An evaluation of ureteral diameter ratio and vesicoureteral reflux index in the treatment of primary vesicoureteral reflux.

Objective: Vesicoureteral reflux (VUR) index is a simple, validated tool that reliably predicts significant improvement and spontaneous resolution of primary reflux in children. The aim of this study was to evaluate and compare the ureter diameter ratio (UDR) and VUR index (VURx) of patients treated with endoscopic injection (EI) and ureteroneocystostomy (UNC) methods in the pediatric age group due to primary VUR. Methods: Patients under the age of 18 years old who underwent EI and UNC with the diagnosis of primary VUR between January 2011 and September 2021 were determined as the participants. The UDR was assessed using voiding cystourethrography, and the VURx score was determined prior to treatment based on hospital records included in the study. Results: A total of 255 patients, 60 (23.5%) boys and 195 (76.5%) girls, with a mean age of 76.5 (range 13.0-204.0) months, were included in the study. EI was applied to 130 (51.0%) patients and UNC was applied to 125 (49.0%) patients due to primary VUR. The optimum cut-off for the distal UDR was obtained as 0.17 with sensitivity and specificity of 73.0% and 63.0%, respectively. The positive and negative predictive values were 66.0% and 70.0%, respectively. Conclusion: When the UDR and VURx score are evaluated together for the surgical treatment of primary VUR in the pediatric age group, it is thought that it may be useful in predicting the clinical course of the disease and evaluating surgical treatment options.

Predictors of reflux persistence after endoscopic dextranomer/hyaluronic Acid copolymer injection in pediatric patients with Vesicoureteral reflux: short-term results.

This study aims to investigate the factors effective in predicting the persistence of reflux after the first subureteric transurethral injection (STING) of dextranomer/hyaluronic acid copolymer in pediatric patients with vesicoureteral reflux. The data of patients without a previous history of surgery to treat vesicoureteral reflux and who underwent STING for the first time between September 2011 and November 2020 were investigated retrospectively. After considering exclusion criteria, of 199 patients, 127 patients and 180 renal units were suitable for inclusion. A renal unit-based evaluation was made. Age < 61 months (univariate: p = 0.001, multivariate: p = 0.015, HR: 2.352 (1.181-4.686), OR (95% CI)), moderate reflux level (grade 3) (univariate: p < 0.001, multivariate: p = 0.019, HR: 2.703 (1.177-6.209), OR (95% CI)), DRF (differential renal function) < 45 (univariate: p = 0.020, multivariate: p = 0.047, HR: 1.992 (1.009-3.935), OR (95% CI)), and UDR (ureteral diameter ratio) > 0.15 (univariate: p < 0.001, multivariate: p = 0.005, HR: 2.786 (1.368-5.672), OR (95% CI)) were found predictors of reflux persistence after STING surgery both univariate and multivariate analysis. High reflux level (grade 4-5) was statistically significant in univariate analysis (p < 0.001) but not statistically significant in multivariate analysis (p = 0.215). In our study, UDR and DRF were found to be factors affecting reflux persistence. UDR and DRF should be considered in order to predict reflux resolution in patients who will undergo STING.

Is percutaneous nephrolithotomy effective and safe in infants younger than 2 Years old? Comparison of mini standard percutaneous nephrolithotomy.

