Predictive factors for manual detorsion success in testicular torsion.

PURPOSE: In cases of testicular torsion (TT), prompt diagnosis and treatment are highly associated with organ salvage, and manual detorsion (MD) is a recommended maneuver as a first intervention. In our study, we aimed to investigate the effect of predictive factors of TT in predicting the success of MD. METHODS: A retrospective, 2-center study was conducted on patients diagnosed with TT between January 2015 and 2024. Demographic, clinical, ultrasound, and laboratory characteristics at presentation were analyzed. MD was routinely performed as the first intervention in all patients. Predictive parameters were compared in the MD success and failure groups. Univariate and multiple logistic regression analysis was used to identify risk factors for MD failure. RESULTS: A total of 94 patients were included in the study. The median age of the patients was 20 (IQR: 12-69) years, and the median symptom duration was 6 (IQR: 4-12) hours. MD confirmed by Doppler ultrasonography was successful in 52 (55.3%) patients and unsuccessful in 42 (44.7%). Age, symptom duration, Testicular Workup for Ischemia and Suspected Torsion (TWIST) score, TWIST risk groups, WBC, neutrophil, monocyte counts, and Monocyte/Eosinophil ratio (MER) were statistically different between the two groups. In multiple logistic regression analysis, the risk factors for failure of MD were found to be being over 18 years of age, the duration of symptoms being longer than 9 h, and MER > 28. CONCLUSION: Current urology guidelines suggest that age, symptom duration, and MER are reliable predictors of the success of MD, which is recommended in all cases of TT.

The impact of low-dose methotrexate on erectile dysfunction, sex hormone profile and spermiogram in male patients with psoriasis: a prospective study.

PURPOSE: Psoriasis, affecting approximately 2% of the world's population, often necessitates systemic treatments, with methotrexate (MTX) as a cornerstone therapy. Despite documented systemic side effects of MTX, concerns about its impact on male reproductive health persist. We aim to investigate low-dose MTX effect on hormonal, cellular and functional ability of male reproductive system. MATERIALS AND METHODS: Our prospective study on 40 male psoriasis patients receiving low-dose MTX (<15mg/week) comprehensively investigates its effects on erectile function, sex hormones, and spermiogram parameters. RESULTS: After six months of MTX treatment, a significant decline in erectile function (p < 0.001) decreased total testosterone levels (p = 0.03) were observed. No significant reduction in sperm count was noted after six months of MTX treatment. CONCLUSIONS: Our study highlights a significant decline in erectile function following low-dose MTX therapy, warranting further investigation into this potential side effect. While reassuring for sperm quantity and quality, the findings emphasise the necessity for larger cohorts and longer follow-up times to validate results and comprehend the complex interactions between MTX and male sexual health.

Retrospective Analysis of the Factors Affecting Intraoperative and Immediate Postoperative Complications of Retrograde Intrarenal Surgery Classified by the Clavien and Satava Grading Systems.

Background: To classify intraoperative and postoperative complications using the modified Clavien classification system (MCCS) and modified Satava classification system (SCS) and to evaluate the parameters associated with complications in patients undergoing retrograde intrarenal surgery (RIRS) for renal and proximal ureteral stones. Materials and Methods: We performed a retrospective analysis of 949 patients who underwent RIRS for renal stones and proximal ureteral stones at two institutions between March 2015 and June 2020. Intraoperative complications were assessed using the SCS, and postoperative complications were graded according to the MCCS. Univariate and multivariate analyses were undertaken to determine predictive factors affecting complication rates. Results: The median stone size was determined as 13 mm (range 10-20 mm). The stone-free rate was 83.6% after the first intervention. Reprocedure was applied to 89 of the patients with residual stones and the final stone-free rate was 94.4% after reprocedure. According to SCS, the number of intraoperative events and complication incidences was 153 (16.1%). MCCS revealed postoperative complications in 121 (12.8%) patients. Major complications were observed in 18 (1.9%) patients. The rate of complications was higher in patients with renal anomalies (9.9% vs 3.4%, p = 0.001). Stone location, stone size, stone burden, stone number, stone density, and residual fragments were determined to be associated with the development of complications (p < 0.001, p < 0.001, p < 0.001, p < 0.001, p = 0.002, and p < 0.001, respectively). In addition, the multivariate analysis revealed that only the presence of residual fragments was a significant predictor of complication development for the patients with Grade ≥3 complications according to MCCS (p = 0.032). However, significant predictors were stone burden (p < 0.001), stone density (p = 0.002), and fluoroscopy time (p < 0.001) for those with Grade ≥2b complications according to SCS. Conclusion: This study showed that abnormal kidney anatomy, operation time, stone burden, and residual fragments were reliable predictors of complication development during and after RIRS. Appropriate preoperative management should be planned according to these predictors to prevent intraoperative and postoperative complications.

