4.2 and 16.9 ± 5.7 years in the SURSLE (Semirigid Ureterorenoscopy Laser Endopyelotomy), and FURSLE (Flexible Ureterorenoscopy Laser Endopyelotomy) groups, respectively. Success of the procedure was confirmed in 20 (83%) patients in the SURSLE group, and 19 (86%) patients in the FURSLE group who had no obstructive symptoms based on USG, GFR and excretion curves on the renogram ordered in the 24th month. Four (16%) patients in the SURSLE group, and 3 (14%) patients in the FURSLE group were accepted as failed, their treatments were arranged for additional surgical procedures, and these patients were taken under the follow-up protocol. DISCUSSION: This is one of the first studies comparing endopyelotomy with semirigid URS and flexible URS in patients with ureteropelvic stenosis. Long-term results with a large series of patients are not known, and our approach can be considered only as an individual method. There are different treatment options in UPJO. The use of fluoroscopy has advantages in endourologic operations. Therefore, lower radiation exposure can be a rational approach for protecting a person. Similarly, providing necessary protection also for physicians and operating room personnel is essential. In our study, shorter fluoroscopy time with SURSLE provided an advantage over FURSLE in terms of radiation exposure. CONCLUSION: Of semirigid and flexible URS techniques that have no superiority over each other in terms of success, preferring semi-rigid URS guided laser endopyelotomy with lower ionizing radiation used, is more rational.

Correlation between the NGF levels and questionnaire forms in patients receiving antimuscarinic treatment and those receiving onabotulinum toxin-A injection.

OBJECTIVE: To compare nerve growth factor (NGF) levels in patients who received antimuscarinic, versus onabotulinum toxin-A (onaBoNT-A) injection, as well as to investigate whether there is a correlation between NGF levels, and 8-item overactive bladder questionnaire(OAB-V8), urogenital distress inventory (UDI)-6, and incontinence impact questionnaire (IIQ)-7 forms. MATERIAL AND METHODS: Fourty adult patients with OAB were enrolled in this prospective study. An antimuscarinic was prescribed to 20 naive patients, and onaBoNT-A injection was administered to 20 patients, who were refractory to antimuscarinics. Urine samples were obtained before, and after 3rd and 6th months of treatment, and NGF levels were measured. Symptom scores of OAB-V8, UDI-6,and IIQ-7 were recorded. RESULTS: There was no significant difference between groups in terms of the initial OAB-V8, IIQ-7, and UDI-6 scores, whereas NGF values showed no significant difference over time in onaBoNT-A group (p=0.069, p=0.069). NGF levels were significantly lower in 3rd and 6th months, in patients receiving antimuscarinic (p=0.003, p=0.007); a strong correlation was found in 3rd month between the NGF levels, OAB-V8 scores (r=0.704, p=0.001), and IIQ-7 scores (r=0.676, p=0.001), and a moderate correlation between NGF levels, and UDI-6 scores (r=0.583, p=0.007). In the 6th months, a very strong correlation was found between NGF levels, and OAB-V8 scores (r=0.811, p=0.004), and a strong correlation was found between NGF levels, and IIQ-7 scores (r=0.671, p=0.001). In onaBoNT-A group, there was no significant correlation between NGF levels, and other variables. CONCLUSION: NGF level might be a good marker to evaluate effectiveness of treatment in patients receiving antimuscarinics, owing to correlation of urinary NGF levels with symptom scores. Lack of correlation in patients receiving onaBoNT-A injection could be a result of differences in the mechanism of action.

Comparison of the patient's satisfaction underwent penile prosthesis; Malleable versus Ambicor: Single center experience.