BACKGROUND: In this study, we aimed to compare the operative outcomes, postoperative outcomes, stone-free status and complications of SPCNL and MPCNL in infants younger than two years of age. METHODS: We retrospectively analyzed 163 patients younger than two years of age who underwent percutaneous nephrolithotomy (PCNL) in our institution between September 1999 and March 2022. The patients were divided into two groups depending on the tract size. The MPCNL group consisted of 73 patients with a tract of 22 Fr or less, and the SPCNL consisted of 90 patients with a tract greater than 22 Fr. RESULTS: The median age of 163 patients included in the study was 17.3 (range 7-24) months. Although the median stone size was lower in the SPCNL group, no statistically significant difference was found between the two groups in terms of stone size (p = 0.073). The median operative time was 74.8 min in the MPCNL group and 62.8 min in the SPCNL group, with a statistically significant difference (p = 0.002). Stone free rates (SFR) were 89 % and 90.8 % in the MPCNL and SPCNL groups, and the clinically insignificant residual fragments (CIRF) rates were 11 % and 4.6 %, respectively (p = 0.064). The fluoroscopy time, nephrostomy withdrawal time, and hospitalization stay were similar in the two PCNL groups (p = 0.535, p = 0.253, and p = 0.143, respectively). Postoperative fever was similar in MPCNL and SPCNL groups (p = 0.504). Although bleeding (6.7%-2.7 %) and blood transfusion (3.3%-1.4 %) rates were higher in the SPCNL group, there was no statistically significant difference (p = 0.248 and p = 0.420, respectively). Prolonged urinary leakage occurred in 6 (8.2 %) patients in the MPCNL group and 1 (1.1 %) patient in the SPCNL group, with a statistically significant difference (p = 0.026). CONCLUSIONS: With the development of MPCNL, the use of SPCNL in infants has decreased considerably. However, SPCNL continues to be an effective and reliable method when needed in suitable patients. Although PCNL in infants shows some differences from adults, it is an effective and safe method for suitable patients. LEVEL OF EVIDENCE: Although we created our study by retrospectively examining the pediatric urology data that we created prospectively, our study is of a retrospective nature. Therefore the Level of Evidence is 3.

Protective effect of dapagliflozin against cyclosporine A-induced nephrotoxicity.

This study aimed to reveal the possible protective effect of dapagliflozin (DAPA) against acute kidney damage due to cyclosporine A (CsA). Thirty-two mice with an eight-week-old Balb\c albino strain were divided into four groups: control group, CsA group, DAPA group, and CsA + DAPA group. On day 9 of treatment, the animals were decapitated, and bilateral nephrectomy was performed. Oxidative stress and apoptosis were evaluated with caspase-3 activity, total oxidant status (TOS), total antioxidant status (TAS), malondialdehyde (MDA), myeloperoxidase (MPO), B-cell lymphoma-2 (Bcl-2), and Bcl-2-associated X protein (Bax) in the right kidney resection material. The left kidney resection material was evaluated histopathologically. CsA increased caspase-3 activity, Bax, TOS, MDA, TAS, and MPO levels, and the administration of DAPA with CsA significantly reduced this increase in levels (p < 0.001, p < 0.001, p < 0.001, p < 0.001, p < 0.001, and p < 0.001, respectively). CsA decreased Bcl-2 levels, and administration of CsA + DAPA significantly increased Bcl-2 levels compared with only CsA administration (p < 0.001). Additionally, administration of DAPA significantly reduced the histopathological findings (parenchymal inflammation, hyaline cast formation, vacuolization, and lysis of renal tubular cells) caused by CsA. DAPA reduces oxidative stress, apoptosis, and histopathological damage caused by CsA in renal tissue.

Immunohistochemical examination of androgen receptor and estrogen receptor alpha expressions in obstructive and non-obstructive azoospermia.

In this study, the expression of the androgen receptor (AR) and estrogen receptor alpha (ERα) in testicular tissue of male patients with obstructive azoospermia (OA) and non-obstructive azoospermia (NOA) were evaluated by immunohistochemistry. NOA (n = 23) and OA (n = 21) groups were created according to clinical and laboratory archival records. Testicular sperm extraction tissue sections were evaluated according to Johnsen's tubular biopsy scoring (JTBS) method. ERα and AR immunostaining results were evaluated semiquantitatively. Serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone, and estradiol were analyzed. Serum FSH and LH concentrations were greater, and testosterone concentrations were lower than the normal values in the NOA group, whereas the OA group revealed normal hormonal values. Serum estradiol concentrations in groups were in the normal range. JTBSs were significantly lower in the NOA group. Decreased AR expression and increased ERα expression were observed in the NOA group compared to the OA group. This suggests that ERα and AR are expressed in Sertoli cells, Leydig cells, and myoid cells and are required for normal testicular function. Decreased expression of the AR and increased expression of ERα in the testis may negatively affect spermatogenesis.Abbreviations: AR: androgen receptor; ER: estrogen receptor; ERα: estrogen receptor alpha; FSH: follicle-stimulating hormone; JTBS: Johnsen's tubular biopsy scoring; LH: luteinizing hormone; NOA: non-obstructive azoospermia; OA: obstructive azoospermia; TESE: testicular sperm extraction.