Safety and Efficacy of Flexible Ureterorenoscopy Surgery in Different Age Groups.

OBJECTIVE: To comparatively investigate the efficacy, safety and complications of flexible ureterorenoscopy (f-URS) in the treatment of patients of different age groups (<60, 60-74 and ≥75 years) with proximal ureteral and kidney stones. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of Urology, HSU Izmir Bozyaka Training and Research Hospital, HSU Ankara Diskapi Training, Research Hospital, and Mustafa Kemal University Faculty of Medicine, between March 2014 and June 2020. METHODOLOGY: Nine hundred and fifty-six patients, who underwent f-URS due to proximal ureteral and kidney stones, were divided into three age groups as <60 years (Group 1), 60-74 years (Group 2) and ≥75 year (Group 3). The patients' American Society of Anesthesiologists (ASA) score, Charlson Comorbidity Index (CCI), anticoagulant use, stone-free rates and surgical and medical complication rates were examined for each group. RESULTS: There were 688 patients in Group 1, 230 in Group 2, and 38 in Group 3. A significant difference was observed between the age groups in terms of CCI and anticoagulant use (p<0.001 for both). The highest rate of medical complications was observed in Group 3 at 42.1%, followed by Group 2 at 17.8%, while the lowest rate was observed in Group 1 at 2.3% (p<0.001). As a result of the multivariate analysis, receiving anticoagulant treatment (p=0.002) and having a high CCI (p=0.005) were independent predictors of medical complication development. CONCLUSION: It was clearly demonstrated that f-URS could be used as a safe and effective alternative for the treatment of moderate-size kidney stones in all age groups. Key Words: Elderly, Geriatric patients, RIRS, Holmium laser lithotripsy, Urolithiasis, Safety, Efficacy.

The effect of renal localization on the fate of clinically insignificant residual fragments after retrograde intrarenal surgery: A prospective 1-year follow-up study. / El efecto de la localización renal en el destino de los fragmentos residuales clínicamente insignificantes después de la cirugía intrarrenal retrógrada: Un estudio prospectivo de seguimiento de 1 año.

OBJECTIVES: Even after a successful retrograde intrarenal surgery (RIRS), clinically insignificant residual fragments (CIRF) could not pass from the kidney. We aimed to find out the differences on the fate of CIRF according to being in the lower pole or other renal localizations. METHODS: 81 patients whose stones were fragmented completely by RIRS were subdivided into two groups as group 1 (lower pole with 41 patients) and group 2 (upper pole, midpole, and renal pelvis with 40 patients). Basal characteristics, urine culture, and renal stone screening were evaluated before and 1-year later from the surgery. RESULTS: While the number of stone-free patients was less and patients with CIRF ≤4 mm was higher in the lower pole stone group 1-year later from the surgery, there was no statistical difference between the two groups (p=0.158, p=0.136). The number of patients whose CIRFs regrew was 46.3% in group 1 and, 52.5% in group 2. A positive correlation was detected between preoperative stone size and first-year maximal residual fragment size in group 1. Linear regression analysis suggested that preoperative stone size is a predictor of the postoperative first-year residual fragment size in group 1. CONCLUSIONS: We observed that almost the half of the CIRFs in all renal localizations regrew and became symptomatic. There is an effect of the stone size on the residual fragment size while performing RIRS for particularly the lower pole renal stones. Patients with CIRF are needed to be followed-up more closely regardless of the renal localization in order to assess the requirement of retreatment.

