After a urological laparoscopic training programme, which laparoscopic method is safer and more feasible in the management of proximal ureteral stones: Transperitoneal or retroperitoneal?

OBJECTIVE: To compare the results of the management of the first 25 transperitoneal laparoscopic ureterolithotomies with the first 25 retroperitoneal laparoscopic ureterolithotomies performed by two surgeons who had just completed a laparoscopic training programme. METHODS: The retrospective study was conducted at Adana Numune Teaching and Research Hospital and comprised retroperitoneal laparoscopic ureterolithotomies and transperitoneal laparoscopic ureterolithotomies performed by two different surgeons on patients with proximal ureteral stones between November 2011 and March 2013. The transperitoneal and retroperitoneal procedures were categorised as Groups A and B, respectively. Patients in Group A were operated on by the same surgeon (DA) and those in Group B were operated on by the other surgeon (FK). Groups were compared according to operative time, duration of drainage and urethral catheter, hospital stay, stone size, surgical success and complications. RESULTS: There were 50 patients in the study; 25(50%) in each of the two groups. Success rates in Group A and B were 21(84%) and 20(80%), respectively (p>0.05). Complications were seen in 8(32%) and 11(44%) patients in Group A and B, respectively (p>0.05). CONCLUSIONS: The transperitoneal approach was more advantageous than the retroperitoneal approach for less-experienced surgeons because it provided a wider operating field, a more familiar anatomy and more convenient suturing.

Surgical approach in adrenal incidentalomas: Report of thirteen cases and review of the literature.

OBJECTIVE: The rate of adrenal incidentalomas detected in routine diagnostic imaging techniques is approximately 4-7%. Although the lesions are generally benign, carcinoma and functional adenomas can be diagnosed with careful clinic and laboratory evaluation. MATERIAL AND METHODS: Data of 13 patients who underwent surgery for an adrenal mass between January 2010-June 2014 were analyzed retrospectively. RESULTS: Seven (54%) patients were male, 6 (46%) were female, and the mean age was 38.2. The clinical diagnosis was pheochromacytoma in 5 patients (38.4%), non-functional adenoma in 5 (38.4), and metastatic lesion, Cushing syndrome, and adrenal carcinoma each in one patient (7.6%). Conventional open adrenalectomy was performed in 8 patients, while 5 patients underwent laparoscopic adrenalectomy. CONCLUSION: Adrenal incidentalomas should be carefully evaluated for hormonal activity even if asymptomatic, and non-functional lesions should be considered as suspicious-for-malignancy. Laparoscopic adrenalectomy has become the gold standard for patients with a mass less than 6 cm, and without infiltration to adjacent organs.

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.

Treatment of Moderate Sized Renal Pelvis Calculi: Stone Clearance Time Comparison of Extracorporeal Shock Wave Lithotripsy and Retrograde Intrarenal Surgery.

PURPOSE: To compare the stone clearance times in patients undergoing extracorporeal shock wave lithotripsy (SWL) or retrograde intrarenal surgery (RIRS) for single radiopaque renal pelvis stones 10-20 mm in size. The results of this study may guide urologists and patients and aid in selecting the optimal preoperative treatment. MATERIALS AND METHODS: Between January 2013 and February 2015, we conducted a retrospective study and collected data from 333 patients treated with SWL (n = 172) or RIRS (n = 161). We included successfully treated patients with a single radiopaque renal pelvis stone 10-20 mm in size to calculate stone clearance times. RESULTS: The average stone size for the SWL group was 14.62 ± 2.58 mm and 14.91 ± 2.92 mm for the RIRS group. The mean Hounsfield unit (HU) of the patients was 585.40 ± 158.39 HU in the SWL group and 567.74 ± 186.85 HU in the RIRS group. Following full fragmentation, the mean stone clearance time was 26.55 ± 9.71 days in the SWL group and 11.59 ± 7.01 days in the RIRS group (P < .001). CONCLUSION: One of the most overlooked parameters in urinary stone treatments is stone clearance. We believe this study will shed light for those who aim to conduct larger randomized prospective studies. .

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.

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.

Experience and learning curve of retroperitoneal laparoscopic ureterolithotomy.

OBJECTIVE: This study was conducted to evaluate clinical experience and learning curve associated with laparoscopic ureterolithotomy performed for upper ureteral stones. MATERIALS AND METHODS: The medical data of 50 patients who had undergone retroperitoneal laparoscopic ureterolithotomy between June 2010 and March 2013 were retrospectively analyzed. To assess the learning curve, patients were divided into two groups: Group A (the first 25 cases) and Group B (the last 25 cases). In Group A, double J stents were placed in 17 patients, whereas in Group B 15 patients received double J stents. In Group A, three ports were placed in nine patients and four ports in 16 patients. In Group B, three ports were placed in 20 patients and five patients had four ports. The patients were compared according to demographics, operative time, stone size, complications, hospital stay, and transfusion. RESULTS: The mean age for Group A was 47.8 ± 14.13 (21-72) years and that for Group B was 44.2 ± 14.98 (22-78) years. Mean operative times were 106.4 ± 38 (55-210) minutes and 70.76 ± 30.4 (30-180) minutes for Groups A and B, respectively (p < 0.05). The mean hospital stay was 7.12 ± 4.47 (3-22) days and 4.04 ± 2.05 (2-12) days for Groups A and B, respectively (p < 0.05). The mean stone size was 20.12 ± 5.18 (12-30) mm and 19.44 ± 4.44 (13-28) mm for Groups A and B, respectively (p > 0.05). CONCLUSION: In our study, as staff experience (in performing laparoscopic retroperitoneal ureterolithotomy) increased, operative time, length of hospital stay, and complication rates have correspondingly declined.