OBJECTIVE: To compare the surgical results, complications, and satisfaction levels of patients who underwent malleable penile prosthesis implantation (M-PPI) and Ambicor penile prosthesis implantation (A-PPI). MATERIAL AND METHODS: One hundred forty two patients who underwent penile prosthesis implantation [M-PPI (Promedon- Tube®, Cordoba, Argentina): 81, and A-PPI (American Medical Systems, Minnesota, USA): 61] between 2013-2018 were evaluated retrospectively. Patients' age, body mass index, smoking history, etiological factors, modified "Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) Questionnaire" scores, shortening of the penis, and complications were recorded. RESULTS: The patients who performed A-PPI implantation were younger (56.27 ± 10.81 vs. 51.47 ± 11.79, p = 0.009). The EDITS scores of 31(38.2%) patients who underwent M-PPI and 44 (72.4%) patients who underwent A-PPI were available. It was observed that the scores on the following questions were statistical significantly higher in the A-PPI group: "Overall, are you satisfied with your penile prosthesis?, How much of your expectations did penile prosthesis meet?, How often do you use your penile prosthesis?" (p = 0.05, p = 0.048, p = 0.038). No difference was observed between the groups in terms of the scores on the other three questions (p = 0.447, p = 0.326, p = 0.365). A 61.3% of patients in MPPI (19/31) group, and 56.8% of patients in A-PPI (25/44) group stated penile shortening (p = 0.417). Mean shortening was reported as 2.1 ± 0.45 cm, and 2.12 ± 0.52 cm, in M-PPI and A-PPI groups, respectively (p = 0.90). CONCLUSION: It is remarkable that the patients who underwent A-PPI experienced higher satisfaction with their prosthesis. Even though it has not been evidenced in the current literature data, patients who have had either M-PPI or A-PPI should be informed about the risk of penile shortening.

Comparison of the efficiency of partial versus subtotal mesh removal on urogenital distress and sexual functions after stress urinary incontinence surgery.

OBJECTIVE: To compare the efficiency of the partial mesh removal (PMR) versus subtotal mesh removal (SMR) on urogenital distress and sexual functions in patients who experienced vaginal mesh extrusion. MATERIAL AND METHODS: Between June 2014 and January 2018, 45 patients who experienced vaginal mesh extrusion following midurethral sling surgeries and therefore underwent mesh excision were evaluated retrospectively. The effectiveness of PMR and SMR was compared using the "Urinary Distress Inventory-6 (UDI-6)" and "Female Sexual Function Index (FSFI)" forms, at the 6th month postoperatively. RESULTS: Fourteen PMR-patients and 21 SMR-patients who met the study criteria were evaluated for the study. There was a significant improvement in UDI-6 scores and FSFI scores in both PMR and SMR groups at the 6th month postoperatively (p=0.001, p=0.001, p=0.001, and p=0.001, respectively). When the two groups were compared in terms of improvement rates, there was no significant difference in UDI-6 scores [(-)30.21±6.56% vs. (-)26.33±9.01%, p=0.222]. However, there was a statistically significant improvement in the FSFI scores in the SMR group [(+)83.71±14.81% vs. (+)124.42±36.82%, p=0.001]. There was no significant difference in overactive bladder symptoms between the two groups, with a decrease of 75% in the PMR group and 71.42% in the SMR group (p=0.721). Recurrent stress urinary incontinence was observed in two (14.2%) patients in the PMR group and four (19.1%) patients in the SMR group at the 6th month postoperatively (p=0.544). CONCLUSION: In cases where extrusion is developed, subtotal/total mesh removal provides a significant improvement in patients' complaints of sexual dysfunction related to extrusion.

The effect of tramadol on oxidative stress total antioxidant levels in rats with renal ischemia-reperfusion injury.