OBJETIVOS: Incluso después de una cirugía intrarrenal retrógrada exitosa (CRIR), fragmentos residuales clínicamente insignificantes (FRCI) no pudieron pasar del riñón. Nuestro objetivo fue conocer las diferencias en el destino del FRCI según esten en el polo inferior u otras localizaciones renales.MATERIAL Y MÉTODOS: 81 pacientes cuyos cálculos se fragmentaron completamente por CRIR se subdividieron en dos grupos: grupo 1 (polo inferior con 41 pacientes) y grupo 2 (polo superior, polo medio y pelvis renal con 40 pacientes). Las características basales, urocultivo y cribado de cálculos renales se evaluaron antes y un año después de la cirugía. RESULTADOS: Mientras que el número de pacientes sin cálculos fue menor y los pacientes con FRCI ≤4 mm fue mayor en el grupo de cálculos del polo inferior 1 año después de la cirugía, no hubo diferencia estadística entre los dos grupos (p=0,158, p=0,136). El número de pacientes cuyo FRCI volvió a crecer fue del 46,3% en el grupo 1 y del 52,5% en el grupo 2. Se detectó una correlación positiva entre el tamaño del cálculo preoperatorio y el tamaño máximo del fragmento residual del primer año en el grupo 1. El análisis de regresión lineal sugirió que el tamaño del cálculo preoperatorio es un predictor del tamaño del fragmento residual del primer año posoperatorio en el grupo 1. CONCLUSIÓNES: Observamos que casi la mitad de los FRCI en todas las localizaciones renales volvieron a aparecer y se volvieron sintomáticos. Hay un efecto del tamaño del cálculo sobre el tamaño del fragmento residual mientras se realiza la CRIR, en particular, para los cálculos renales del polo inferior. Es necesario realizar un seguimiento más detenido de los pacientes con FRCI independientemente de la localización renal para evaluar la necesidad de retratamiento.

External validation and comparison of current scoring systems in retrograde intrarenal surgery: Multi-institutional study with 949 patients.

OBJECTIVES: To externally validate and compare Resorlu-Unsal stone score (RUSS), modified Seoul National University Renal Stone Complexity Score(S-ReSC), Ito's nomogram, and Retrograde Intra-Renal Surgery (R.I.R.S.) scoring systems for predicting capabilities of both the stone-free status and complications in a multi-institutional study. MATERIALS AND METHODS: We performed a retrospective analysis of 949 patients who underwent flexible ureterorenoscopy (f-URS) and laser lithotripsy for renal stones in two institutions between March-2015 and June-2020. The RUSS, modified S-ReSC, Ito's nomogram, and R.I.R.S. scores were calculated for each patient by the same surgeon on imaging methods. Results were compared for their predictive capability of stone-free status and complications. RESULTS: Of 949 patients 603 were male and 346 were female with a mean age of 47.2 ± 14.3 (range 2-84 years). Mean stone burden was 102.6 ± 42.2 (48-270 mm2 ). All nomograms predicted stone-free status (Area Under Curve (AUC) were 0.689, 0.657, 0.303, and 0.690, respectively). All four scoring systems predicted complications with AUC values of 0.689, 0.646, 0.286, and 0.664 for RUSS, modified S-ReSC, Ito's nomogram, and R.I.R.S., respectively. Although all scoring systems were able to predict complications only Ito's nomogram was able to predict Clavien ≥2 complications. CONCLUSION: All four scoring systems (RUSS, modified S-ReSC, Ito's nomogram, and R.I.R.S.) could predict stone-free status after f-URS, however, the AUC values are not satisfactory in our large patient cohort. Although these scoring systems were not developed for predicting post-operative complications, they were associated with complications in our study. However, these four scoring systems have some significant limitations. The ideal scoring system is yet to be developed.

Outcomes with ureteral access sheath in retrograde intrarenal surgery: a retrospective comparative analysis.

