Comparison of two percutaneous nephrolithotomy methods for the treatment of pediatric kidney stones: mini-percutaneous nephrolithotomy and standard percutaneous nephrolithotomy.

OBJECTIVE: In this study, the aim was to compare the results of mini and standard percutaneous nephrolithotomy (PCNL) for the treatment of pediatric kidney stones. MATERIALS AND METHODS: Data for 128 patients < 18 years of age who underwent mini and standard PCNL due to pediatric kidney stones were retrospectively examined. Patients were divided into two groups: mini-PCNL (16-20 Fr) and standard PCNL (26 Fr). Surgery time, number of punctures to the pelvicalyceal system, hospital stay, postoperative hemoglobin drop, complications and stone-free status (SFR) were compared between the groups. Additional surgical intervention (double-J stent, ureterorenoscopy, secondary PCNL) performed after the surgery was recorded. The absence of residual stones or < 3 mm residual stones on kidney, ureter and bladder radiography (KUB) and ultrasonography (USG) performed in the third postoperative month were accepted as success criteria. RESULTS: There were 32 (43.8%) patients in the mini-PCNL group and 41 (56.2%) patients in the standard PCNL group. The mean age was 9.3 ± 4.1 years in the mini-PCNL group and 10.1 ± 5.4 years in the standard PCNL group. Mean stone size in the mini-PCNL group was 2.1 ± 1.2; while for standard PCNL it was 2.3 ± 1.4. The mean surgery time was statistically significantly higher in the mini-PCNL group (p = 0.005). There was no difference between the groups in terms of intraoperative double J stent use, postoperative complications and SFR. A double J stent was inserted in two patients in the mini-PCNL group and in one patient in the standard PCNL group due to urine leakage from the nephrostomy tract in the postoperative period. Although the postoperative hemoglobin drop was found to be significantly higher in standard PCNL (p = 0.001), hematuria and blood transfusion rates were low in both groups. Mean hospital stay was shorter in the mini-PCNL group compared to standard PCNL (3.6 ± 1.2 days vs. 2.5 ± 1.1; p = 0.018). CONCLUSIONS: Although mini-PCNL has longer surgery time compared to standard PCNL, it should be preferred for the treatment of pediatric kidney stones due to advantages such as similar success and complication rates to standard PCNL, short hospital stay and less postoperative hemoglobin drop.

Which Method Is More Effective for the Treatment of 1-2 cm Renal Pelvis Stones in Obese Patients: Extracorporeal Shock Wave Therapy or Flexible Ureterorenoscopy?

OBJECTIVE: This study aimed to compare the clinical outcomes and complications of obese patients who underwent extracorporeal shock wave lithotripsy (ESWL) and flexible ureterorenoscopy (FURS) for treating 1-2 cm renal pelvic stones. METHODS: This study included 89 patients with a body mass index (BMI) >30 who underwent ESWL and FURS surgeries for 10-20 mm renal pelvic stones between January 2015 and July 2023. Three months after the treatments, patients underwent full abdominal computed tomography (CT) and were examined for stone-free status and the presence of residual stones. The presence of ≥4 mm residual stones on imaging was considered a failure, and these patients were treated again. Demographic data, stone characteristics, stone-free rate (SFR) three months after the procedure, surgery/procedure time, and complications such as bleeding, urosepsis, and collecting system perforation were compared between the groups. RESULTS: The patients included in the study were divided into two groups: ESWL (n=46) and FURS (n=43). Demographic and clinical data were similar between the groups. Retreatment rates were higher in the ESWL group compared to the FURS group. The mean procedure time was similar between the groups (p=0.085). The three-month SFR was found to be higher in the FURS group (88.3% vs. 73.9%; p=0.043). There was no difference in complication rates between groups. CONCLUSION: FURS is a more effective treatment method than ESWL in obese patients with stones 1-2 cm in size located in the renal pelvis.

Hydronephrosis Due to Intraureteral Migration of Missed Intrauterine Device.

