Is it Necessary to Perform Nephrostography before Tube Removal after Percutaneous Nephrolithotomy.

BACKGROUND: The aim of this study is the caparison of the complications rate among the patients which underwent nephrostomy removal with and without performing nephrostography. MATERIALS AND METHODS: Between October 2010 and November 2011, 200 patients who underwent standard percutaneous nephrolithotomy (PCNL) procedures were included in this study. The patients were randomly assigned into two groups, Group A (n = 100) did not undergo the antegrade nephrostography on postoperative day 2 and the patients were discharged keeping the nephrostomy until postoperative day 3, while in Group B (n = 100) the nephrostomy tube was removed on postoperative day 3 after antegrade nephrostography demonstrating ureteral drainage down to the bladder. Postoperative complications in both groups were recorded and compared between two groups. RESULTS: A total of 200 patients were treated with standard PCNL. The persistent leakage of urine after removal of the nephrostomy tube was encountered in 5 (5.0%) and 3 (3%) of patients in Groups 1 and 2, respectively. Urinary leakage was resolved with conservative management in 3 and 2 patients of Groups 1 and 2, respectively, but a double-J stent was inserted in 2 and 1 patients in each group because of persistent leakage of urine more than 1-week. The two groups show comparable complications such as prolonged urinary leakage which managed in a similar manner, however, postoperative hospital stay was lesser in Group 1. CONCLUSION: Our results revealed postoperative performing nephrostogramy before tube removal changed the planning of complications such as prolonged urinary leakage and could be omitted in cases.

Efficacy of Varicocele Repair in Different Age Groups.

OBJECTIVE: To compare semen parameters and spouse pregnancy rates after varicocele repair in 2 age groups. MATERIALS AND METHODS: Mean changes in spermatozoa concentration, motility, and morphology after varicocele repair in 83 patients were compared between patients aged 30 years or younger (group 1) and those older than 30 years (group 2). Spouse pregnancy rates were compared between the 2 age groups. RESULTS: The mean sperm concentration increased significantly in both groups (P <.05). The percentage of motile sperm increased from 48.2% to 56.6% in group 1 and from 47.2% to 53.2% in group 2 one year after varicocele repair. The increase in motility was statistically significant for both groups (P <.05), but there was no statistically significant difference in the increase in sperm motility between the 2 groups (P = .01). The percentage of sperm with abnormal morphology decreased significantly in both groups 12 months postoperatively (from 62.7% to 59.6% in group 1 and from 61.3% to 58% in group 2; P = .03). However, there was no statistically significant difference in the improvement in sperm morphology between the 2 groups (P >.05). The pregnancy rates in the patients' spouses were 51.1% and 44.7% in groups 1 and 2, respectively. This difference was not statistically significant (P = .9). CONCLUSION: There was no statistically significant difference in semen parameter improvement and spouse pregnancy rates after varicocelectomy in the 2 age groups.

Percutaneous nephrolithotomy success rate and complications in patients with previous open stone surgery.

PURPOSE: To determine the effect of previous single or multiple open stone surgeries on percutaneous nephrolithotomy (PCNL) results and complications. MATERIALS AND METHODS: We reviewed medical records of 1422 patients who had been undergone PCNL in our institute between 1998 and 2011 by the same surgeon. Patients were divided into 3 groups. The first group included patients with no history of previous ipsilateral open stone surgery (n = 711). Patients in second group had been undergone only one open stone surgery before PCNL (n = 405) and patients with more than one previous open stone surgery were placed in third group (n = 306). We compared operation duration, stone free rate (SFR), number of attempts to access the collecting system and intraoperative and postoperative complications between 3 groups. RESULTS: There were no differences in sex, body mass index, stone burden and laterality between 3 groups. Operation time was significantly shorter in the first group (P = .000) while there was no statistically significant differences in operation duration between second and third groups (P > .973). The number of attempts to enter the collecting system was significantly lower in the first group in comparison to other two groups (P = .00). We didn’t find significant differences between 3 groups in hospital stay, SFR, intraoperative and postoperative complications. CONCLUSION: Our findings demonstrated that PCNL can be performed in patients with one or more open stone surgery history successfully without further complications.

Prostate cancer: Relationship between vascular diameter, shape and density and Gleason score in needle biopsy specimens.

