Management of Priapism: Results of a Nationwide Survey and Comparison with International Guidelines.

OBJECTIVE: The aim of this study is to evaluate current urologic practice regarding the management of priapism in Turkey and compare with international guidelines. METHODS: Urologists and urology residents were invited to an online survey consisting of 30 multiple-choice questions on priapism-related clinical practices that were consid- ered most important and relevant to practices by using Google Forms. RESULTS: Total number of responses was 340. Respondents reported that they recorded a detailed patient's medical history and physical examination findings (n = 340, 100%) and laboratory testing, which includes corporal blood gas analysis (n=323, 95%). Participants announced that they performed Doppler ultrasound for 1/4 cases (n = 106, 31%), but 22% of the participants (n=75) replied that they performed in >75% of cases. Participants (n=311, 91%) responded that the first-line treatment of ischemic priapism is decompression of the corpus cavernosum. Moreover, most respondents (n = 320, 94%) stated that sympathomimetic injection drugs should be applied as the second step. About three-quarters of respondents (n = 247, 73%) indicated adrenaline as their drug of choice. Phosphodiesterase type 5 inhibitors seems to be the most pre- ferred drug for stuttering priapism (n=141, 41%). Participants (n=284, 84%) replied that corpora-glanular shunts should be preferred as the first. A large number of par- ticipants (n = 239, 70%) declared that magnetic resonance imaging can be performed in cases with delayed (>24 hours) priapism to diagnose corporal necrosis. Most of the participants (84%) responded that penile prosthesis should be preferred to shunts in cases with delayed (>48 hours) priapism. CONCLUSION: It would be appropriate to improve the training offered by professional associations and to give more training time to the management of priapism during residency.

A multicenter-based critical analysis of laser settings during intrarenal laser lithotripsy by the Turkish academy of urology prospective study group (ACUP study).

OBJECTIVE: In this multicenter prospective study, we aimed to evaluate the use of holmium:yttrium-- aluminum-garnet laser during retrograde intrarenal surgery for kidney stones and the relationship between laser-related parameters and procedure-related perioperative parameters. MATERIAL AND METHODS: The 769 patients whose laser setting parameters (fiber thickness, number of shots, frequency (max.), laser power (max.), and total energy) were completely registered were included in this study program. The intraoperative ureteral lesions were evaluated using postureteroscopic lesion scale (PULS) scores and the postoperative complications with the modified Clavien-Dindo classification system. RESULTS: The maximum levels of laser power and the frequency were used in the middle calyceal stones; the value of total energy consumed was found to be higher gain in cases with multiple stones (all parameters P < .05). There was a significant positive correlation among (mean number of shots [P < .001, r » 0.46], frequency [P » .009, r » 0.1], maximum power [P < .001, r » 0.11], total energy [P < .001, r » 0.25]), anesthesia time (P < .001, r » 0.42), surgery time (P < .001, r » 0.47), and stone size. The mean number of shots increased (P < .001, r » 0.25), and the frequency level decreased (P < .001, r » -0.17) significantly with increasing Hounsfield unit (HU) values. Again, the mean number of shots and maximum laser power increased in correlation with the increasing hospitalization time (P » .004, r » 0.09 and P » .02, r » 0.07, respectively). In addition, it was observed that higher laser subparameter values and thicker fibers were used in PULS grade 2. CONCLUSION: As the stone size and HU values increased, laser-setting parameters were found to show significant variability. The increase in different parameters of the laser setting was found to be associated with longer anesthesia time, surgery time, and hospitalization period and increased risk of local trauma with PULS grade.

Retrograde intrarenal surgery of renal stones: a critical multi-aspect evaluation of the outcomes by the Turkish Academy of Urology Prospective Study Group (ACUP Study).

AIMS: To outline and evaluate the incidence, management and follow-up of the residual fragments (RFs) following retrograde intrarenal surgery (RIRS) of renal stones by the Turkish Academy of Urology Prospective Study Group (ACUP Study). METHODS: Following the ethical committee approval, 15 centers providing data regarding the incidence, management, and follow-up of RFs after RIRS were included and all relevant information was recorded into the same electronic database program ( https://acup.uroturk.org.tr/ ) created by Turkish Urology Academy for Residual Stone Study. RESULTS: A total of 1112 cases underwent RIRS for renal calculi and RFs were observed in 276 cases (24.8%). Of all the parameters evaluated, our results demonstrated no statistically significant relation between preoperative DJ stenting and the presence of RFs (χ2 (1) = 158.418; p = 0.099). RFs were significantly higher in patients treated with UAS (82 patients, 29.3%) during the procedure compared to the cases who did not receive UAS (194 patients, 23.3%) (χ2 (1) = 3.999; p = 0.046). The mean period for a secondary intervention after RIRS was 28.39 (± 12.52) days. Regarding the procedures applied for RF removal, re-RIRS was the most commonly performed approach (56%). CONCLUSIONS: Despite the reported safe and successful outcomes, the incidence of RFs is higher, after the RIRS procedure particularly in cases with relatively larger calculi. Such cases need to be followed in a close manner and although a second flexible ureteroscopy is the treatment of choice for fragment removal in the majority of these patients, shock wave lithotripsy and percutaneous nephrolithotomy may also be preferred in selected cases.