The impact of movement, physical activity and position on urine production: A pilot study.

BACKGROUND: Many different internal factors have been proven to influence urine production such as age, weight, and quality of sleep. External factors such as consumption of caffeine and fluid consumption have been shown to have an impact on urine production. AIM: To investigate the impact of movement, physical activity and position on urine production. METHODS: This prospective observational study was executed at Ghent University Hospital, Belgium. Study participation was open for anyone visiting the hospital. Participants collected one basic and two extended 24-hour urine collections and filled in questionnaires concerning their general health and physical activity. Urinary levels of osmolality, sodium and creatinine were determined. Data on movement, physical activity and position was described. RESULTS: An increase in body movement leads to a significant increase in diuresis during daytime, night-time, and 24 hours (P = .002, P < .001, and P < .001, respectively). An increase in body movement leads to a significant decrease in osmolality during night-time and 24 hours (P = .009, and P = .004, respectively). However, no significant influence of movement on osmolality was found during daytime (P = .12). An increase in body movement leads to a significant decrease in creatinine during daytime, night-time and 24 hours (P = .001, <0.001, and P < .001, respectively). An increase in body movement leads to a significant increase in sodium during daytime (P = .046) but this was statistically significant during night-time and 24 hours (P = .32, and P = .84 respectively). CONCLUSION: Our study demonstrates a statistically significant association of movement, physical activity, and position with urine production. It would therefore be interesting to explore this association further with the use of new technology to have more accurate data. Here, lays a potential role for conservative measurements and lifestyle adaptations in the management of patients with bothersome LUTS and more precisely nocturia.

Risk factors associated with nocturia in patients with obstructive sleep apnea syndrome.

AIM: To evaluate the risk factors associated with nocturia in patients with obstructive sleep apnea syndrome (OSAS). MATERIALS AND METHODS: Patients aged over 18 years who had been diagnosed with OSAS using polysomnography (PSG) from January to December 2019 were evaluated. The number of nocturia episodes had been assessed in a 3-day bladder diary. We analysed the age, sex, body mass index (BMI) score, apnea-hypopn ea index (AHI) score and severity, hypertension, diabetes mellitus, smoking and heart diseases in all patients. RESULTS: A total of 124 patients with a mean age of 49.9 ± 11.6 years (range: 25-81 years) were included in the study. Ninety-two (75.8%) patients had nocturia. The mean number of nocturia episodes of patients with nocturia was 2.4 ± 1.3. To determine factors affecting the risk of nocturia, the logistic regression analysis was performed. Patient age and BMI scores were found as the most effective risk factors determining nocturia (P < .05). The odds of patient age were 1.06 (odds ratio: 1.12; 95% confidence interval: 1.01-1.11; P = .010) times higher for patients with nocturia. Every 1-unit increase in the BMI score increased the risk of nocturia 1.12 times. In the study period, 48 patients with nocturia had undergone the continuous positive airway pressure (CPAP) therapy or surgical treatment. The mean number of nocturia episodes of these patients was 2.3 ± 1.4 before treatment and 1.7 ± 2.2 after treatment, showing a significant decrease (P = .032). Although the total daily urine volume increased significantly with the treatment, the total night-time urine volume decreased significantly at night (P = .016 and P = .024, respectively). CONCLUSION: The age and BMI score were the risk factors associated with nocturia in patients with OSAS.

The Effect of Percutaneous Nephrolithotomy on the Estimated Glomerular Filtration Rate in Patients with Chronic Kidney Disease.