OBJECTIVE: To evaluate the protective effect of tramadol on renal tissue in rats with induced renal ischemia-reperfusion injury (I/R injury), and its effects on oxidative stress. MATERIAL AND METHODS: Thirty adult, male Wistar rats weighing 250-300 g were selected as subjects. Rats were randomized into 3 groups: group 1, sham; group 2, renal I/R injury; and group 3, renal I/R+Tramadol. In order to obtain ischemia in groups 2 and 3, renal artery was clamped for 1 h. Total oxidant status (TOS) and total antioxidant capacity (TAC) were analyzed using biochemical assays in the serum samples. RESULTS: TOS values were measured as 1.68±0.4 in group 1, 3.35±1.0 in group 2, and 3.49±0.9 in group 3. When group 1 was compared with group 2 and group 3, the TOS values of group 1 were significantly lower (p<0.05), whereas there was no difference between group 2 and group 3 (p>0.05). TAC values were measured as 1.65±1.4 in group 1, 1.85±0.1 in group 2, and 2.79±0.6 in group 3. The antioxidant status of group 1 was not significantly different from that of group 2 (p>0.05), whereas there was a significant difference between group 1 and group 3 (p>0.05). CONCLUSIONS: Tramadol has positive effects on antioxidant levels in renal I/R injury. We think that tramadol may be used in patients who underwent renal surgery and have I/R injury risk. There is a need for studies on this subject including human series.

Immunohistochemical evaluation of Cajal-like cells and Caveolin-1 levels at ureteropelvic junction obstruction. / Evaluación inmunohistoquímica de las células de Cajal-like y los niveles de Caveolina-1 en la obstrucción de la unión pieloureteral.

OBJECTIVE: To compare c-kit-positive interstitial Cajal-like cells (ICC) and Caveolin-1 protein levels as a pacemaker and signaling molecules, on ureteropelvic junction (UPJ) specimens, between two groups of pediatric patients with and without ureteropelvic junction obstruction (UPJO). METHODS: We evaluated the UPJ specimens of 45 pediatric patients operated between 2005- 2012 retrospectively. Group 1 included 37 patients who underwent dismembered pyeloplasty due to UPJO. Eight patients underwent nephrectomy by the other reasons (renal tumor, trauma etc) and had normal UPJ were accepted as Group 2. The specimens were examined immunohistochemically with CD117 and Caveolin-1 antibody. According to the total number of ICC; 0-5 cells were accepted as a few (1), 610 cells as moderate (2), and > 10 as many (3). According to the staining intensity of Caveolin-1 at muscle tissue, a subjective evaluation was performed as; mild staining (1), moderate staining (2) and strong staining (3). RESULTS: The mean value of ICC distribution was calculated 1.37 ± 0.54 in Group 1 and 2.13 ± 0.64 in Group 2 (p = 0.003), and the median value of ICC distribution was found 1 [1-3] in Group 1 and 2 [1-3] in Group 2 (p = 0.008). Median values for the intensity of staining with Caveolin-1 were found 2 [1-3] in the Group 1, and 2.5 [2-3] in the Group 2 (p = 0.025). CONCLUSIONS: A decrease in ICC and Caveolin-1 levels support that there may be a relationship between ICC and Caveolin-1 for UPJO associated with signal transduction and peristalsis in urinary system.

OBJETIVO: Comparar las células intersticiales Cajal-like, c-kit positivas, y los niveles de proteína Caveolina -1 como marcapasos y moléculas señalizadoras en piezas de unión pieloureteral (UPU) comparando dos grupos de pacientes pediátricos con o sin obstrucción de la UPU.MÉTODOS: Evaluamos retrospectivamente las piezas obtenidas en la operación de 45 pacientes pediátricos entre 2005-2012. El grupo 1 incluía 37 pacientes sometidos a pieloplastia desmembrada por estenosis de UPU. Ocho pacientes que fueron sometidos a nefrectomía por otras razones (tumor renal, traumatismo, etc) y tenían una UPU normal se incluyeron en el grupo 2. Las piezas fueron examinadas mediante inmunohistoquímica con CD117 y Caveolina-1 en el tejido muscular. Se realizó una evaluación subjetiva como: tinción leve (1), tinción moderada (2) y tinción fuerte (3). RESULTADOS: Se calculó el valor medio de la distribución de las células intersticiales de Cajal (CIC), 1,37 ± 0,54 en el Grupo 1 y 2,13 ± 0,64 en el Grupo 2 (p = 0,003), y la mediana, de 1 [1-3] en el Grupo 1 y 2 [1-3] en el Grupo 2 (p = 0,008). Los valores de la mediana para la intensidad de la tinción con Caveolina- 1 fueron de 2 [1-3] en el Grupo 1 y 2,5 [2-3] en el Grupo 2 (p = 0,025). CONCLUSIONES: Una disminución de las células intersticiales de Cajal y los niveles de Caveolina 1 apoyan que puede haber una relación entre las células intersticiales de Cajal y la Caveolina 1 en la estenosis de la UPU asociada con la transducción de la señal y el peristaltismo en el sistema urinario.