Robotic simple prostatectomy is a safe and effective technique for benign prostatic hyperplasia: Our single center initial short-term follow-up results for 42 patients.

OBJECTIVE: Benign prostatic hyperplasia is one of the biggest problems of aging men. Prostate surgery is now well defined in the case of failure of medical therapy. Robotic simple prostatectomy is a minimally invasive surgical method with an alternative to open simple prostatectomy in large prostate volumes. We present our simple prostatectomy technique with robot, perioperative, and short-term functional result in our clinic. MATERIAL AND METHODS: Between January 2017 and January 2021, 42 patients underwent simple robotic prostatectomy were retrospectively evaluated. Preoperative, perioperative, and post-operative clinical data were analyzed. Post-operative continence status, voiding, and erectile functions were evaluated using uroflowmetry and international prostate symptom score (IPSS) at sixth week and third month. RESULTS: The mean age of the patients was 71 (66-78) years. No major complications were observed in any of the patients. Urethral catheters were removed on the fourth post-operative day. Except for one case, all of the cases urinated spontaneously after the catheter was removed. One case could not urinate spontaneously, and urethral catheter was placed again. Three days later, the urethral catheter was removed, and patient urinated spontaneously. None of the patients reported stress urinary incontinence or erectile dysfunction. The mean operative time was 112minutes, the mean hospital stay was 1.6 days, the mean post-operative IPSS was 6, and the mean post-operative Q max was 24.4mL s 1. CONCLUSION: Robotic simple prostatectomy may be an effective and safe alternative minimally invasive technique in the treatment of large-volume benign prostatic hyperplasia.

Does biofeedback therapy improve quality of life in children with lower urinary tract dysfunction: parents' perspective.

INTRODUCTION: Lower urinary tract dysfunction (LUTD) is a situation that often disrupts the quality of life (QoL) of both the child and the family with daytime and nighttime incontinence. Although the first-line treatment option for children with LUTD is standard urotherapy, biofeedback therapy can be performed in children in which standard urotherapy failed. OBJECTIVE: We studied the biofeedback success in children with LUTD according to parents' expressions. METHODS: We retrospectively analyzed our hospital records of children who were diagnosed with LUTD between 2005 and 2017. In total, 281 patients, refractory to standard urotherapy were included into the study and directed to biofeedback treatment. Their parents completed the dysfunctional voiding symptom scores (DVSS) before and after biofeedback therapy. RESULTS: At the end of the six-month follow-up period, all voiding disorders and voiding patterns were evaluated. According to DVSS, QoL tools before biofeedback treatment 48 (17%) parents appraised that LUTD caused no effect in their children's daily life, 104 (37.8%) expressed little effect, 89 (31%) moderate effect, and 40 (14.2%) serious effect. And, 120 (43%) parents expressed no effect, 95 (34%) little effect, 51 (18%) moderate effect, and 15 (5%) serious effect (P = 0.001) after biofeedback therapy. Biofeedback therapy affected positively the daily life of LUTD's family. The less serious the effect of LUTD on these children's family, the more success rate of biofeedback therapy. The effect of biofeedback therapy was less successful in moderated and serious affected families. CONCLUSIONS: Biofeedback treatment is a non-invasive and effective treatment modality for improving the QoL for LUTD families who were less suffered from LUTD.

Does preoperative use of silodosin affect the stages of F-URS procedure? / ¿Afecta el uso de silodosin preoperatorio los pasos de la ureteroscopia flexible?