BACKGROUND: Retrograde intrarenal surgery is used for treatment of urinary system stones. The ureteral access sheath (UAS) is used to decrease intrapelvic pressure, help with access of multiple instruments, and facilitate drainage and removal of the fragmented stones. OBJECTIVE: Assess the effect of the UAS on the outcomes of retrograde intrarenal surgery. DESIGN: A retrospective patient data review. SETTING: Training and research hospital in Turkey. PATIENTS AND METHODS: We reviewed the data of patients who had undergone retrograde intrarenal surgery between 2012-2019. Patients who had kidney anomalies, were <18 years old, and who had ureteral and urethral strictures were excluded from the study. The demographic characteristics, stone type, complications, intraoperative and postoperative data of the patients were reviewed. A successful outcome was defined as being stone free or having clinically insignificant residual fragments (<3 mm). The use of the UAS was compared with other procedures in terms of efficiency and safety. Factors determining UAS usage were assessed by multivariate analysis. MAIN OUTCOME MEASURES: Stone free rate and complication rate in patients who underwent retrograde intrarenal surgery. SAMPLE SIZE: 1808 patients met inclusion criteria. RESULTS: The UAS was used in 1489 procedures, while other methods were used in 319 procedures. Operation time was 46.9 (17.3) minutes and 42.9 (19.0) minutes with other methods. Postoperative double J stent usage rates were 88.2% and 63% in the UAS and other methods, respectively. The rate of successful outcome was 88.2% and 81.2% in the UAS and other methods, respectively (P<.001). The rate of complications was similar in both groups (P=.543). In a multivariate analysis, UAS usage was directly proportional with stone size and inversely proportional with preoperative JJ stent usage CONCLUSION: The UAS can be effectively and successfully used in retrograde intrarenal surgery for treatment of urinary system stones. UAS usage should be considered for the patients who have large stones (2 cm) and do not have a preoperative double J stent. LIMITATIONS: Retrospective design. CONFLICT OF INTEREST: None.

Comparison of the efficiency, safety and pain scores of holmium laser devices working with 20 watt and 30 watt using in retrograde intrarenal surgery: One center prospective study.

OBJECTIVES: Holmium:Yttrium Aluminum Garnet laser lithotripsy is used in Retrograde Intrarenal Surgery. Fragmentation is made with a certain value of pulse energy (Joule) and frequency (Hertz) in Holmium laser lithotripsy and the multiplication of these values gives us total power (Watt). Devices with maximum power of 20 Watt and 30 Watt are used in clinical practice. We want to compare the efficiency, safety and pain scores of the lithotripsy made below 20 Watt and over 30 Watt with 30 Watt laser device. MATERIALS AND METHODS: 60 patients who had 2-3 cm sized kidney stones and operation planned were prospectively divided into three groups. Groups were random identified. In the first group, fragmentation was performed below 20 Watt power with 20 Watt laser device. In the second group, fragmentation was performed below 20 Watt power with 30 Watt laser device. In the third group, fragmentation was performed over 20 Watt power with 30 Watt laser device. Demographic, stone, intraoperative and postoperative data were recorded. We compared these groups regarding efficiency, safety and pain score. RESULTS: For demographic and stone data, there was a statistically significant difference only for stone number. For intraoperative and postoperative data, there was a statistically significant difference only for ureteral access sheath usage between the groups. Success was lower than the other groups in Group 1. CONCLUSIONS: Success was higher in groups using 30 Watt laser device. There was not statistically significantly difference between complications and pain. 30 Watt laser device is safe and efficient in Retrograde Intrarenal Surgery.

Is RIRS Safe and Efficient In Patients With Kidney Stones Who Had Previous Open, Endoscopic, or Percutaneous Kidney Stone Surgery? One Center Retrospective Study.

PURPOSE: In our study, we assessed the efficiency and reliability of retrograde intrarenal surgery secondary to open surgery for kidney stone treatment. Moreover, we compared the efficiency and safety of retrograde intrarenal surgery for the patients with previous history of open surgery, percutaneous nephrolithotomy, secondary retrograde intrarenal surgery (RIRS) and primary RIRS. MATERIALS AND METHODS: Data was retrospectively reviewed. Patients who had kidney anomalies, who had been stented due to ureteral stricture in the operation and who were < 18 years old, were excluded. There were 30 patients who underwent RIRS secondary to open surgery. The demographic and stone characteristic as well as intraoperative and postoperative data of the patients were recorded. 30 patients with similar demographic and stone characteristics to those patients were selected by match pairing method from patients who had previous PNL, RIRS history and had undergone primary RIRS. A total of 120 patients, in total 4 groups, were included in the study. RESULTS: Statistically significant difference was detected among the groups with regards to shock wave lithotripsy history and preoperative JJ stent rate. There was no statistically significant difference in terms of stone characteristics, intraoperative and postoperative data. CONCLUSION: RIRS is an efficient and safe method for kidney stone treatment of the patients with previous history of open surgery, percutaneous nephrolithotomy and retrograde intrarenal surgery. It has a similar efficiency and safety for the patients who have undergone retrograde intrarenal surgery. This is the first study that compares the patients especially  with different previous surgery methods.

