Natural history of patients with infantile nephrolithiasis: what are the predictors of surgical intervention?

BACKGROUND: We evaluated the risk factors for the requirement of surgical intervention in infants with nephrolithiasis. METHODS: The medical records of 122 (156 kidney units (KU)) infants were reviewed. The clinical features, stone characteristics, changes in stone status, and treatment protocols were noted. The stone status of the KU was categorized into 3 groups according to the change in size between the first and last ultrasound: resolution, unchanged, and growth. RESULTS: The median age was 8 months (r: 2-12). The median length of follow-up was 16 months (r: 10-36). Resolution was detected in 94 KUs (60%). Stone growth was detected in 39 KUs (25%), and stone size was unchanged in 23 KUs (15%). Surgical intervention was required in 26 patients (17%). A history of intensive care unit (ICU) follow-up and a stone size > 5 mm at time of diagnosis were defined as independent risk factors for stone growth (p = 0.005, < 0.001, respectively). The surgical intervention rate was higher in stones > 5 mm and stones with pelvic localization (p = 0.018, 0.021, respectively). Stone resolution was higher in patients with stone size ≤ 5 mm (p = 0.018). CONCLUSION: A stone size > 5 mm at the time of diagnosis and a history of ICU follow-up are independent risk factors for stone growth. Pelvic localization of stones and stones > 5 mm are associated with an increased risk of surgical intervention.

Do urinary mast cell mediators predict immune response to BCG in patients with primary high-grade non-muscle invasive bladder cancer?

BACKGROUND: Mast cells play a critical role in cancer-associated immunity. We aimed to determine the predictive value of urinary mast cell mediators in patients with non-muscle invasive bladder cancer (NMIBC) treated with Bacillus Calmette-Guérin (BCG) immunotherapy. METHODS: In this prospective study, 19 patients who received immunotherapy because of NMIBC (Group 1) and 19 healthy participants (Group 2) were enrolled. Urine samples were collected to assay N-methylhistamine, histamine, and tryptase levels immediately before the first BCG instillation, immediately after the third and sixth instillations, and 4 weeks after the sixth instillation in Group 1 and at a single visit in Group 2. The changes in urinary markers because of BCC response, BCG instillation, and the presence of NMIBC were assessed. RESULTS: The average age was 56.1 ± 10.5 years in Group 1 and 52.6 ± 9.7 years in Group 2. Fourteen patients had high-grade Ta tumours and five had T1 tumours. While 12 patients had responded to the BCG, seven patients did not respond to the BCG. There was no correlation between mast cell mediators and BCG response. The N-methylhistamine and histamine levels significantly increased with the onset of immunotherapy, and N-methylhistamine levels significantly decreased when immunotherapy was terminated (P < .05). The pre-BCG estimated marginal mean values of N-methylhistamine were significantly higher in Group 1 than in Group 2 (P < .05). CONCLUSIONS: Our study is the first to identify the changes in mast cell mediators with the onset of immunotherapy and in presence of bladder cancer. However, these mediators cannot predict patients' response to immunotherapy.

Comparison of Ga-68 PSMA positron emission tomography/computerized tomography with Tc-99m MDP bone scan in prostate cancer patients

Background/aim: The aim of our study was to compare Tc-99m MDP bone scan and Ga-68 PSMA PET/CT in terms of detection of bone metastasis in prostate cancer patients. Materials and methods: A total of 28 prostate cancer patients with bone scan and PSMA PET/CT performed within 90 days were retrospectively included in our analysis. All bone lesions were scored as negative (score-0), positive (score-1), or suspicious (score-2) for metastasis by two experienced nuclear medicine physicians. Both patient-based and region-based analyses were made for all osseous lesions. Results: On per-patient analysis; sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were 72.7%, 52.9%, 50%, 75%, and 60.7%, respectively, for bone scan and 90.9%, 100%, 100%, 94.4%, and 96.4%, respectively, for PSMA PET/CT. On per-region analysis; sensitivity, specificity, PPV, NPV, and accuracy were 76.2%, 80.9%, 57.1%, 91.1%, and 79.8%, respectively, for bone scan and 85.7%, 100%, 100%, 95.5%, and 95.4%, respectively, for PSMA PET/CT. Conclusion: Ga-68 PSMA PET/CT has higher sensitivity, specificity, and accuracy compared to bone scan in terms of bone metastasis detection in prostate cancer patients. Therefore, it might be the modality of choice for patients with suspicion for metastatic disease, despite negative bone scan and conventional imaging results

Risk factors predicting upper urinary tract deterioration in patients with spinal cord injury: A retrospective study.