OBJECTIVES: To evaluate the effect of silodosin on stages of the flexible ureterorenoscopy (F-URS) procedures. METHODS: Between November 2015 and August 2017, a total of 76 patients suffering from 10-30 mm kidney stone were enrolled in this randomized prospective study. Patients were randomly divided into 2 groups for treatment: Group 1 had F-URS with preoperative daily uptake of 8 mg silodosin for 10 days, and group 2 had F-URS without silodosin uptake. None of the patients had preoperative JJ stenting. Stages of the F-URS was defined as entrance to bladder time (ETBT) with a semirigid ureterorenoscope (R-URS), entrance to ureteric orifice time (ETUOT) with R-URS using a guide wire and proceeding 2 cm inside the ureter, application of access sheath time (AAST) using the guide wire advanced through R-URS, F-URS time (FURST) + lithotripsy with laser time (LT), and total operation time (OT). We compared the time of each stage between two groups. RESULTS: There were 38 patients group1 and 2, respectively. There was one ureteral access sheath (UAS) application failure in group 1, and 3 failures in group 2 (p=0.307). The ETBT, ETUOT, and AAST were significantly short in group 1 than group 2 (p=0.001,0.007,0.002). CONCLUSIONS: Although preoperative use of silodosin facilitated only an insignificant positive effect on UAS placement failure, it eased the F-URS procedure by reducing the ETBT, ETUOT, and AAST in seconds. More studies are needed to make an exact conclusion.

OBJETIVOS: Evaluar el efecto de la silodosina en las etapas de los procedimientos de ureterorrenoscopia flexible (F-URS).MÉTODOS: Entre noviembre de 2015 y agosto de 2017, un total de 76 pacientes con cálculos renales de 10-30 mm se inscribieron en este estudio prospectivo aleatorizado. Los pacientes se dividieron aleatoriamente en 2 grupos para el tratamiento: el grupo 1 tenía F-URS con captación diaria preoperatoria de 8 mg de silodosina durante 10 días, y el grupo 2 tenía F-URS sin captación de silodosina. Ninguno de los pacientes tenía stent JJ preoperatorio. Las etapas del F-URS se definieron como entrada al tiempo de la vejiga (ETBT) con un ureterorrenoscopio semirrígido (R-URS), entrada al tiempo del orificio ureteral (ETUOT) con R-URS usando una guía y 2 cm dentro del uréter. Aplicación del tiempo de vaina de acceso (AAST) utilizando el cable de guía avanzado a través de R-URS, tiempo de F-URS (FURST) + litotricia con tiempo de láser (LT) y tiempo total de operación (OT). Comparamos el tiempo de cada etapa entre dos grupos. RESULTADOS: Hubo 38 pacientes grupo 1 y 2, respectivamente. Hubo una falla en la aplicación de la cubierta de acceso ureteral (UAS) en el grupo 1 y 3 fallas en el grupo 2 (p=0,307). ETBT, ETUOT y AAST fueron significativamente cortos en el grupo 1 que en el grupo 2 (p=0,001, 0,007, 0,002). CONCLUSIONES: Aunque el uso preoperatorio de silodosina facilitó solo un efecto positivo insignificante en la falla de colocación de UAS, alivió el procedimiento de F-URS al reducir el ETBT, ETUOT y AAST en segundos. Se necesitan más estudios para llegar a una conclusión exacta.

Unusual intrascrotal lesions in adults in urological practice. / Lesiones intraescrotales inusuales en adultos en la práctica clínica urológica.

OBJECTIVE: Unusual intrascrotal lesions in adults generally have been described as case reports in the medical literature. We present two lesions observed in two clinics over more than 28 years, with their radiological, pathological and clinical characteristics. METHODS: Retrospective study preformed between 1989 and 2017 in 446 patients undergoing inguinal orchiectomy. Clinical data were obtained reviewing patient` s tables. All patients were evaluated with physical examination, medical history, serum tumor markers (alpha fetoprotein, beta human chorionic gonadotropin, LDH), and scrotal ultrasound in the perioperative period. RESULTS: In 396 cases (88,78%) the diagnosis was germ cell or non-germ cell tumor and the remainder 50 patients (11.2%) presented 15 different intrascrotal lesions. These lesions were rhabdomyosarcoma (1 patient), intrascrotal cavernous hemangioma (1 patient), dermoid cyst (2 cases), epidermoid cyst (4 patients), paratesticular mesothelioma (1 case), parietal testicular tunica vaginalis cyst (2 patients), spermatic granuloma (3 cases). The number of patients with tuberculosis orchitis was 6 and granulomatous orchitis 8. There were 8 patients with fibrous pseudotumor. 1 patient presented testicular plasmocytoma. Metastatic involvement secondary to lymphoma and leukemia appeared in 4 cases. Brucella epididymitis-orchitis 7 cases. 2 cases of adult pure yolk sac testicular tumors. Additional evaluations and treatments were performed depending on histologic diagnosis. CONCLUSIONS: The exact diagnosis of these lesions is difficult due to their rarity and they must always be considered for differential diagnosis.

