Comparison of oncological and functional results of robotic and open perineal radical prostatectomy.

OBJECTIVE: We aimed to compare the functional and oncological outcomes of patients who underwent open perineal radical prostatectomy (OPP) and robotic perineal radical prostatectomy (RPP) for prostate cancer (PCa). METHODS: The data of patients who underwent OPP and RPP from June 2016 to February 2019 due to localized PCa were analyzed. Demographic characteristics, perioperative data and oncological results of the patients were recorded. In addition, the incontinence status of the patients immediately after catheter removal and at the 3rd, 6th, and 12th months were compared. Potency status was evaluated among the patients with preoperative potency, and 12th month potency status was compared. RESULTS: A total of 135 patients were included, of whom 58 (43%) were in the OPP group and 77 (57%) were in the RPP group. The operation time was statistically significantly shorter in the OPP group (83.90 ± 15.48 vs. 110.88 ± 28.10 min, p = 0.001). The amount of bleeding was significantly lower in the RPP group (59.51 ± 22.04 vs. 74.06 ± 17.66, p = 0.002). The continence rates evaluated at the early period, 3rd, 6th, and 12th months were 40.3%, 80.5%, 87.0%, and 90.9%, respectively, for the RPP group and 36.2%, 70.7%, 86.2%, and 89.7%, for the OPP group, indicating no statistically significant difference (p > 0.05). There was no statistically significant difference in the 12th month rates of postoperative potency according to the surgical technique (p > 0.05). CONCLUSION: Although differences were observed between the OPP and RPP techniques in terms of perioperative parameters, oncological and functional results were similar.

Comparison of Open and Robot-Assisted Kidney Transplantation in terms of Perioperative and Postoperative Outcomes.

Background: The gold standard treatment method for end-stage renal disease (ESRD) is renal transplantation (RT). RT can be done with open or minimally invasive surgical methods. We aimed to compare the outcomes between patients who underwent robot-assisted renal transplantation (RART) and open renal transplantation (ORT). Methods: Data of the patients who underwent ORT or RART in two institutions between June 2015 and February 2020 were retrospectively reviewed. Patients who underwent live donor RT were included, and all donor nephrectomy procedures were performed by the laparoscopic technique. Demographic data, ischemia times, anastomosis times, operation times, and postoperative complications were recorded. Results: 98 patients were included in the ORT group, while 91 patients were included in the RART group. There was a significant difference between the two groups regarding mean patient age. While total ischemia time was 86.9 ± 7 minutes in the RART group, it was calculated as 71.2 ± 3.3 minutes in the ORT group, with a significant difference. The anastomosis time was significantly shorter in the ORT group than in the RART group. The incision length and duration of hospital stay were significantly shorter, visual analogue scores were significantly lower, and estimated blood loss was less in the RART group than in the ORT group. Conclusion: Both ORT and RART are effective and safe methods for treating ESRD. According to our study, RART is associated with relatively longer ischemia times but lower complication rates and higher patient comfort.

Supine Percutaneous Nephrolithotomy in a Patient with Solitary Lung: A Case Report and Literature Review.

Percutaneous nephrolithotomy (PNL) surgeries are performed with different patient positions, anesthesia methods and different-sized access sheaths in order to reduce the complication rates. Supine positioned PNL can be performed safely in the high-risk group patients with comorbidities. Herein, we present a patient who had a past surgical history of right pneumonectomy and underwent a supine PNL procedure under regional anesthesia for a staghorn renal stone in the right kidney.

Effect of access sheath diameter used in percutaneous nephrolithotomy on renal function: a prospective randomized study.

We aimed to determine the effect of the access sheath diameter used in percutaneous nephrolithotomy (PNL) on renal function. We also investigated the predictors of impaired renal function. Data were prospectively collected from patients who underwent PNL from December 2020 to December 2021. The patients were randomized into two groups according to access sheath diameter: Group 1 (22 Fr, n = 44) and Group 2 (28 Fr, n = 44). Relative renal function (RRF) was calculated by technetium-99 m dimercaptosuccinic acid scintigraphy, and glomerular filtration rate (GFR) was calculated by diethylenetriamine pentaacetic acid scintigraphy. A difference of 5% or more in RRF was considered a significant functional change. Preoperative and postoperative Kidney Injury Molecule-1 (KIM-1) levels were measured. Preoperative demographic data and stone characteristics were similar between the groups. There were also no statistically significant differences between the groups in terms of scar development, changes in RRF, GFR, or KIM-1/creatinine (Cr) (p > 0.05). Significant deterioration in RRF was detected in a total of six (6.8%) patients, three in each group. The factors predicting loss of function were analyzed by regrouping the patients without loss of function as Group A (n = 82) and those with loss as Group B (n = 6). Only stone volume was statistically significant in multivariate analysis (p = 0.002). Access sheath diameter had no significant effect on renal function after PNL. However, the stone volume was found to independently correlate to a loss of renal function after PNL.