Objective: We evaluated the influence of percutaneous nephrolithotomy (PCNL) on the estimated glomerular filtration rate (eGFR) in patients with chronic kidney disease (CKD). Materials and Methods: Between September 2007 and April 2019, 280 patients with a preoperative eGFR level <90 mL/min/1.73 m2 and who underwent PCNL were retrospectively examined. The primary endpoint of this study was the effect of PCNL on eGFR levels in the 1st and 12th month after surgery in patients with CKD according to CKD stages. The secondary endpoint of this study was the identification of potential risk factors for deteriorated eGFRs. Results: The mean eGFR of patients was 48.7 ± 17 mL/min/1.73 m2 in the preoperative period, 54.7 ± 21 mL/min/1.73 m2 in the postoperative 1st month, and 59.1 ± 23.2 mL/min/1.73 m2 in the postoperative 12th month. It was determined that the increases in eGFRs in the postoperative 1st and 12th months were significant in all CKD stages (p < 0.005). Compared with preoperative values, the eGFR value was reduced in 61 (21.8%) patients in the 1st month and 49 (17.5%) patients in the 12th month. When these patients were compared with those in the stable eGFR and recovery group, multiaccess PCNL was an independent risk factor for renal function deterioration at the postoperative 1st and 12th month on multivariate analysis (odds ratios were 6.94 and 9.46, respectively). Conclusion: PCNL was found to have a positive effect on short- and long-term eGFRs in patients with CKD. However, multiaccess PCNL may have adversely affected eGFRs in both the short and long term.

Percutaneous Nephrolithotomy in Young-Old, Old-Old, and Oldest-Old Patients: A Multicenter Study.

Introduction: To compare percutaneous nephrolithotomy (PCNL) outcomes between the elderly and young age groups and examined differences between young-old, old-old, and oldest-old patients. Methods: A retrospective analysis was conducted on 8191 renal units that underwent PCNL between September 1997 and March 2020 at three Turkish academic institutions. Patients were classified into young (18-64 years) and elderly (65+ years) age groups. The elderly age group was classified into young-old (65-69 years), old-old (70-79 years), and oldest-old (80+ years). Demographics, stone features, and perioperative and postoperative outcomes were compared between groups. The factors affecting stone-free rates and complications were determined in the elderly age group. Results: The patients' median age was 47 years (18-100) and the female to male ratio was 1:1.72. The stone-free and complication rates were 78.9% and 16.4%, respectively. General complications, blood transfusion, postoperative urinary tract infections, and major complications rate were similar between the young and elderly age groups (P = .902, P = .740, P = .659, P = .219, respectively). The stone-free rate was higher in the elderly age group (P = .002). Presence of partial or complete staghorn stones and number of stones were independently associated with stone-free rates for elderly age group patients (P = .006, P < .001, respectively). Stone burden (≥400 mm2) and presence of partial or complete staghorn stones were significantly associated with complications for the elderly age group patients (P = .038, P = .014, respectively). Conclusions: In the young-old, old-old, and oldest-old age group, PCNL appears like the preferred treatment with high stone-free rates but similar complication rates compared to their younger counterpart.

Which factors affect the success of pediatric PCNL? Single center experience over 20 years.

OBJECTIVE: We aimed to investigate the impact of surgeons' experience on pediatric percutaneous nephrolithotomy (PCNL) outcomes. MATERIALS AND METHODS: Between June 1997 and June 2018, 573 pediatric patients with 654 renal units underwent PCNL for renal stone disease by senior surgeons. Data were divided into two groups, group-1 (n = 267), first ten years period, group-2 (n = 387); second ten years period. RESULTS: Mean ± SD age of patients was 7.6 ± 4.9 (1-17) years. The stone-free rates (SFR) assessed after 4 weeks were 74.9% vs. 83.4% in group-1 vs. group-2, respectively (p = 0.03). The mean operation time, fluoroscopy time, and the number of patients requiring blood transfusion significantly decreased in group 2 (100.4 ± 57.5 vs. 63.63 ± 36.3, 12.1 ± 8.3 vs. 8.3 ± 5.4, and 24.3% vs. 2.9%; p < 0.001, p < 0.001, and p = 0.002 in group-1 versus group-2, respectively). On multivariate analysis, increasing stone size increased operation time (p < 0.001), fluoroscopy time (p < 0.001), intraoperative and postoperative blood transfusion rates (p = 0.006 and p = 0.018, respectively), and hospital stay (p = 0.002) but was not associated with change of glomerular filtration rate (GFR) (p = 0.71). Sheath size also correlated with increased fluoroscopy time (p < 0.001), operation time (p < 0.001), intraoperative blood transfusion (p < 0.001) and hospital stay, but sheath size did not affect postoperative blood transfusion (p = 0.614) or GFR change (p = 0.994). CONCLUSIONS: The percutaneous nephrolithotomy (PCNL) is a minimally invasive procedure and is well accepted because of its lower complication rate and high efficiency for pediatric patients. Stone and sheath size are predictive factors for blood loss and hospital stay. During 20 years, our fluoroscopy time, operation time, blood loss, and complication rates decreased, and stone-free rate increased.