OBJETIVO: Las lesiones intraescrotales adultas inusuales generalmente se han descrito como un informe de caso en la literatura. Estas lesiones que se observaron en dos clínicas durante más de 28 años se presentan aquí con características radiológicas, patológicas y clínicas.MÉTODOS: Este estudio retrospectivo se realizó entre 1989 y 2017 en 446 pacientes sometidos a orquiectomía inguinal. Los datos clínicos se obtuvieron mediante la revisión de tablas de pacientes. En el período preoperatorio, todos los pacientes evaluados con examen físico, historial de detalles, marcadores tumorales séricos (alfa-fetoproteína, beta-gonadotropina coriónica humana, lactato deshidrogenasa), ultrasonografía doppler escrotal. RESULTADOS: Se diagnosticaron tumores testiculares germinales y no germinales en 396 casos (88,78%) y los 50 pacientes restantes (11,22%) presentaron 15 lesiones intraescrotales diferentes. El tipo de estas diferentes lesiones intraescrotales fueron rabdomiosarcoma paratesticular (1 paciente), hemangioma cavernoso intraescrotal (1 caso), quiste dermoide (2 casos), quiste epidérmico (4 pacientes), mesotelioma paratesticular (1 caso), quiste de capa parietal de túnica testículo vaginal (2 pacientes), granuloma espermático (3 casos). El número de pacientes con orquitis tuberculosa y granulomatosa fue de 6 y 8 pacientes, respectivamente. Los pacientes con pseudotumor fibroso fueron 8 casos. Plasmacitoma del testículo se observó en 1 paciente. La afectación metastásica debida a linfoma y leucemia se observó en un total de 4 casos. Se observó epididimo- orquitis de Burucella en 7 casos. El número de tumores adultos en el testículo puro del saco vitelino fue de 2 casos. Se realizaron evaluaciones y tratamientos adicionales según el diagnóstico histológico. CONCLUSIONES: El diagnóstico exacto de estas lesiones es difícil debido a su rareza y siempre debe considerarse en el diagnóstico diferencial.

High neutrophil to lymphocyte ratio predicts acute allograft rejection in kidney transplantation; a retrospective study

Background/aim: Our research focused on the identification of easily available and sensitive markers for early prediction of acute kidney allograft rejection (AR). We aimed to investigate the association between neutrophil-to-lymphocyte ratio (NLR) and AR in kidney transplant patients. Materials and methods: The medical records of 51 kidney transplant patients [12 female/39 male; median age of 32 (IQR: 24­44) years] were evaluated retrospectively. We considered a cut-off value of >2.5 as high NLR. Results: A total of 22 biopsy-proven AR patients and 29 controls were evaluated. The AR group had a higher NLR compared to the controls (P < 0.001). NLR levels over 2.5 [95% CI: 54.88 (9.96­302.3), P < 0.001] were significantly associated with AR in univariate analysis. The NLR levels were the only significant factor associated with AR in multivariate models, in model 1 (adjusted by age and sex) [95% CI: 114 (11.1­1175), P < 0.001], and in model 2 (adjusted by steroid dosage, uric acid, and NLR) [95% CI: 4.60 (1.59­29.3), P = 0.004]. Conclusions: Our data showed that higher NLR values (>2.5) are associated with AR in kidney transplant patients, leading to the conclusion that NLR might be an easily available and useful marker option for detection of AR in this patient population.

Comparison of renal function after robot - assisted laparoscopic radical prostatectomy versus retropubic radical prostatectomy

ABSTRACT Purpose: To investigate the effect of robot assisted laparoscopic radical prostatectomy (RALP) and open retropubic radical prostatectomy (RRP) on early renal function in this study. Materials and Methods: Preoperative and postoperative urea, creatinine, Hb, eGFR values of patients who had undergone RALP and RRP with prostate cancer (PCa) diagnosis were recorded in our clinic. The percentages of change in these values are calculated. Preoperative and postoperative urea, creatinine, Hb and eGFR changes were compared with each other. Student-t test was used for intergroup comparison, and paired sample t test was used to compare changes between preoperative and postoperative values of the same group. Results: There were 160 and 93 patients in the RALP and RRP group, respectively. In the RALP group, postoperative urea and creatinine increased significantly compared to preoperative baseline values while eGFR was decreased (p = 0.0001, p = 0.001, p = 0.0001, respectively). Except for Hb in the RRP group, the changes in these values were statistically insignificant (p = 0.50, p = 0.75, p = 0.30, respectively). Conclusions: We should be more careful when we perform RALP in patients at risk of impaired renal function despite being a minimally invasive surgical method with superior visual characteristics.

Comparison of renal function after robot - assisted laparoscopic radical prostatectomy versus retropubic radical prostatectomy.