A comparative analysis of the efficacy and safety of mini-percutaneous nephrolithotomy performed in the supine and prone positions for the treatment of pediatric kidney stones: a single-center experience.

Mini-percutaneous nephrolithotomy (MPCNL), which has a smaller tract size (14-20 Fr) than conventional percutaneous nephrolithotomy, has been shown to be safe and effective in pediatric patients with large and complex upper urinary tract stones. This study aimed to compare the efficacy and safety of MPCNL between the supine and prone positions in a pediatric population. The data of pediatric patients who underwent MPCNL at our center between January 2010 and March 2023 were retrospectively analyzed. According to the surgical position, the patients were divided into the prone (Group P) and supine (Group S) groups. In both groups, dilatation was performed using 14-18 Fr metallic dilators. The two groups were compared in terms of perioperative data, postoperative stone-free rates (SFRs), and complications. There were 36 (59%) patients in Group P and 25 (41%) patients in Group S. Stones were mostly located in the pelvis (49.2%) and second most frequently in the lower pole (27.9%). Fluoroscopy time was shorter in Group S but did not statistically significantly differ compared to Group P (p = 0.181). However, operation time was statistically significantly shorter in Group S (73.8 ± 35 vs. 99.8 ± 37.4 min, p = 0.008). Although there was no significant difference, relatively higher SFR were detected in Group S (88% vs. 83%, p = 0.725). Endoscopic combined intrarenal surgery (ECIRS) was performed on six (24%) patients in Group S, and the SFR was 100% among these patients. There was no significant difference between the two groups in terms of the presence of complications (16.7% vs. 16%, p = 0.945). Both supine and prone MPCNL appear to be safe and effective in the pediatric age group, with similar stone-free and complication rates. In the supine procedure, the operation time is shortened compared to the prone. In addition, simultaneous retrograde access has the potential to increase the overall success rate of surgery.

Comparison of Incision Types Used for Kidney Extraction in Laparoscopic Donor Nephrectomy: A Retrospective Study.

PURPOSE: Laparoscopic donor nephrectomy (LDN) is the most commonly used method for kidney removal in kidney transplantation and, various incisions are used for kidney extraction. In this study, we aimed to compare the results of LDN operations using iliac fossa incision and Pfannenstiel incision. MATERIAL AND METHOD: LDN cases performed in our institute between June 2016 and February 2020 were retrospectively analyzed. Patients with previous abdominal surgery, bleeding coagulation disorders, ectopic kidneys, and patients who were converted to perioperative open surgery were excluded. Demographic data of the patients, operation times, warm ischemia times, complications were recorded and the patients were divided into two groups according to incision types. RESULTS: After the inclusion and exclusion criteria, 203 patients were included in the study. Iliac fossa incision was used in 65% of the patients and the Pfannenstiel incision was used in 35% of the patients to remove the donor's kidney. There were no difference in age, body mass index, gender, and Charlson Comorbidity Index (CCI) scores between the two groups. Operation time and warm ischemia time were significantly longer in the Pfannenstiel group (p = 0.001 and p = 0.016 respectively). There was no significant difference between the two groups in terms of bleeding amount, length of hospital stay, need for narcotic analgesic, visual analog scale scores, and postoperative complications. CONCLUSION: Both types of incisions can be used successfully and safely for the extraction of the kidney in LDN. Although WIT and operation time has been observed to be longer when a Pfannenstiel incision is made, complications and analgesic use are not different between Pfannenstiel incisions and iliac fossa incisions.

Pre-Operative Parameters Predicting Hemoglobin Decline Related to Percutaneous Nephrolithotomy.