AIMS: To determine the risk factors predicting upper urinary tract (UUT) deterioration in patients with spinal cord injury (SCI). METHODS: Medical records of 303 SCI patients who referred to the urodynamic unit of a rehabilitation hospital between 1996 and 2003 were retrospectively reviewed. The data included general patient demographics, SCI characteristics, bladder management methods, serum creatinine level, presence of urinary tract infection, indwelling catheter time, radiological findings of upper and lower urinary tract, and video-urodynamic (VUD) findings. Univariate and multivariate analyses were used to determine the risk factors predicting UUT deterioration. ROC analysis was done to determine the cut-off values of detrusor pressure and cystometric bladder capacity volume predicting UUT deterioration. RESULTS: Complete data were available on 255 patients. Median patient age was 33 years (18-75). The leading causes of SCI were motor vehicle accidents (40%) and falls (29%). Upper urinary tract deterioration was determined in 63 patients (25%). Abnormal radiological LUT findings, the absence of antimuscarinic drug usage in the history, detrusor pressures greater than 75 cmH2 O and cystometric bladder capacity less than 200 ml were found to be independent risk factors in logistic regression analysis. ROC analysis revealed that values ≥75 cmH2 O for maximum detrusor pressure, <200 ml for bladder capacity, and >6 months for indwelling catheter time were cutoff values for UUT deterioration. CONCLUSION: Abnormal radiological LUT findings, the absence of antimuscarinic drug usage, detrusor pressures ≥75 cmH2 O, and cystometric bladder capacity <200 ml were independent risk factors predicting UUT deterioration SCI patients. Neurourol. Urodynam. 36:653-658, 2017. © 2016 Wiley Periodicals, Inc.

Tablets of the potassium citrate may cause a stone-like image: a case report.

An 8-year-old girl with left proximal ureteral stone (4 mm) was referred to our hospital to treat with shock wave lithotripsy (SWL). Fifteen days after the first SWL session, a plain film of kidneys, ureters and bladder (KUB) demonstrated a new stone-like opacity (10 mm) on the left kidney location other than previous stone of 4 mm. We counseled with her parents and learned that she took a potassium citrate tablet 2 h before. Potassium citrate is a radio-opaque drug and may cause a stone-like image during the stone management. Urologists should consider this particularity of potassium citrate in patients using this drug to avoid unnecessary interventions. To our knowledge, this is the first case in the literature.

Laparoscopic Treatment of the Isolated Renal Hydatid Cyst: Long-Term Outcomes from a Single Institution.

OBJECTIVE: To determine the effectiveness of treatment via laparoscopic approach and to present the long-term outcomes in patients with isolated renal hydatid cyst. MATERIALS AND METHODS: We reviewed the data of 11 patients who underwent laparoscopic treatment for isolated renal hydatid cyst between March 2004 and January 2017. Demographic characteristics and clinical, laboratory, and radiological findings of cases were examined. Mann-Whitney U and t-test were used in statistical analysis. RESULTS: The mean age of the patients was 36.7 years (25-51). The common complaint of the patients was lumbar pain and 9 patients had a palpable mass. It was identified that serologic evaluation of Echinococcus granulosus was positive in 5 patients. The mean cyst size was determined as 72 mm (40-150). The mean operation time was 128 minutes (120-150) while the length of hospital stay was 4 days (3-13). Perioperative major complication was not observed in any of the patients. The levels of hematocrit and creatinine were measured, 37.8 (26-43) and 0.93 (0.5-1.3), respectively, in the postoperative period, while these levels were 39 (26-45) and 0.90 (0.5-1.3) in the preoperative period and there was no statistically significant difference (P > .05). The mean follow-up time was 84 months (40-166). No relapses were observed in any patients. CONCLUSIONS: The treatment of renal hydatid cyst disease with laparoscopic approach is a safe and effective method. There was no recurrence in any of the patients in the long-term period. Further studies including a large series of patients are needed.