PURPOSE: To investigate the effect of robot assisted laparoscopic radical prostatectomy (RALP) and open retropubic radical prostatectomy (RRP) on early renal function in this study. MATERIALS AND METHODS: Preoperative and postoperative urea, creatinine, Hb, eGFR values of patients who had undergone RALP and RRP with prostate cancer (PCa) diagnosis were recorded in our clinic. The percentages of change in these values are calculated. Preoperative and postoperative urea, creatinine, Hb and eGFR changes were compared with each other. Student-t test was used for intergroup comparison, and paired sample t test was used to compare changes between preoperative and postoperative values of the same group. RESULTS: There were 160 and 93 patients in the RALP and RRP group, respectively. In the RALP group, postoperative urea and creatinine increased significantly compared to preoperative baseline values while eGFR was decreased (p = 0.0001, p = 0.001, p = 0.0001, respectively). Except for Hb in the RRP group, the changes in these values were statistically insignificant (p = 0.50, p = 0.75, p = 0.30, respectively). CONCLUSIONS: We should be more careful when we perform RALP in patients at risk of impaired renal function despite being a minimally invasive surgical method with superior visual characteristics.

Is fluoroscopy necessary during flexible ureteroscopy for the treatment of renal stones?

OBJECTIVE: To investigate the feasibility and effectiveness of flexible ureteroscopy (fURS) without fluoroscopy during the treatment of renal stones. PATIENTS AND METHODS: Between April 2013 and August 2018, 744 patients' data were evaluated retrospectively. Of these, 576 patients were included in the study. All fURS were performed by experienced surgeons. All procedures were planned with zero-dose fluoroscopy. But, if fluoroscopy was necessary for any reasons, these patients were excluded from the study. Demographic data, perioperative parameters, stone-free rate (SFR), and complication rates were recorded. RESULTS: Of the patients planned for fluoroless fURS (ffURS), the procedure was successfully achieved in 96.7% (557/576 patients), as 19 patients required fluoroscopy during the procedure for various reasons. In the patients included in the study, the mean (SD) stone size was 11.6 (5.2) mm and the mean (SD) operating time was 39.4 (8.2) min. After the first session of ffURS, the SFR was 83.3% (achieved in 464 patients). Second and third sessions of ffURS were performed in 32 (5.7%) and seven (1.2%) patients, respectively. Overall, the complication rate was 11.8% and all complications were minor (Clavien-Dindo Grade I or II). CONCLUSIONS: The ffURS technique seems to be a safe and effective treatment compared to conventional fURS in patients with renal stones. This procedure should be performed in experienced centers, where fluoroscopy can be considered not to be mandatory during fURS. ABBREVIATIONS CIRF: clinically insignificant residual fragment; CT: computed tomography; EAU: European Association of Urology; (f)fURS: (fluoroless) flexible ureteroscopy; FT: fluoroscopy time; KUB: plain abdominal radiograph of the kidneys, ureters and bladder; mSv: millisievert; PCNL: percutaneous nephrolithotomy; pps: pulse-per-second; rem: roentgen equivalent man; PUJ: pelvi-ureteric junction; SFR: stone-free rate.

Our experience with ureterocystoplasty in bilateral functional kidneys.

OBJECTIVE: We have reviewed the data of the patients in order to evaluate the effectiveness of our ureterocystoplasty technique in augmentation cystoplasty operation. MATERIAL AND METHODS: Data of a total of 16 patients with bilateral functional kidneys who had undergone augmentation ureterocystoplasty between January 1995 and June 2018 which were retrieved during the retrospective archive scanning were included in the study. Ultrasonography (USG), serum blood urea nitrogen and creatinine values and Technetium-99 DTPA (Tc-99 DTPA) scan were used to evaluate the renal function of the patients. Intravenous pyelography (IVP) and USG were used to evaluate the ureters before surgery. Magnetic resonance (MR) urographies were performed in our center. RESULTS: Of the total 16 patients, 10 were male and 6 were female, while ages ranged from 1 to 24 years. Among 16 patients, the most common cause of neurogenic bladder etiology was meningomyelocele. In the urodynamic studies performed before the operation, it was determined that the bladder capacities of the patients were between 40-180 mL and the bladder compliances were 1.0-4.0 cc/cmH2O. At postoperative 3rd months, it was determined that the bladder capacities of the patients were between 180-330 mL and the bladder compliances were between 6.0-24.0 cc/cmH2O. CONCLUSION: Augmentation ureterocystoplasty seems to be an appropriate technique in which successful results are obtained with appropriate patient selection. Besides, complications that may occur due to use of ileal segment are avoided.

Flexible Ureterorenoscopy versus Mini-Percutaneous Nephrolithotomy for the Treatment of Renal Stones.