Objectives: Percutaneous nephrolithotomy (PNL) for upper urinary tract stones is a minimally invasive, effective treatment modality. Despite its high success rates, its potential complications pose a risk. In this study, we aimed to determine the risk factors associated with bleeding which is one of PNL's most important complications. Methods: The data of patients who underwent PNL between January 2017 and December 2018 were retrospectively analyzed. The median reduction in post-operative hemoglobin levels compared to preoperative levels was found to be 1.6 g/dl, which was accepted as the threshold value. The patients with hemoglobin decrease above the threshold were assigned as Group 1, and below the threshold as Group 2. Pre-operative, perioperative data, and stone characteristics of the patients were recorded. Results: 169 patients, 85 patients in Group 1 and 84 patients in Group 2 were included in the study. The mean age of Group 1 was significantly higher (47.4±7.9 and 32±9.4 years, respectively, p=0.001) Sixteen in Group 1 (18.8%) and six in Group 2 (7, 1%) had a diagnosis of hypertension (HT) and a significant difference was found (p=0.038). The average stone burden was 2733±1121.3 mm3 in Group 1, and 2326.5±975.6 mm3 in Group 2. It was observed that there was a significantly higher stone burden in Group 1 (p=0.001). There was a significant difference between the groups in terms of mean operation time (84.4±7 and 76.2±9.9 min, respectively, p<0.001). When the complication rates were analyzed, complications were observed in 25 (29.4%) patients in Group 1 and 12 (14.2%) patients in Group 2, and a significant difference was found between both groups (p=0.019). Age and HT were found to be significant independent risk factors associated with hemoglobin decline in multivariate analyzes (p<0.001 and p<0.027, respectively). Conclusion: In this study; advanced age, presence of HT, and high stone burden were found to be predictive of reductions in hemoglobin levels. Furthermore, a correlation of decreased hemoglobin levels was detected with operative times and occurrence of complications.

Is neutrophile to lymphocyte ratio a predictor of Gleason score upgrading according to risk classifications in patients with prostate cancer.

OBJECTIVES: We aimed to determine the parameters that predict Gleason Score (GS) upgrading in patients undergoing robot-assisted laparoscopic radical prostatectomy (RARP) and especially the ability of neutrophile to lymphocyte ratio (NLR) in predicting the upgrading. METHODS: Patients who underwent RARP for prostate cancer in our clinic between January 2013 and January 2018 were retrospectively analyzed. Patients' demographic data, preoperative and postoperative parameters were all recorded in the database. NLR was calculated by dividing the absolute neutrophil count (NC) by the absolute lymphocyte count (LC). Patients were classified as low, moderate and high risk according to the National Comprehensive Cancer Network (NCNN) Guidelines. Any increase in GS between biopsy results and radical prostatectomy specimens were consideredas an GS upgrading. RESULTS: After applying the inclusion and exclusion criteria, a total of 571 patients, 205 patients without GS upgrading (Group 1) and 366 patients with GS upgrading (Group 2), were included. The mean preoperative PSA values and prostate volumes were 10.8 ± 8 ng/dL and 45 ± 18.8 ml, respectively. Group 2 had a significantly high NC and NLR, significantly low platelet count (PC) and LC, (p=0.0001, 0.0001, 0.001 and0.002, respectively). Group 2 was found to have significantly higher positive surgical margin (PSM), extraprostatic extension (EPE) and seminal vesical invasion (SVI) (p<0.001). There was no significant correlation between the parameters of NLR and PSM, EPE, SVI, and lymph node invasion (LNI). Binomial logistic regression showed patients with increased NLR had 1.68 times higher odds to exhibit an upgrade in GS in the post-surgical histopathological analysis. CONCLUSIONS: NLR calculated preoperatively is an easy diagnostic method that can predict GS upgrading in patients scheduled for radical prostatectomy for prostate cancer.

OBJETIVOS: Determinamos los parámetros que predicen el grado de sobregradación de Gleason en pacientes que recibieron prostatectomía radical robótica asistida por laparoscopia (PRRL) y especialmente la habilidad de la tasa de neutrófilos/linfocitos (NLR) a la hora de predecir la sobregradación.MÉTODOS: Los pacientes que recibieron PRRL por cáncer de próstata en nuestra clínica entre enero 2013 y enero de 2018 se analizaron retrospectivamente. Los datos demográficos, parámetros preoperatorios y postoperatorios fueron reportados en la base de datos. NLR se calculo dividiendo el numero absoluto de neutrófilos (NC) por el numero absoluto de linfocitos (LC). Los pacientes se clasificaron como bajo, moderado y alto riesgo en la relación a las guías de National Comprehensive Cancer Network (NCNN). Cualquier aumento en el grado de Gleason entre los resultados de la biopsia y la prostatectomía radical fueron considerados como una sobregradación de grado deGleason. RESULTADOS: Después de aplicar los criterios de inclusión y exclusión, un total de 571 pacientes, 205 sin sobregradación de Gleason (Grupo 1) y 366 pacientes con sobregradación de Gleason (Grupo 2). La media de PSA preoperatorio y volúmenes prostáticos fueron de 10,8 ± 8 ng/dL y 45 ± 18,8 ml, respectivamente. El grupo 2 presentó un NC y NLR más alto, significativamente, bajos niveles de plaquetas y LC (p=0,0001, 0,0001, 0,001 y 0,002, respectivamente). El grupo 2 demostró tener niveles significativamente más altos de márgenes quirúrgicos (PSM), extensión extraprostatica (EPE) e invasión de vesículas seminales (SVI) (p<0,001). No se econtró una correlación significativa entre los parámetros de NLR y PSM, EPE, SVI, invasión ganglios linfáticos. El modelo de regresión binomial logística demostró que los pacientes con un incremento de NLR tuvieron 1,68 más veces de tener una sobregradación de Gleason en el análisis histopatológico postquirúrgico. CONCLUSIONES: El cálculo de NLR preoperatorio es un método fácil de diagnóstico que puede predecir la sobregradación de Gleason en pacientes que van a recibir una prostatectomía radical por cáncer de próstata.