Patient Decision Making Prior to Radical Prostatectomy: What Is and Is Not Involved.

The current study assessed the decision-making process before surgery in prostate cancer patients. A structured telephone interview was conducted by an independent third party in 162 consecutive patients who underwent surgery for prostate cancer. Responders revealed that details regarding diagnosis and treatment alternatives were withheld from a significant number of patients. Radiation and active surveillance were presented as alternative options to surgery in 57 (39%) and 20 (14%) of responders, respectively. Twenty-six (18%) patients reported not being informed regarding potential surgical side effects. Patients were not active participants in critical aspects of decision making in 61 (42%) of the cases. Being inadequately informed and more frequent visits to the urologist appeared to make decisions more difficult. Treatment regret was reported by 23 (16%) of the patients who underwent surgery and was more common when the patient was not involved in the decision or was inadequately informed. As such, shared decision making should replace paternalism when managing patients with localized prostate cancer in urologic practice.

Adult paratesticular myxofibrosarcoma: report of a rare entity and review of the literature.

A case of 70 years old man with a slowly enlarging painful scrotal mass is herein reported. Computed tomography scan of the scrotum showed a homogenous and encapsulated mass, associated with the tunica albuginea. There was no evidence of any metastatic lesion(s). Orchidectomy was performed with high ligation of the spermatic cord. Histopathologic examination revealed a rare case of paratesticular myxofibrosarcoma. Complete surgical resection is the only curative treatment modality in the treatment of these low grade tumors. Adjuvant chemotherapy or radiotherapy are not recommended for paratesticular myxofibrosarcomas.

Risk Factors for Women to Have Urodynamic Stress Urinary Incontinence at A Turkish Tertiary Referral Center: A Multivariate Analysis Study.

PURPOSE: To investigate the risk factors in women with urodynamic stress urinary incontinence (USTIC) at a Turkish tertiary referral center. MATERIALS AND METHODS: The urodynamic records of 3038 consecutive women were analyzed between 1990 and 2011. The patients who had etiological factor of neurologic disease were excluded. There were 1187 women who had USTIC after urodynamic investigation and 274 women who had no incontinence symptoms were included in the study. Multivariate analyses were done using logistic regression test to determine the risk factors for USTIC. RESULTS: The mean age was 50.1 years (range, 86-18). Increased age, vaginal delivery, cesarean section, anterior prolapse existence in physical examination, previous anti-incontinence surgery, and previous pelvic organ prolapse surgery was found to be significant risk factors for USTIC at multivariate analyses. CONCLUSION: There are risk factors for women to have USTIC. Increased age, having vaginal delivery, having cesarean section, anterior prolapse, previous anti-incontinence surgery and previous prolapse surgery were found to be risk factors for women to have USTIC at this study.

What changed in the management of pediatric stones after the introduction of minimally invasive procedures? A single-center experience over 24 years.