PURPOSE: To compare the pain status and stone free rates of flexible ureterorenoscopy (F-URS) versus mini-percutaneousnephrolithotomy (mini-PNL) for the treatment of 1-to 2-cm renal stones. MATERIALS AND METHODS: This study was retrospectively designed with match paired method. Between January 2013 and December 2016, 387 patients underwent stone surgery for renal stones, 45 patients underwent FURS and 45 patients underwent mini-PNL. 90 patients were divided into two groups according to the surgical procedures. Group 1 patients underwent F-URS, and Group 2 patients underwent mini-PNL. During the intraoperative andpostoperative periods, pain management for all patients was standardized. Pain scores were determined using a visual analogue scale (VAS) completed at 2, 6, 12 and 24 hours postoperatively. The stone free status, hemoglobin levels, fluoroscopy time (FT), operation time (OT), hospitalization time (HT), return to work time (RWT), and complications were noted for each patient. RESULTS: Of all patients, the mean age was 41.1 ± 12.1 years and the mean stone size was 13.9 ± 2.9 mm. The VAS scores were significantly higher in the mini-PNL group at 2, 6, 12 and 24 hours (P < .05). The stone-free status and complication rates were similar between the two groups (P > .05); however, the hemoglobin decreases and the fluoroscopy, operation, hospitalization and return to work times were higher in the mini-PNL group than in the F-URS group (P < .05). CONCLUSION: F-URS is less painful than mini-PNL for the treatment of 1- to 2-cm renal stones. However, the stone free rate is similar between the two procedures while mini-PNL is superior in terms of fluoroscopy, operation, hospitalization and return to work duration. We think that F-URS is more comfortable and less painful than mini-PNL and achieves a similar stone free rate for the treatment of 1- to 2-cm renal stones.

Shock wave lithotripsy or retrograde intrarenal surgery: which one is more effective for 10-20-mm renal stones in children.

OBJECTIVES: To compare shock wave lithotripsy and flexible ureteroscopy in children with renal stone's diameter of 10 to 20 mm. MATERIALS AND METHODS: This is a retrospective study including 79 children, who had renal stone and underwent either shock wave lithotripsy or flexible ureteroscopy between January 2007 and June 2017. Of those, 38 patients underwent shock wave lithotripsy assigned as group 1 and 41 patients underwent flexible ureteroscopy assigned as group 2. Stone-free rate, fluoroscopy time, procedure time, complication rates, hospitalization time, and cost-effectiveness were monitored and included in the analyses. RESULTS: The mean patient age was 4.4 ± 3.5 in group 1 and 4.9 ± 4.1 in group 2. Stone-free rate was not different in both groups in the first and third months of follow-up. The mean fluoroscopy time was statistically significantly longer in group 1 compared to group 2. Procedure and hospitalization times were longer in group 2 compared to group 1. No complications were seen in either groups. The expenditure was calculated as 135.23 and 869.41 Euro per patient for groups 1 and 2, respectively, which shows significant higher cost in group 2. CONCLUSIONS: In this present study, we have shown that shock wave lithotripsy is cheaper, has short hospitalization time and long fluoroscopy time and similar stone-free rate, and has the same efficiency compared to flexible ureteroscopy regarding pediatric renal stones with the diameter between 10 and 20 mm.

The Efficacy of Ureteroscopy Without Fluoroscopy for Ureteral and Renal Stones in Pediatric Patients.

OBJECTIVES: In the pediatric population, there have been significant improvements in the treatment of stones in recent years. Conventionally, ureteroscopy (URS) and/or retrograde intrarenal surgery are techniques performed with fluoroscopy. When using fluoroscopy, problems, including malignancy, may arise because of radiation exposure in the patient, physician, and operation room staff. The aim of this study is to evaluate the possibility of ureteroscopic treatment without fluoroscopy in children with ureteral and renal stones. MATERIALS AND METHODS: Between December 2010 and April 2017, pediatric patients were enrolled in this study. Data were retrospectively evaluated. URS was performed by the experienced surgeons in our center. Fluoroscopy was not routinely used during the operations. Demographic data, perioperative parameters, and success and complication rates were evaluated. RESULTS: Sixty-seven renal units from 61 patients were operated on. URS without fluoroscopy was achieved in 95.0% of 61 patients (95.5% of 67 renal units). Three patients needed fluoroscopy during the operation. The mean stone size was 12.4 ± 5.3 mm, and the mean operation time was 41.9 ± 15.1 minutes. The success rates in the postoperative first and third mounts were 82.1% (55 renal units) and 88.0% (59 renal units), respectively. For 10 patients, second-session URS without fluoroscopy was needed. Clinically insignificant residual fragments were detected in three patients. There were no major complications. CONCLUSION: URS without fluoroscopy for ureteral and renal stones in pediatric patients can be safely and effectively performed in experienced centers.