Results of minimally invasive procedures for ESWL refractory renal stones smaller than 2 cm: A single center experience. / Resultados de los procedimientos mínimamente invasivos en litiasis renales menores de 2 cm refractarias a litotricia extracorporea. Experiencia individual en un centro.

OBJECTIVES: To evaluate the efficacyand reliability of endourological procedures in patientswith renal stones up to 2 cm that were found to be resistantto extracorporeal shock wave lithotripsy (ESWL). METHODS: 611 patients who had undergone ESWLdue to renal stones up to 2 cm at the ESWL unit of ourclinic, were retrospectively evaluated. Standard percutaneousnephrolithotomy (PNL), micro-PNL, retrogradeintrarenal surgery (RIRS) was performed on the patientswho had stones resistant to ESWL. Demographic data,stone free rate, duration of hospital stay, duration of operation,the duration of scopy, the rates of transfusion andthe complications were recorded. RESULTS: The mean age of 611 patients included tothe current study was 40.76±15.45 years, the meansize of stones was calculated as 205.47±90.5 mm2.While the renal stones were removed in 468 patients(76.59%) after ESWL, endourological procedures wereperformed in 142 patients (23.24%) who had ESWLresistant stones. Standard PNL was performed in 73patients (51.4%), RIRS was performed in 51 patients(35.91%), micro-PNL was performed in 18 patients(12.68%). The success rates after the surgical procedureswere 93.15%, 90.16% and 88.88%, respectively.No major complication was observed in patient groupswho had undergone RIRS and microPNL. CONCLUSION: The surgical approaches, which areselected according to the size and localization of stones,could provide a success rate of 98.03% in ESWLresistant stones and these procedures could be reliablyperformed with considerably lower complication rates.

OBJETIVO: Evaluar la eficacia y fiabilidad de los procedimientos endourológicos en pacientes con litiasis renal de hasta 2 cm resistentes a litotricia extracorporea por ondas de choque (LEOC).MÉTODOS: 611 pacientes que habían recibido LEOC por litiasis renales de hasta 2 cm en la unidad de litotricia de nuestra clínica fueron evaluados retrospectivamente. En los pacientes con cálculos resistentes a LEOC se realizaron nefrolitotomía percútanea estándar,micro-NLP y cirugía intrarenal retrograda (CIRR). Se registraron los datos demográficos, las tasas de pacientes libres de litiasis, duración de la estancia hospitalaria,duración de la operación, duración de la escopia, tasas de transfusiones y las complicaciones. RESULTADOS: La edad media de los pacientes incluidos en el estudio (n=611) fue 40,76±15,45 años, el tamaño medio de la litiasis 205,47±90,5 mm2. La LEOC resolvió la litiasis en 468 pacientes (76,59%) pero en 142 pacientes con litiasis resistentes a LEOC(23,24%) se realizaron intervenciones endourológicas.Se realizó NLP estándar en 73 pacientes (51,4%), CIRR en 51 (35,91%), y micro NLP en 18 (12,68%). Las tasas de éxito después de los procedimientos quirúrgicos fueron del 93,15%, 90,16% y 88,88%, respectivamente. No se observaron complicaciones mayoresen los grupos de pacientes sometidos a CIRR y micro NLP.CONCLUSIÓN: Los abordajes quirúrgicos, que son seleccionadosen función del tamaño y localización de las litiasis, pueden ofrecer una tasa de éxitos del 98,03% en litiasis resistentes a LEOC y estos procedimientos pueden ser realizados de forma fiable con una tasa de complicaciones considerablemente menor.