Migration of intrauterine devices (IUDs) to the ureter causing ureteral obstruction is an extremely rare event. A 45-year-old female patient was admitted to our hospital with a complaint of pain in the right flank and inferior right quadrant of the abdomen. On genitourinary system ultrasonography, grade 3 hydronephrosis was found in the right kidney. On the abdominopelvic radiography, there was an appearance consistent with two IUDs, one in the region consistent with the course of the right distal ureter and the other in the usual localisation. The first IUD was thought to have spontaneously detached from the uterus, so a second IUD was implanted. A right-sided extravesical ureteroneocystostomy (Lich-Gregoir) operation was performed. The operation was terminated with the placement of a 4.8 French, 26 cm double-J stent in the ureter. The patient was followed up in our hospital for 26 months and she was asymptomatic during follow-up, hydronephrosis was resolved completely, and no complications were encountered during follow-up clinical and ultrasonography examinations.

Safety and Efficacy of Flexible Ureterorenoscopy Surgery: Results of Our Large Patient Series.

INTRODUCTION: The aim of our study is to evaluate the success rates of our retrograde intrarenal surgery operations and the complications we encountered and to determine in which kidney segment the operations were more successful with flexible ureterorenoscopy. METHODS: The records of retrograde intrarenal surgery operations performed between March 2013 and January 2021 in Health Sciences University, Adana City Training and Research Hospital, urology clinic were analyzed retrospectively. Patients' age, body mass index, operation side, stone size, stone density, duration of operation, first-day and first-month operation success status, presence of preoperative and postoperative ureteral stent, preoperative and postoperative first-day and first-month creatinine levels, and preoperative and postoperative first-day and first-month hematocrit levels were recorded. RESULTS: Our study consisted of a total of 1128 patients, 618 males (54.7%) and 510 (45.2%) females, with an average age of 42.3±14.4. Kidney stones were most commonly found in the renal pelvis (54.2%). The postoperative first-day success rate was highest in the pelvis stone group (P=0.009). The first month's success rates were highest in those with pelvic stones (93.1%), and the lowest in patients with multiple stones (85.7%). Patients' operation time, postoperative hematocrit and creatinine levels, and complications did not differ statistically between the groups (P>0.05). CONCLUSION: Retrograde intrarenal surgery is an acceptable minimally invasive and effective surgery with low complication rates. There is a high success rate, especially in pelvis stones.

Does Holmium laser enucleation of the prostate (HoLEP) still have a steep learning curve? Our experience of 100 consecutive cases from Turkey.

AIM: The aim of our study is to examine the learning curve of HoLEP and to discuss our results in the light of the literature. METHODS: 100 patients who had LUTS resistant to medical treatment and complicated BPH to whom HoLEP procedure had been administered regardless of the size of the prostate in the last 1 year were analysed retrospectively. To evaluate the learning curve, the patients were classified into 4 main groups of 25 consecutively operated patients beginning from the first case. The 4 main groups were divided into 2 subgroups including patients who had prostate volume below or above 80 grams. RESULTS: The mean age of the 100 patients who had HoLEP was 64.5 years. The mean prostate volume was 99.1 cc (45-281 cc). When those with prostate smaller than 80 g are examined, Enucleation efficiency was 0.76 g/min (0.46-0.97 g/min) and Morcellation efficiency was 3.07 g/min (3.34-4 g/min). When those with prostates larger than 80 g are examined, Enucleation efficiency was 0.89 g/min (0.66-1.04 g/min) and Morcellation efficiency was 4.01 g/min (3.93-4.25 g/min). These two parameters were statistically and significantly different in all the 4 groups (p < 0.05). CONCLUSIONS: HoLEP still has a steep learning curve. It is necessary to reach the number of cases of 25-50 to reach fundamental experience.

Long-term follow-up results and complications in cancer patients with persistent nephrostomy due to malignant ureteral obstruction.