Oxidative stress parameters in patients with prostate cancer, benign prostatic hyperplasia and asymptomatic inflammatory prostatitis: A prospective controlled study.

BACKGROUND: The imbalance between oxidant and reductant mechanisms creates a nidus for the etiopathogenesis of several diseases. In this study, we aimed to compare the oxidative stress (OS) parameters in patients who were diagnosed with prostate cancer (pCa), benign prostatic hyperplasia (BPH) or asymptomatic inflammatory prostatitis (AIP), according to the histopathologic examination of transrectal ultrasonographic prostate biopsy and transurethral prostate resection specimens. OBJECTIVES: In this study, we aimed to compare oxidative stress between histologically proven prostate cancer, hyperplasia and prostatitis. MATERIAL AND METHODS: According to histopathologic examinations, 97 patients were divided into 3 study groups: group 1: pCa (n = 30), group 2: BPH (n = 41), and group 3: AIP (n = 26). Finally, 30 patients were enrolled in a control group. MDA levels, CuZn-SOD, Se-GPx, CAT activities, and trace element levels were evaluated. RESULTS: A statistically significant difference between prostate cancer and other groups were documented in terms of MDA activity. Contrary to AIP, a statistically significant difference has also been encountered between BPH and the control group. Decreased CuZn-SOD enzyme levels were found in PCa and BPH patients without statistical significance. Increased CAT activity was also documented in PCa, BPH and AIP patients. No significant difference in GPX activity was documented between the groups, except BPH and control group. Trace element levels were low in the patients with prostate cancer and BPH when compared with the control group. CONCLUSIONS: Despite the data regarding OS in PCa patients, there is a paucity of data regarding BPH and especially AIP patients. Our study revealed obvious oxidative stress in BPH and PCa patients as opposed to AIP. Assessing the oxidative stress in these patients may assist in the future prevention, diagnosis and also treatment. However, the question whether the presence of OS-related parameters and drugs could be used for the diagnosis or management of prostatic diseases, needs to be addressed in future larger and better studies with a more rational basis.

Our experiences with robot- assisted laparoscopic surgery in pediatric patients: the first case series from Turkey.

OBJECTIVE: Robotic surgery is a leading treatment option for minimally invasive surgery and has an increasing popularity in pediatric population, as well. In this article, we reported our case series of robot-assisted laparoscopic surgery in pediatric population. MATERIAL AND METHODS: We retrospectively reviewed 29 consecutive pediatric patients who underwent robot- assisted procedures between May 2014 and October 2016. Patient demographics, hospitalization time, estimated blood loss, robotic time and total operative and peri-, and post-operative complications were evaluated. RESULTS: A total of 24 ureter units (18 patients) with grade 1-5 vesicoureteral reflux in 13 female and 5 male, 1 male patient with vesicoureteral stenosis were underwent robot- assisted laparoscopic ureteral reimplantation (RALUR). All patients had complete resolution after surgery. Robot-assisted laparoscopic pyeloplasty (RALP) was performed in 6 patients with ureteropelvic junction obstruction. All patients had complete resolution after surgery. Completely intracorporeal robotic assisted laparoscopic augmentation ileocystoplasty (RLAIC) was applied to two patients with neurogenic bladder. The symptoms and preoperative hydronephrosis were regressed on the first month of follow-up. Robot-assisted laparoscopic reduction cystoplasty (RALRC) was performed in 14-year-old boy with a bladder diverticula and recurrent urinary tract infection. The last case was eleven- year-old female patient with non-functioning kidney. She had recurrent urinary tract infections and was treated with robotic assisted laparoscopic nephrectomy (RALN). CONCLUSION: Robot-assisted laparoscopic surgery is safe and efficient in pediatric population. Although open surgery is still the gold standard for many pediatric diseases, inherent reconstructive advantages of robotic assisted laparoscopy have a chance to change this view.

Surgical management of urinary stones with abnormal kidney anatomy.