Can alpha blockers facilitate the placement of ureteral access sheaths in retrograde intrarenal surgery?

OBJECTIVE: To investigate the effects of alpha blocker treatment on the placement of ureteral access sheaths (UAS) during retrograde intrarenal surgery (RIRS). MATERIAL AND METHODS: This study was a retrospective analysis of prospectively collected data. Patients who underwent RIRS due to renal stones between November 2015 and December 2017 were seperated into two groups. Age, gender, body mass index (BMI), stone size, laterality, hydronephrosis degree, and renal stone density were recorded. Tamsulosin (0.4 mg/day) was prescribed to the study group (n=25) 2 weeks before the operation. The control group (n=25) underwent the operation without any additional treatment. All the operations were performed using a 7.5 Fr flexible ureteroscope and 9.5/11.5 Fr (Cook, Blooming, USA) UAS. RESULTS: Two patients in the study group were excluded from the study as they suffered from dizziness and retrograde ejaculation. No statistically significant difference was found between the patients in the study group (n=23) and control group (n=25) in terms of age, gender, BMI, stone size, laterality, hydronephrosis, and renal stone density (p=0.470, p=0.536, p=0.456, p=0.102, p=0.555, p=0.732, and p=0.317, respectively). The UAS could be successfully placed on the first attempt in 15 (65.2%) patients in the study group and 11 (44%) patients in the control group during the first attempt itself. Even though the successful UAS placement rate was higher in the study group, no statistically significant values were observed (p=0.141). CONCLUSION: The data obtained from the present study showed that the use of alpha blockers prior to RIRS did not improve the UAS placement rates. It is considered that studies conducted on more patients might be able to achieve significant values.

Colonizations on biofilm layers of D-J catheters under sterile urine conditions. / Colonización de las capas de biofilm de los catéteres doble J en condiciones de orina estéril.

OBJECTIVE: To evaluate colonizations onbiofilm layers of Double J (D-J) catheters implanted forkidney stones or ureteral stones under sterile conditions. METHODS: D-J catheters implanted between January2012 and February 2014 and removed in 0-90 days,were examined in microbiology laboratory prospectively.Fifty two patients divided into three groups regardingthe duration of the D-J catheters as; 0-30 days, 31-60days, 61-90 days. The colonization (≥1.000 colony)was reported after biofilm layer on D-J catheter was holdin culture media. The upper, middle and lower parts ofthe catheters were analyzed seperately. RESULTS: Thirty five patients had symptomatic urinarytract infection or positive urine culture after implantationwere excluded from the study. Colonization on biofilm layer was detected in 11 patients (21.15%) [Coagulase-negative staphylococci (CNS): 3, Escherichia coli (E. coli): 3, Candida species (Candida spp.): 3, Klebsiella species (Klebsiella spp.): 2]. The rates of colonization according to the duration of the catheterization were; 12.5% in 0-30 days, 18.51% in 30-60 days, 29.4% in 60-90 days (Group 1 vs 2; .696 , group 1 vs group 3; .356 , group 2 vs group 3; .401). The rates of colonization according to the location of the catheter were; 100% in upper and lower parts, 54.4% in middle part (Group 1 vs 2; .011, group 1 vs group 3; , group 2 vs group 3; .011). CONCLUSIONS: Colonization on catheters is possibleeven in the sterile urinary conditions according to thepresent findings. The risk of colonization increases 1.5times in 30-60 days and 2.5 times in 60-90 days comparedto the first 30 days. Besides the risk of colonizationincreases about 2 times in the convoluted edges ofthe catheter compared with the middle part. Thus, D-Jcatheter should be removed as soon as possible and therisk of colonization should be minimalized.