Evaluation of the efficacies of methylphenidate and biofeedback treatments in giggle incontinence: One-year follow-up study.

INTRODUCTION: Giggle incontinence is a type of urinary incontinence (GI) that occurs with laughing due to the urinary bladder's involuntary contraction leading to complete emptying. There are studies in the literature that biofeedback therapy or methylphenidate can be effective in the treatment of this condition. OBJECTIVE: This study aimed to compare the efficacies of biofeedback therapy and methylphenidate treatment in patients with GI. STUDY DESIGN: In this non-randomized observational study, children aged 5-18 years who were diagnosed with GI between January 2014 and December 2019 were included in the study. Patients who were treated by biofeedback were assigned to Group 1, while patients who were given methylphenidate treatment were placed in Group 2. Patients in Group 1 were treated with biofeedback, which was planned once a week for four weeks and once a month for the following two months. They continued their pelvic floor strengthening exercises at home for the following nine months. Patients in Group 2 were prescribed 5 mg oral methylphenidate qid for three months. Patients in both groups were followed up with 3-month intervals within a year. The results were classified as complete response, partial response or no response as per The International Children's Continence Society (ICCS) recommendations. RESULTS: The study population consisted of 38 patients with GI. Mean age of the patients was 7.7 (5-11). Among these patients, 31 (81.5%) were female, while 7 (18.4%) were male. Two groups were similar regarding mean patient age and gender distribution. There was no difference between the two groups regarding treatment responses evaluated during the 1st, 3rd, and 6th-month outpatient clinic encounters (p > 0.05). However, treatment responses assessed during the 12th-month outpatient clinic encounter revealed 15 (94.1%) patients with complete response in Group 1, while there were 10 (55.6%) patients who showed complete response in Group 2, with a significant difference (p = 0.03). DISCUSSION: Our study showed that treatment responses were reduced after discontinuation of methylphenidate. We achieved high complete response rates in the first, third, sixth, and twelfth-month assessments by biofeedback treatment. CONCLUSIONS: Significantly more favorable treatment outcomes were achieved with biofeedback therapy than methylphenidate treatment after completion of 1-year. Multi-center, randomized studies are needed to evaluate efficacy and safety.

An Unexpected Complication After Extracorporeal Shock Wave Lithotripsy: Emphysematous Pyelitis.

Emphysematous urinary tract infections (UTI) are life-threatening conditions caused by gas-forming organisms. Emphysematous pyelitis (EP) is a rare, acute bacterial UTI characterized by gas formation only in the renal collecting system. Extracorporeal shock wave lithotripsy (ESWL) treatment was performed for 10-mm sized stone in the left renal pelvis in an 81-year-old female patient with no known comorbidities other than hypertension. In the 10th hour following ESWL treatment, the patient referred to the emergency department with fever and left flank pain. Gas was noticed in the left renal collecting system in non-contrast computed tomography (NCCT). A wide spectrum antibiotic was given to the patient due to EP diagnosis and a nephrostomy catheter was placed in the left renal pelvis. EP should be considered in the patient with fever and flank pain after ESWL and NCCT should be performed for further examination. Quick diagnosis, examination and treatment of these patients in the emergency department are important.

Postrenal Acute Renal Failure Due to Giant Fecaloma-related Bilateral Hydronephrosis: A Case Report and Brief Literature Review.

An 88-year-old woman presented to the emergency department with abdominal distention, fever, and constipation of about a week's duration. Laboratory tests showed impaired kidney function tests and fluid electrolyte values. Bilateral hydroureteronephrosis was observed on non-contrasted abdominal CT. Imaging revealed no intrinsic urological pathology (ureteral stones, etc.) that could lead to obstruction in the urinary system; however, excessively dilated and feces-loaded rectum and colon were observed. The patient was treated with conservative methods. Unfortunately, she passed away due to general condition disorder.

Splenic Injury During Percutaneous Nephrolithotomy: A Case Report of a Rare Complication.

Percutaneous nephrolithotomy has often been the preferred method for large and complex kidney stones. During percutaneous access to the collecting system, we encounter organ injuries due to anatomic neighborhoods. However, splenic injury is a relatively rare complication. We aimed to report how the complication process was managed conservatively in our case with transsplenic access. Then, a brief literature review on management strategy in similar conditions is highlighted.