In spite of the fact that urologic surgical techniques used by urologists are becoming more and more minimally invasive and easier because of developing technologies, surgical approaches for the urinary stones in kidneys with abnormal anatomy are still confusing. The objective of this article is to determine the treatment options in these kidneys. For this purpose, between 2005 and 2015, we retrospectively evaluated patients operated for urolithiasis with various congenital renal anomalies in five referral urology clinics in our country. Of the 178 patients (110 male, 60 female), 96 had horseshoe kidneys, 42 had pelvic ectopic kidneys (PEKs), and 40 had isolated rotation anomalies (IRAs) of the kidney. We evaluated the patients for stone-free rate (SFR), mean operation time, mean hospitalization time, and complication rate. In horseshoe kidney, SFRs for retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PNL) groups were 72.2% and 90%, respectively. In PEKs, these rates were 83.6% and 100% for RIRS and laparoscopic pyelolithotomy, respectively. SFRs in kidneys with IRA were 75% for RIRS and 83.3% for PNL. The mean operation time for RIRS and PNL groups in horseshoe kidney was 40.5±11.2 minutes and 74.5±19.3 minutes, respectively. In PEKs, these times were 52.1±19.3 minutes and 53.1±24.3 minutes for RIRS and laparoscopic pyelolithotomy, respectively. Mean operation time in kidneys with IRA was 48.7±14.4 minutes for RIRS and 53.2±11.3 minutes for PNL. Mean hospitalization times for RIRS and PNL groups in horseshoe kidneys were 1.4±0.7 days and 2.2±1.4 days, respectively. In PEKs, these times were 2.7±1.8 days and 1.9±0.4 days for RIRS and laparoscopic pyelolithotomy, respectively. Mean operation time in kidneys with IRA was 1.5±0.9 days for RIRS and 1.8±0.6 days for PNL. The results of our study showed that RIRS could be used in all of types of abnormal kidneys with small- and medium-sized renal calculi safely and satisfactorily.

Effect of Voided Volume on Voiding Patterns and Reliability of Uroflowmetry-Electromyography Results in Children with Lower Urinary Tract Dysfunction.

OBJECTIVE: To examine whether voided volume (VV) could change the uroflow patterns and result in children with lower urinary tract dysfunction (LUTD). METHODS: Between January 2009 and May 2010, the children with LUTD were enrolled in this study. Uroflowmetry (UF) combined with electromyography (EMG) was performed two times and was reviewed independently by two urologists. UF-EMG curves were classified as bell, staccato, intermittent, plateau, and tower. Patients' expected bladder capacity (EBC) and VV were recorded. Patients were divided into four groups according to their VV and EBC. Group 1, VV <50% of EBC; group 2, VV between 50 and 100% of EBC; group 3, VV between 100 and 125% of EBC; group 4, VV >125% of EBC. RESULTS: A total of 143 patients underwent UF-EMG at least two times and 382 results were obtained. Groups 1, 2, 3 and 4 consisted of 27, 60, 27 and 29 children, respectively. The percentages of normal, intermittent, plateau voiding patterns were 58.5, 12.8, 7.1% in group 1; 79.8, 5.4, 1.8% in group 2; 59.2, 8.5, 2.8% in group 3; and 37.2, 5.1, 2.6% in group 4, respectively. The percentages of staccato and tower pattern were 1.4, 20% in group 1; 9.1, 3.6% in group 2; 30, 0% in group 3; and 55.1, 0% in group 4, respectively. The rate of tower shape curve decreased as voided volume increased, but the rate of staccato curve increased as voided volume increased. CONCLUSIONS: In case of exceeding the EBC, the test should be repeated with normal VV when UF results are being evaluated.

Concised Form for Lower Urinary Tract Dysfunction Symptom Scale in Children.

INTRODUCTION: Symptom Scales (SS) are questionnaires for evaluating and following up of special illnesses. SS used for the diagnosis and follow-up of Lower Urinary Tract Dysfunction (LUTD) in children is called LUTD Symptom Scale (LUTDSS). AIM: Aim of the present study was to identify the questions which are more important for the diagnosis of LUTD in children and create a simpler SS. MATERIALS AND METHODS: From January 2005 to March 2015, 631 children between the age 5 and 15 were enrolled in this study. Eleven children with active urinary tract infections were excluded from the study. Two hundred sixty three children from the nursery and secondary school saying that they have no urinary complaints and having LUTDSS <9 were designed as control group. Three hundred fifty seven children with LUTDSS score ≥9 were thought as having LUTD and diagnoses were verified with 3-day bladder diaries and 2-time Uroflow-EMG-PVR tests. The answered questions of LUTDSS in patient and control group were compared. RESULTS: Children with daytime incontinence (first question of questionnaire) were 47.7 (4.8-510) times (p=0.01), children with enuresis (third question) were 59.53 (6.2-961) times (p=0.001), children with pause while urinating (eighth question) were 28.7 (4.4-2090) times (p=0.001), children with urgency (tenth question) were 54.7 (29.3-604) times (p=0.039) more likely to have LUTD than the children not having these complaints. The area under ROC curve created by using 1,3,8, and 10 questions was calculated 86.4%. CONCLUSION: The diagnosis and control of LUTD can be made by using only 1., 3., 8. and 10. questions, and these 4 questions could form simpler SS for LUTD in children.