BACKGROUND: Tumor growth requires expansion and development of vascular network. An increase in Gleason score is representative of an increase in tumor invasion and extent. In this study, the relationship between Gleason score and vascular characteristics of needle biopsy samples in prostate cancer patients has been evaluated. MATERIALS AND METHODS: We evaluated vascular characteristics including density and size of vessels; and percentage of vessels with irregular shape in 62 cancer-positive samples obtained by prostate needle biopsy under ultrasound guide, and compared them to Gleason score. RESULT: Gleason scores of 23 patients were ≤6; Gleason scores of 18 patients were 7 and 21 patients had their Gleason score from 8 to 10. An increase in Gleason score was associated with increased vascular density (P < 0.0001), increased percentage of vessels with irregular shape (P < 0.02) and decreased average vascular diameter (P < 0.015), from which the relationship with vascular density was clearer and more evident. CONCLUSION: Vascular morphological characteristics can be representative of angiogenic potential of prostate cancer which is required for tumor progression. As Gleason score can prognosticate the behavioral characteristics of prostate cancer in future, vascular characteristics may also be able to express tumor behavior. With attention to vascular characteristics in biopsy samples and apart from Gleason score, we may also be able to divide patients into other subtypes in a way being helpful for the establishment of treatment plan.

Renal Solid Mass as a Rare Presentation of Wagener's Granulomatosis: A Case Report.

Wagener's granulomatosis (WG) is a rheumatologic disease with unknown etiology which renal and pulmonary involvement is commonly seen. Renal involvement in Wagener's granulomatosis represents as a segmental necrotizing glomerulonephritis which is not visible with imaging techniques and usually presents with proteinuria, microhematuria, and hypertension. A rare presentation of the disease is a renal mass which can be mistaken as renal tumors, abscess, or lymphoma. We report a 22-year-old female with flank pain and fever who was admitted in our hospital. The patient underwent renal tumor biopsy and diagnosed with Wagener's granulomatosis in pathologic staining. The aim of this work is introduction of Wagener's granulomatosis as a differential diagnosis of renal tumors, to prevent unnecessary interventions and delayed treatment.

A comparison between blind and nerve stimulation guided obturator nerve block in transurethral resection of bladder tumor.

PURPOSE: To compare blind and nerve stimulation guided transurethral obturator nerve block (ONB) in transurethral resection of bladder tumor (TURBT) to prevent obturator reflex. PATIENTS AND METHODS: One hundred and twelve patients with lateral bladder wall tumors and at high risk for general anesthesia were categorized randomly in three groups. In the first group (34 patients), after spinal analgesia was administered, the exact site of the obturator nerve was determined by nerve stimulation and 15 mL of lidocaine HCl 2% was injected around the nerve. In the second group (31 patients), we determined the obturator nerve using nerve stimulation (like the first group), then 20 mL of saline was injected. In the third group (47 patients), the obturator nerve was determined based on anatomic landmarks and blocked subsequently. Leg jerking was reported and compared in the three groups. RESULTS: The median ages in the three groups were 55.4, 59.4, 57.8 years in the first, second, and third groups, respectively. Male/female ratios were 79.5% in the first, 80.7% in the second, and 80.9% in the third group (P=0.986). Leg jerking was reported in 5.8%, 34%, and 6.3% of patients in the first, second, and third groups, respectively (P=0.0001). ONB took 6.7 minutes in the first, 6.1 minutes in the second, and 5.2 minutes in the third group, on average. There was no report of adverse effects of lidocaine HCl in this study. CONCLUSION: Transvesical ONB is a safe and effective method of ONB before TURBT. This method is feasible by urologists and promising even without nerve stimulation and only by anatomic landmarks.

E-cadherin expression as a prognostic factor in transitional cell carcinoma of the bladder after transurethral resection.

PURPOSE: To analyze the role of negative versus positive immunoexpression of E-cadherin in recurrence rate of low-grade bladder tumors. MATERIALS AND METHODS: A total of 180 patients with unifocal, superficial, low-grade, papillary transitional cell carcinoma of the bladder were included in this study. The E-cadherin expression was evaluated using E-cadherin antibody. The patients were followed up for 36 months. Thereafter, recurrence rate of the tumor was compared between E-cadherin positive and negative groups. RESULTS: Of 180 low-grade carcinomas, E-cadherin immunoexpression was negative in 101 (56%) and positive in 79 (44%) patients. The recurrence rate in negative and positive groups was 65.6% and 37.9%, respectively. Negative in comparison with positive E-cadherin expression was associated with more disease recurrence (P = .045). CONCLUSION: There is an association between decreased E-Cadherin immunoexpression and tumor recurrence in low-grade and non-muscle invasive transitional cell carcinoma of the bladder.