Management of erosion of inflatable penile prosthesis reservoir into bladder. A different approach.

We report a rare case of erosion of an inflatable penile prosthesis reservoir into the bladder that was managed with a different approach from the literature by preserving the existing reservoir. Inflatable penile implant was applied to a 54-year-old male patient who had undergone with a robot-assisted radical prostatectomy operation due to localized prostate cancer 2 years before. Two months after the operation, the patient referred to our clinic with predominant symptoms of lower urinary tract system associated with scrotal pain and swelling. The urinary system ultrasonography (USG) and the lower abdomen magnetic resonance imaging (MRI) demonstrated that the reservoir of the penile prosthesis was in the bladder. Cystoscopy confirmed that the reservoir was in the bladder. According to literature the reservoir was surgically removed from bladder. After bladder repair, the rectus muscles were repaired creating a space between the rectus muscle and the skin, where the reservoir was placed. After postoperative observation, the patient was discharged without any infection and regression of the lower urinary tract symptoms. No problem was referred by using the penile prosthesis when at 1-month and 3-month follow up and the patient was not uncomfortable in this regard. In conclusion no drawback occurred by using the old reservoir.

Evaluation of the Intravesical Ureters after Failed Endoscopic Treatment of Vesicoureteral Reflux with Dextranomer/hyaluronic Acid in Children via Light and Transmission Electron Microscopic Analysis. A Matched Case-Control Study.

INTRODUCTION: The cytokine profile and the ultrastructural changes of refluxing ureterovesical junctions(UVJs) of children treated with failed dextranomer/hyaluronic-acid (Dx/HA) injections were investigated using immunohis-tochemical methods and transmission electron microscopy(TEM). PATIENTS AND METHODS: Eighteen children who had undergone injection for reflux were included the study. The smooth muscle arrangement of the ureteral wall, transforming growth factor-? (TGF-?1),vascular-endotheli-al-growth factor (VEGF) and CD34 were evaluated immunohistochemically, and the results were compared with 10 age-matched autopsy specimens as controls. The ultrastructural evaluation and morphological description was made semi-quantitatively and compared with published data. RESULT: Four of the patients (22%) were male, and 14 (78%) were female. The mean age of the patients was 105.4 ± 44.5(48-184) months. There was no correlation between the vesicoureteral reflux (VUR) grade and age (P = 0.85). The mean VEGF and CD34 scores were 16.2 ± 9.6 (0-90) cells per HPF and 10.2 ± 3.5 (4-16) vessels per HPF in ureters with reflux; these values were 60.6±16.4 (32-84) cells per HPF and 17.8 ± 4.1 (12-24) vessels per HPF in the control group. The amount of VEGF and CD34 were significantly decreased in patients compared with the control group (P < 0.001, P < 0.001).The TGF-?1 levels were significantly higher in patients with VUR compared with the control group (34.2 ± 19.9 vs 5.0±1.9; P=0.001).The amount of VEGF, CD34, and TGF-?1 were not correlated with the grade of reflux (P = 0.26, P = 0.94, and P = 0.42, respectively). Ultrastructural changes in the muscle cells were observed in all the VUR specimens (Grade II-IV). CONCLUSION: Refluxing ureters exhibited immune-histopathological abnormalities and ultrastructural changes of the muscle cells in all VUR specimens in the ureterovesical junctions of children treated with failed Dx/HA injec-tions for reflux.

Is the Homocysteine Level a Good Predictive Marker for Evaluating Kidney Function in Patients After Percutaneous Nephrolithotomy.