OBJETIVO: Evaluar la colonización de las capas de biofilm de los catéteres doble J (DJ) implantados por litiasis renal o ureteral bajo condiciones estériles.MÉTODOS: Los catéteres DJ implantados entre enero 2012 y febrero 2014 y retirados en 0-90 días fueron examinados de forma prospectiva en el laboratorio de microbiología. Cincuenta y dos pacientes fueron divididos en tres grupos conforme al tiempo del DJ: 0-30 días, 31-60 días y 61-90 días. La colonización (>100.000colonias) fue comunicada tras el cultivo de la capa de biofilm del catéter. Se analizaron por separado las zonas superior, media e inferior de los catéteres DJ. RESULTADOS: 35 pacientes que tenían infección urinaria sintomática o cultivo de orina positivo después del implante fueron excluidos del estudio. Se detectó colonización de la capa de biofilm en 11 pacientes (21,5%) [estafilococo coagulasa negativo (SCN): 3, Escherichia coli (E.coli): 3, Cándida especies (Cándida spp: 3, Klebsiela especies (Klebsiela spp.): 2] Las tasas de colonización de acuerdo con el tiempo de catéter fueron 12,5% en 0-30 días, 18,51% en 30-60 días, 29,4% en 60-90 días (Grupo 1 vs 2; ,696 , grupo 1 vs grupo 3; ,356, grupo 2 vs grupo 3; ,401). Las tasas de colonización de acuerdo con la localización del catéter fueron del 100% en las porciones superior e inferior y 54% en la porción media (Grupo 1 vs 2; ,011, grupo 1 vs grupo 3; , grupo 2 vs grupo 3; ,011). CONCLUSIONES: La colonización de los catéteres es posible incluso en condiciones de orina estéril de acuerdo con los hallazgos presentes. El riesgo de colonización aumenta 1,5 veces en 30-60 días y 2,5 veces en 60-90 días comparado con los primeros 30 días. Además, el riesgo de colonización aumenta unas 2 veces en los extremos espirales del catéter en comparación con la porción media. Así, los catéteres DJ deben ser retirados tan pronto como sea posible y el riesgo de colonización debe ser minimizado.

A comparison of efficacy of doxazosin 4 and 8 mg in medical expulsive therapy of distal ureteral stones: a prospective randomized clinical trial.

We aimed to investigate the efficacy of two different doses of doxazosin, 4 and 8 mg, in medical expulsive therapy (MET). This prospective randomized study included a total of 66 patients with distal ureteral stones which were radio-opaque and ≤10 mm. All patients were randomly divided into three groups: Group 1 included 25 patients receiving 4 mg doxazosin. Group 2 included 22 patients receiving 8 mg doxazosin. Diclofenac 100 mg p.o. and daily 1500-2000 cc hydration were advised to the patients in Groups 1 and 2 to relieve pain. Group 3 consisted of 19 patients who were defined as control group and received only hydration and analgesics. The mean age of the patients was 30 ± 7.6, 37.9 ± 11.5 and 33 ± 11.3 in Group 1, Group 2 and Group 3, respectively. The mean stone size was 6.6 ± 1.4, 7.1 ± 1.5 and 6.6 ± 1.5 in Group 1, Group 2 and Group 3, respectively. The stone expulsion rate of the patient groups was 18/25 (72 %), 15/22 (68.1 %) and 5/19 (25.3 %). There were significantly fewer pain episodes and lower analgesic requirement in Groups 1 and 2 (p = 0.021). However, the difference between Group 1 and Group 2 was non-significant (p = 0.207). Given the data of the present study, doxazosin, an alpha receptor blocker, exhibited equal efficacy with 4 or 8 mg doses in MET and was used safely and efficiently in ureteral stones <10 mm. The findings of the present study showed that 4 mg dose is effective, when doxazosin is preferred for MET.