Retrograde Intrarenal Surgery Following Laser Endopyelotomy; Sequential Procedures for Ureteropelvic Junction Obstruction and Nephrolithiasis.

PURPOSE: This study was designed to evaluate the effectiveness and safety of retrograde intrarenal surgery (RIRS)following retrograde laser endopyelotomy (rLEP) in concomitant ureteropelvic junction obstruction (UPJO) andstone disease. MATERIALS AND METHODS: Patients with concomitant UPJO and renal stone disease who were first treated in ourclinic by rLEP for obstruction and then RIRS for stone disease were enrolled. Study period went from 2012 to2017. RIRS following rLEP was performed earliest at the sixth week. Patients who underwent rLEP were matchedwith those with normal anatomy at a 1:1 ratio based on the propensity scores. Additionally, clinical results werecompared in order to evaluate the effects of rLEP surgery on RIRS. Subsequently, patients who underwent RIRSfollowing rLEP were independently evaluated and factors affecting the success of sequential procedures wereinvestigated. RESULTS: The sole difference between those that underwent RIRS following rLEP (n=27) and controls with normalanatomy that underwent RIRS was in operative times (p = .011). Evaluation of potential success factors inthe sequential rLEP-RIRS group revealed that primary etiology, obstruction length less than 1cm, smaller stonesize and presence of single stone showed significant effects (p = .047, p = .030, p = .040, p ? .001, respectively).RIRS following rLEP generated an 81.5% stone-free and, after a median follow-up time of 32 months, a 74.1%obstruction-free rate. CONCLUSION: RIRS following rLEP in patients with UPJO and renal stones is an effective treatment method. It canbe used safely in patients with single stones < 2cm, short obstruction lengths, and presence of primary etiology.

Comparison of Retrograde Intrarenal Surgery and Percutaneous Nephrolithotomy Methods For Management of Big- Sized Kidney Stones(? 4 cm): Single Center Retrospective Study.

Purpose: Management of ? 4 cm sized kidney stone is a rarely seen problem in urology. Few studies are present about this issue. Percutaneous nephrolithotomy(PNL), Retrograde Intrarenal Surgery(RIRS) and open surgery are the methods used in stone management. In our study we aimed to compare RIRS and PNL in the management of ? 4 cm sized kidney stones. MATERIALS AND METHODS: Among patients who had undergone RIRS and PNL in D?skap? Y?ld?r?m Beyaz?t Train-ing and Research Hospital, 94 patients who had ? 4 cm sized kidney stones were included our study. The demo-graphic, intraoperative and postoperative data of these patients and complications were evaluated retrospectively. RESULTS: 94 patients (67 PNL, 27 RIRS) were in the study. Stone laterality, urinary anomaly and gender were sim-ilar in two groups.(Group PNL(P) and Group RIRS(R)) Stone number were 2.55 ± 1.44 and 2.78 ± 1.42 in Group P and R, respectively. Stone size were 47.06 ± 7.02 and 46.41 ± 6.00 mm. in Group P and R, respectively. The differences between two groups were not statistically significant.(P > .05) In Group P scopy time, hospital stay and stone free rate were higher and operation time was lower than Group R. And the difference was statistically significant(P < .05). CONCLUSIONS: As a result, PNL is an effective method and operation time is lower than RIRS. Also a second oper-ation for JJ stent taking is lower in PNL . RIRS is a safe method. RIRS has less complications and hospitalization time. They are feasible in treatment of ? 4 cm sized kidney stones.

Do the etiological factors in artificial urinary sphincter reimplantation cases affect success and complications?