PURPOSE: The purpose of this study is to evaluate the preoperative, early and late postoperative homocysteine levels and its relationship with kidney function in patients after undergoing percutaneous nephrolithotomy (PNL). MATERIALS AND METHODS: Twenty-three patients with kidney stones underwent PNL and blood samples were taken preoperatively as well as at 48 hours and three months after the operation. The homocysteine level was determined by high pressure liquid chromatography and the fluorometric method in blood samples with ethylenediaminetetraaceticacid. The Cockcroft - Gault formula was used to calculate the glomerular filtration rate (GFR). Non-contrast computed tomography was performed for all patients before surgery. Stone burden was calculated asthe sum of the area of each stone in mm2. RESULTS: Fourteen male (60.9%) and nine female (39.1%) patients were recruited for this study, and the median age was 44.3 ± 15.17 (20 - 71) years. There were no statistically significant differences between the preoperative homocysteine level and the level at 48 hours post-operation (P = .460). However, the homocysteine level three months after the operation was significantly lower than the preoperative and 48 hour levels (P = .001 and P = .003, respectively). CONCLUSION: Renal function, which deteriorated after the PNL procedure, was preserved or improved over time. Homocysteine may be a sensitive indicator to assess the change in renal function pre-and post-PNL.

Examining Pediatric Cases From the Clinical Research Office of the Endourological Society Ureteroscopy Global Study.

OBJECTIVE: To evaluate the characteristics and outcomes of ureteroscopy (URS) in children treated in several hospitals participating in the Clinical Research Office of the Endourological Society (CROES) Study, and to present the overall results of pediatric URS compared with adults. PATIENTS AND METHODS: The CROES Study collected data on consecutive patients treated with URS for urolithiasis at each participating center over a 1-year period. The collected prospective global database includes data for 11,885 patients who received URS at 114 centers in 32 countries. Of these URS-treated patients, 192 were ≤18 years old. RESULTS: Of the 114 centers participating in the study, 42% had conducted pediatric URS. Among the pediatric cases, 7 were infants, 53 were small children, 59 were school-aged children, and 73 were adolescents. A considerable number (37%) of the pediatric cases had previously undergone URS treatment. No differences in the surgical outcomes of the adults and children were reported. The URS-treated children had a greater number of positive preoperative urine cultures when compared with adult cases treated. A semirigid scope was used in the vast majority of pediatric cases (85%). According to the present data, within the group of URS-treated children, the younger the child, the more readmissions occurred. CONCLUSION: URS is as efficient and safe in children as it is in adults. The data suggest that readmissions among URS-treated children are associated with age, with the likelihood of readmissions greater among younger age groups.

Percutaneous nephrolithotomy in prone position in patients with spinal deformities.

INTRODUCTION: The feasibility, safety and efficacy of percutaneous nephrolithotomy (PCNL) in patients with spinal deformities were evaluated and the results of a single centre experience were reported. PATIENTS AND METHODS: Between July 1999 and December 2014, 16 patients with spinal deformities underwent PCNL. The anomalies included 5 cases with kyphoscoliosis, 4 with post-polio syndrome, 3 with osteogenesis imperfecta, 3 with myotonic dystrophy, and 1 with ankylosing spondylitis. All patients were preoperatively evaluated by an intravenous urogram and computerized tomography to assess the anatomy and appropriate access. The operative details, stone clearance rates, and complications were retrospectivelyanalyzed. RESULTS: A total of 16 standard PCNL procedures were performed on 16 renal-units. The mean age of the patients was 30.7 ± 17.2 (5-62) years, and the mean stone burden was 609.6 ± 526.9 (100-1800) mm(2). The mean operative and fluoroscopy times were 76.6 ± 35.1 (35-150) minutes and 12.5 ± 8.5 (3-34) minutes, respectively. At the end of the surgery, 13 (81.2%) of the patients were stone free. The overall success rate was 93.7% with the inclusion of 2 patients with clinically insignificant residual fragments (<3 mm). Complications (31.2%) included haemorrhage requiring a transfusion in 2 patients, prolonged urine leakage requiring double J catheter insertion in 1, infection in 1, and nephrectomy due to bleeding in 1. Mean hospitalization time was 4.6 ± 2.4 (3-13) days. CONCLUSION: PCNL is an effective, safe and minimally invasive procedure for the treatment of kidney stones in patients with spinal deformities, and it can be performed with low morbidity and high success rates. To achieve better results and minimizing the risk factors, systematic and anatomic evaluations for anaesthesia and operative planning are crucial before surgery.

Ultrastructural and immunohistopathological evaluation of intravesical ureters via electron and light microscopy in children with vesicoureteral reflux.