PURPOSE: We aimed to evaluate the long-term complications and predisposing factors for these complications in patients with malignant ureteral obstruction (MUO) treated with percutaneous nephrostomy (PN). METHODS: The records of patients with MUO treated with PN between January 2015 and 2018 were retrospectively reviewed for PN dislodgement, PN obstruction, PN replacement, pyelonephritis, hospitalizations due to PN complications, and other complications due to PN such as macroscopic hematuria, skin infections, or renal/perirenal abscess. RESULTS: Data for a total of 147 patients (229 renal units [RU], 107 males, 40 females) were evaluated. In 174 (76%) RU, PN was replaced due to PN dislodgement. The predisposing factors for PN dislodgement were follow-up time, body mass index (BMI), chemotherapy, diabetes mellitus (DM), low educational level (LEL), pyelonephritis, and catheter-related skin infections (CSRI). The PN was replaced in 40 RU due to obstruction. The predisposing factors for obstruction were follow-up time and BMI. Pyelonephritis developed at least once in 61 (41.5%) patients. Follow-up time, BMI, previous surgery, DM, and LEL were the predisposing factors for pyelonephritis. CSRI developed in 16 RU. Follow-up time, BMI, DM, and LEL were the predisposing factors for CSRI. Macroscopic hematuria developed in 11 patients. Follow-up time, previous surgery, DM, chemotherapy, and LEL were predisposing factors for macroscopic hematuria. CONCLUSION: The most common complication in patients with MUO treated with PN was PN dislodgement. However, life-threatening complications such as macroscopic hematuria and severe infections can also occur. Patients with DM, LEL, and chemotherapy are at high risk of PN-related complications.

Small renal pelvis stones: Shock wave lithotripsy or flexible ureteroscopy? A match-pair analysis.

OBJECTIVE: Kidney stones in renal pelvis may be treated using various methods. For larger stones, percutaneous nephrolitotomy (PNL) is the first choice of option; where for smaller stones, shock wave lithotripsy (SWL) or flexible ureteroscopy (F-URS) could be more suitable options. In this article we aimed to compare the outcomes of F-URS and SWL on the treatment of renal pelvis stones <10 mm. MATERIAL AND METHODS: Files of patients treated with SWL and F-URS for renal pelvis stones <10 mm between March 2013 and May 2016 in our clinic were analyzed. For comparison, a match-pair analysis was designed. Complete stone removal was considered success. RESULTS: Forty patients were treated using F-URS (Group 1) and 40 patients underwent SWL (Group 2). Patients were assessed the day after the last session of the procedure. The early stone-free rates were 70% (28/40) in Group 1, and 15% in Group 2 (p<0.05). The same analysis was performed after three months. Stone-free rates were 100% and 92.5% in Groups 1 and 2, respectively (p=0.079). Three patients in Group 2 were not stone free after 3 sessions of SWL and considered unsuccessful. They were all successfully treated by F-URS. CONCLUSION: Even though there is no statistical difference among groups, our data may be interpreted as having better outcomes and tolerability with F-URS than SWL. We believe F-URS may have a great treatment prospect in this particular patient group.

A Rare Foreign Material in the Bladder: Piece of Pencil.

Cases with foreign bodies in the bladder are rarely seen. According to literature, it has been reported that foreign bodies were removed from the bladder. The etiology of these cases are iatrogenic causes, migration from adjacent organs, tissues and self-insertion. In this case report, we presented a 22-year-old female who was admitted to the emergency room with vaginal bleeding, and groin pain. The foreign body was removed from the urinary bladder.

A rare cause of lower urinary tract symptoms: retrovesical hydatid cyst.

Retrovesical cysts are extremely rare. For differential diagnosis radiologic findings and serologic tests can be used. In this article, we aimed to report our approach to diagnose and to treat a primary huge hydatid cyst in retrovesical space, between sigmoid colon and bladder. A 34-year old patient presented to our hospital with lower urinary tract symptoms (LUTS). Abdominal ultrasound reported a 14x8 cm cystic lesion adjacent to the posterior wall of the bladder. Computerized tomography revealed a 14 x 8 cm cystic mass adjacent to bladder posteriorly and prostate and seminal vesicle anteriorly in the retrovesical space. Patient received albendazole prophylaxis and intervention was planned by transperitoneal approach. In a two-year of follow-up patient did not encounter any recurrences. Retrovesical cysts may cause LUTS. With patients suffering from LUTS, hydatid cyst should be kept in mind.