Background/aim: The artificial urinary sphincter (AUS) is still one of the best options for incontinence treatment. It may also have an advantage for revision or reimplantation in the management of complications. In this study we aimed to discuss the etiological factors for AUS reimplantation and effects of these etiological factors on success rates, patient satisfaction rates, time to reimplantation surgery, and complications Materials and methods: Data from 30 patients for whom AUS reimplantation was performed were analyzed retrospectively. Incontinence due to fluid loss from the cuff or reservoir balloon, inability of the cuff to adequately compress the urethra, and devices that were thought to have completed their lifespans were defined as mechanical reasons while incontinence caused by conditions such as cuff erosion and infection were defined as nonmechanical reasons. Patients who went through reimplantation due to mechanical and nonmechanical causes were included in Group 1 and Group 2, respectively. Success rates, patient satisfaction rates, time between the implantation of the first and second AUS, and complications were compared between the groups. Results: The mean follow-up period was 79 (3­308) months for patients who went through primary AUS implantation due to postprostatectomy incontinence. Our success rates were found as 75% and 66% in Group 1 and Group 2, respectively. The differences between the groups in terms of success and patient satisfaction rates were not statistically significant, while the time to reimplantation was longer in Group 1 and statistically significant. Conclusion: Reasons for AUS reimplantation may affect the success and patient satisfaction rates. Our success rates of AUS performed for nonmechanical reasons were slightly lower, but not statistically significantly so. AUS reimplantation may take a longer time if mechanical failure is detected.

The Association of a Number of Anatomical Factors with the Success of Retrograde Intrarenal Surgery in Lower Calyceal Stones.

PURPOSE: To determine anatomical factors affecting Retrograde Intrarenal Surgery (RIRS) success in the treatment of renal lower calyx stones. MATERIALS AND METHODS: The results of patients were evaluated retrospectively. The patients who have preoperative intravenous urography (IVU) and computed tomography (CT) were divided into two groups as successful (S)(N=103) and unsuccessful(U) (N=29). The anatomic characteristics such as infundibulopelvic angle (IPA), infundibular length (IL), infundibular width (IW) and pelvicaliceal height (PCH) values were compared among two groups. RESULTS: Mean patient age was 47±13.6 years in group S and 49.5 ±11.9 years in group U. The mean stone size was 10mm (6-54mm) in group S and 19mm (8-45mm) in group U (P < .001) Mean IPA was 85.8 ±16.9 degree in group S versus 54.7 ± 11.5 degree in group U. The mean PCH was 1.9cm (0.5-4cm) in group S versus 2.3cm (0.7-3.9cm) in group U. The mean IL were 2.7 ± 0.8 cm and 3.2±0.7cm in group S and group U, respectively. The mean IWs were 0.7 cm (0.2-2.3cm) and 0.7cm (0.3-2) in group S and group U, respectively. The differences were statistically significant for IPA, PCH, IL (P < .05) while was not statistically significant for IW (P > .05). After multivariate analyses, PCH, IPA and stone size were statistically significant factors. CONCLUSION: In our study we found that IPA, PCH and stone size were significant anatomical factors affecting RIRS success in the treatment of renal lower calyx stones. The patients whose IPA, PCH and stone size valuables are unsuitable, may need multiple RIRS sessions or additionaltreatment modalities.

Comparison of Dilation Methods in Percutaneous Nephrolithotomy: Which One Is More Successful?

OBJECTIVE: Creation of the access tract is an important step in percutaneous nephrolithotomy (PNL). In this study, we compared the efficiency and safety of Amplatz, Alken, and balloon dilation methods in the creation of the access tract. MATERIALS AND METHODS: Data from 487 PNL patients admitted to 517 renal units in 3 centers were analyzed. The Amplatz (280 patients), Alken (142 patients), and balloon (95 patients) dilation methods were compared for their success, duration of the dilation, injury to the collecting system, durations of fluoroscopy and surgery, stone-free and complication rates, pre- and postoperative hematocrit levels, and need for blood transfusion. RESULTS: The dilation methods did not significantly differ with respect to patient demographic data, mean stone area, decrease in hematocrit, need for blood transfusion, unsuccessful tract dilation, injury to the collecting system, stone-free rate, and rate of postoperative complications. The mean fluoroscopy times during Amplatz, Alken, and balloon dilation were 288.52 ± 164.67, 287.34 ± 164.99, and 169.23 ± 21 seconds, respectively. The mean duration of surgery was 96.48 ± 46.07, 94.72 ± 42.25, and 78 ± 25.96 minutes, respectively. The duration of tract creation was 328.67 ± 172.99, 325.14 ± 175.70, and 203.50 ± 32.76 seconds, respectively. The durations of surgery and tract creation were significantly shorter in the balloon dilation group. CONCLUSION: None of the dilation methods was significantly superior in terms of surgical success, efficiency, or safety. Although balloon dilation was advantageous with respect to time parameters, the role of surgical experience should not be ignored.