PURPOSE: We used immunohistochemical methods and transmission electron microscopy to investigate the cytokine profiles and ultrastructural changes in the ureterovesical junction of children with primary vesicoureteral reflux. MATERIALS AND METHODS: A total of 39 distal intravesical ureters were obtained from 23 children who underwent ureteroneocystostomy for primary vesicoureteral reflux. Ureteral wall smooth muscle organization and transforming growth factor-ß1, vascular endothelial growth factor and CD34 were evaluated immunohistochemically and compared to controls, which consisted of 10 age matched autopsy specimens. Ultrastructural evaluations and morphological descriptions were performed semiquantitatively and compared to the published data. RESULTS: Of the patients 6 (26%) were male and 17 (74%) were female, and mean ± SD age was 73.2 ± 34.3 months (range 12 to 168). There was no correlation between reflux grade and age (p = 0.39). Smooth muscle disorganization score differed significantly between patients with intravesical ureters and controls (p = 0.01). Transforming growth factor-ß1 levels were significantly higher (p = 0.001) and vascular endothelial growth factor levels and microvessel densities were significantly lower in the patients with reflux compared to controls (both p <0.001). Vascular endothelial growth factor, CD34 and transforming growth factor-ß1 levels did not correlate with reflux grades (p = 0.84, p = 0.76 and p = 0.10, respectively). Urothelium, lamina propria and tunica adventitia appeared normal in the specimens for all grades of vesicoureteral reflux using transmission electron microscopy. Damage was observed in the muscular layers of the ureterovesical junction, especially in patients with grade IV or V reflux. CONCLUSIONS: Primary refluxing ureters exhibit immunohistopathological abnormalities compared to normal ureters irrespective of reflux grade, and ultrastructural changes are especially severe in cases of high grade reflux. These abnormalities can hinder the normal ureteral valve mechanism, and may lead to reflux due to smooth muscle dysfunction and microvascular alterations.

Factors affecting complication rates of percutaneous nephrolithotomy in children: results of a multi-institutional retrospective analysis by the Turkish pediatric urology society.

PURPOSE: We assessed factors affecting complication rates of percutaneous nephrolithotomy in children. MATERIALS AND METHODS: We retrospectively evaluated data on 1,205 renal units in 1,157 children treated with percutaneous nephrolithotomy at 16 Turkish centers between 1991 and 2012. Of the patients 28.3% had a history of urolithiasis. Complications were evaluated according to the Satava classification system and modified Clavien grading system. Univariate and multivariate analyses were done to determine predictive factors affecting complication rates. RESULTS: A total of 515 females and 642 males were studied. Mean ± SD patient age was 8.8 ± 4.7 years (range 4 months to 17 years). Mean ± SD stone size, operative time and postoperative hospital stay were 4.09 ± 4.06 cm(2), 93.5 ± 48.6 minutes and 5.1 ± 3.3 days, respectively. Postoperative stone-free rate was 81.6%. A total of 359 complications occurred in 334 renal units (27.7%). Complications were intraoperative in 118 cases and postoperative in 241. While univariate analysis revealed that stone history, positive urine culture, operative time, length of hospitalization, treatment success, punctured calyx and location of the stone significantly affected the complication rates (p <0.05), operative time, sheath size, mid calyceal puncture and partial staghorn formation were the statistically significant parameters affecting complication rates on multivariate logistic regression analysis. CONCLUSIONS: Percutaneous nephrolithotomy is the treatment of choice for most renal calculi in children. The technique is effective and safe in children, with a high success rate and a low rate of major complications. The significant factors identified should be considered by clinicians to decrease associated complication rates.

Clinical characterization of unusual cystic echinococcosis in southern part of Turkey.

BACKGROUND AND OBJECTIVES: The incidence of primary extrahepatic cystic echinococcosis (CE) is rare. Generally, radiological and serological findings can help establish the diagnosis of hepatic and pulmonary CE, but a CE in an unusual location with atypical radiological findings may complicate the differential diagnosis. The objective of this study is to present the characteristics of cases with extrahepatic CE in respect of sites of involvement, clinical presentations, radiological findings, serological diagnostic evaluations, and outcomes of infected patients. DESIGN AND SETTINGS: A retrospective analysis of surgically treated CE was conducted between January 1993 and January 2014 in the General Surgery, Pediatric Surgery, Urology, Cardiovascular Surgery, Neurosurgery, and Orthopedics departments of University of Cukurova, Faculty of Medicine, Balcal Hospital. PATIENTS AND METHODS: Among the 661 patients managed for CE, 134 had unusual sites of involvement. Radiological and serological examinations were used to differentiate CE from alveolar echinococcosis. RESULTS: Of 134 cases with unusual sites of involvement, 32 cases had liver CE (23.9%), 7 cases had lung CE (5.2%), and 2 cases had concomitant liver and lung CE (1.5%). In 93 (69.4%) cases, unusual organ involvement was isolated without any liver or lung involvement. The mean age was 45 years. Abdominal pain was the main symptom and was found in 104 patients. Thirty-one (23.1%) of 134 extrahepatic CE cases were evaluated as negative with indirect hemagglutination (IHA). However, positive results were obtained in 54 cases evaluated with Echinococcus granulosus IgG Western blot (WB), including 10 IHA-negative cases. CONCLUSION: CE with unusual localizations may cause serious problems of diagnostic confusion. The combination of clinical history, radiological findings, and serological test results (especially the WB) are valuable in diagnosing extrahepatic CE.

The effect of prophylactic treatment with Shohl's solution in children with cystinuria.

OBJECTIVE: To investigate the effect of prophylactic treatment with Shohl's solution on the rates of stone recurrence in paediatric patients with cystinuria. PATIENTS AND METHODS: Between June 2007 and October 2011, 185 patients aged 16 years and younger whose stones had been completely removed by percutaneous nephrolithotomy (PCNL) were assessed for metabolic risk factors. Seventeen (9%) patients with positive cyanide-nitroprusside tests (CNT) and cystine stones enrolled in this study, and a Shohl's solution was used for alkalinisation. The patients were followed up for a mean period of two years for stone recurrence. RESULTS: Of the patients, 10 (59%) were male, and 7 (41%) were female (p = 0.13). Twelve patients (70.5%) continued to receive medical prophylaxis regularly, whereas 5 (29.5%) patients did not. The mean pre-treatment and post-treatment urinary pH values were 5.8 ± 0.5 (5-7) and 7.5 ± 0.4 (6.5-8), respectively (p < 0.001). The pre-treatment and post-treatment specific gravities of the urine were 1021.5 ± 5.4 (1010-1030) and 1006 ± 2.3 (1004-1015), respectively (p < 0.001). The rates of recurrence were 16.6% among those who continued prophylaxis and 100% among those who did not receive prophylaxis (p = 0.001). The most common combination of metabolic anomalies was cystinuria and hypocitraturia (p < 0.001). CONCLUSIONS: This study demonstrated that detailed clinical and laboratory evaluations should be performed for all children with cystine stone disease, and, appropriate prophylactic treatment should be recommended to prevent the reformation of stones.

Effects of Long-term Administration of the Antiaging Hormone Dehydroepiandrosterone Sulfate on Rat Prostates and Testes as Androgen-Dependent Organs.

PURPOSE: This study aimed to determine the effects of the long-term use of dehydroepiandrosterone sulfate (DHEAS) on rat prostates and testes as well as on serum testosterone and DHEAS levels. MATERIALS AND METHODS: Thirty male rats aged 4 to 5 months were studied. A DHEAS suspension of 5 mg/kg per rat was administered orally to the 15 rats in the experimental group 5 times a week, whereas saline was administered concurrently to the 15 rats in the control group. Intracardiac blood samples were drawn to determine hormone levels, and histological samples of prostate and testes were evaluated under light microscopy. RESULTS: At the end of the 6-month study period, histological examinations performed on prostate preparations showed that the atrophy score of the experimental group was significantly lower than the scores of the sham and control groups (p<0.001 and p<0.001, respectively). The serum total testosterone and DHEAS levels of the rats in the study group were significantly increased (p<0.001). CONCLUSIONS: In our study, we determined that the long-term use of DHEAS does not have any detrimental effects on the prostate or the testis; on the contrary, it protects the prostate from atrophy, which is imperative for the continuation of fertility as well as for increasing serum testosterone and DHEAS levels.