Comparison of Ho:Yag laser and pneumatic lithotripsy combined with transurethral prostatectomy in high burden bladder stones with benign prostatic hyperplasia.

OBJECTIVES: To compare the efficacy and reliability of Ho:YAG laser lithotripsy (HLL) and pneumatic lithotripsy (PL) in the treatment of bladder stones in patients with benign prostatic hyperplasia and stones ≥ 20 mm who were transurethrally treated in the same surgical session. METHODS: We studied the data of patients with benign prostatic hyperplasia and ≥20 mm bladder stones who were treated with transurethral resection of the prostate and cystolithotripsy in the same session, obtained between January 2010 and February 2014 from three urology clinics. All patients underwent bipolar plasmakinetic (PK) transurethral resection of the prostate. For treatment of the bladder stone, either HLL or PL was applied. A total of 62 patients were divided into two groups: PK-PL (Group 1, n = 29) and PK-HLL (Group 2, n = 33). The data of both groups were analyzed for stone dimensions, stone fragmentation time, total operating time, hospitalization duration, prostate dimensions, success rates, and complications. RESULTS: Group 1 included 29 patients with a mean age of 70 ± 7.6 (range, 57-85) years, whereas Group 2 included 33 patients with a mean age of 67.5 ± 10.5 (range, 45-84) years. In Group 1, five patients had mucosa injury, one patient had residual stone, and one patient had bladder perforation. In Group 2, three patients had mucosa injury, three patients had postoperative fever, and one patient had residual stone. Total operation time and stone fragmentation time were significantly lower in Group 2 (p < 0.05). The remaining analyzed data were similar (p > 0.05). CONCLUSION: PK-HLL using a single shaft without the need for repeated access has the advantages of shorter fragmentation and operation time.

Single early instillation of mitomycin C and urinary alkalinization in low-risk non-muscle-invasive bladder cancer: a preliminary study.

BACKGROUND: The purpose of this study was to determine the effectiveness of a single early instillation of mitomycin C (MMC) after transurethral resection of bladder tumor (TURBT) together with urinary alkalinization in patients with low-risk non-muscle-invasive bladder cancer (NMIBC). METHODS: Between February 2006 and November 2010, patients diagnosed as having a primary bladder tumor were randomized into standard and optimized treatment groups. The treatment groups were formed prospectively from patients with NMIBC according to results of pathological examination postoperatively, whereas the control group was formed retrospectively. Patients in the standard group (n = 11) were given intravesical MMC 40 mg in the first 6 hours after TURBT, while the patients in the optimized group (n = 15) underwent urinary alkalinization prior to MMC. In the control group (n = 23), no drug treatment was given. The patients were followed after surgery at months 3 and 12, and then annually for the first 5 years using cystoscopy and ultrasound. Time to recurrence and recurrence-free survival rates were calculated. RESULTS: There were no statistically significant differences between the standard and optimized groups, between the control and optimized groups, or between the control and standard groups in terms of mean recurrence-free survival rates (P = 0.132, 0.645, and 0.173, respectively). The mean time to recurrence was 34.8 (range 28.5-41.1) months in the optimized group and 51.8 (range 44.3-59.2) months in the control group. There was no recurrence during the follow-up period in the standard group. CONCLUSION: The results of this preliminary study could not demonstrate the efficacy of urinary alkalinization before a single dose of early MMC following TURBT to increase the effectiveness of the MMC, so we did not continue the study further.