OBJECTIVE: To assess the impact of new technology on the management of pediatric urolithiasis by analyzing our local practice over the past 24 years, and determining the role of open surgery at the present time. METHODS: We retrospectively reviewed the charts of 768 children (783 procedures) who underwent surgical treatment for urolithiasis between June 1987 and October 2010. Data were analyzed with respect to patient characteristics and changing patterns of treatment with time. We compared the type of procedures performed between four time periods: the first was before ESWL, the second was after the introduction of ESWL, the third was after introduction of PCNL, and the fourth was our experienced period with a pediatric urologist. RESULTS: The mean age of the children was 7.50 years (range 9 months-17 years). There were 495 renal, 228 ureteral, 21 bladder, 11 urethral stones, and the remaining 13 had stones in multiple locations. Of the 783 procedures performed, 75.9% were open surgery during the first period (1987-1992), 29.7% during the second period (1993-1998), 6.1% during the third period (1999-2004) and 0.2% during the fourth period (2005-2010). The number of children who underwent urinary stone treatment increased significantly (p = 0.001) and the age of the children at the time of surgery decreased (9.09-6.08 years) (p = 0.001) with time. CONCLUSION: The majority of stones in children can be managed using endourological procedures. Additionally, technological advances and improved surgical skills have greatly reduced the number of children requiring open surgery, which is mainly used for those with complex urinary calculi presenting with anatomic abnormalities. Minimally invasive techniques allow us to treat stones at an earlier age.

A spontaneous giant urinoma: a cause of abdominal mass.

OBJECTIVES: To report a case of unilateral ureteral obstruction associated with giant retroperitoneal urinoma which was treated successfully by percutaneous drainage. METHODS: A 19G ultrasound guided needle was introduced into the mass and after dilatation procedure, a 14 Fr nephrostomy catheter was placed and 5.5 of liquid were drained. RESULTS: Drainage from the nephrostomy catheter stopped 24 hours later. Patient was discharged with the nephrostomy tube. One week later, on control tomography, absence of left renal suprahilar posteromedial focal cortical contour was seen. CONCLUSIONS: A minor cortical or forniceal rupture with no urinary extravasation on radiographic examination is thought to be the cause of this urinoma. Percutaneous drainage may be considered as an alternative treatment option to surgical intervention in the treatment of urinomas, especially when there is no persistent ureteral obstruction or communication between the collecting system and the urinoma.

Urinoma gigante espontáneo como causa de masa abdominal / A spontaneous giant urinoma: a cause of abdominal mass

OBJETIVO: Presentamos un caso obstrucción ureteral unilateral asociada con un urinoma retroperitoneal gigante que fue tratado satisfactoriamente mediante drenaje percutáneo.MÉTODO: Se introdujo bajo control ecográfico una aguja del 19G en la masa, y después de dilatación se colocó un catéter de nefrostomía del 14Fr drenando 5,5 L de líquido.RESULTADOS: El drenaje por el catéter de nefrostomía cesó después de 24 horas. El paciente fue dado de alta con el tubo de nefrostomía. En la tomografía de control, una semana más tarde, se apreciaba la ausencia focal del contorno renal suprahiliar postero-medial izquierdo.CONCLUSIONES: Se piensa que la causa de este urinoma fue una rotura fornicial o cortical menor sin extravasación urinaria en las pruebas radiológicas. En el tratamiento de los urinomas el drenaje percutáneo puede considerarse una alternativa terapéutica a la cirugía, especialmente cuando no existe una obstrucción ureteral persistente ni una comunicación entre el sistema colector y el urinoma (AU)

A spontaneous giant urinoma: a cause of abdominal mass / A spontaneous giant urinoma: a cause of abdominal mass

OBJETIVO: Presentamos un caso obstrucción ureteral unilateral asociada con un urinoma retroperitoneal gigante que fue tratado satisfactoriamente mediante drenaje percutáneo. MÉTODO: Se introdujo bajo control ecográfico una aguja del 19G en la masa, y después de dilatación se colocó un catéter de nefrostomía del 14Fr drenando 5,5 L de líquido. RESULTADOS: El drenaje por el catéter de nefrostomía cesó después de 24 horas. El paciente fue dado de alta con el tubo de nefrostomía. En la tomografía de control, una semana más tarde, se apreciaba la ausencia focal del contorno renal suprahiliar postero-medial izquierdo. CONCLUSIONES: Se piensa que la causa de este urinoma fue una rotura fornicial o cortical menor sin extravasación urinaria en las pruebas radiológicas. En el tratamiento de los urinomas el drenaje percutáneo puede considerarse una alternativa terapéutica a la cirugía, especialmente cuando no existe una obstrucción ureteral persistente ni una comunicación entre el sistema colector y el urinoma (AU)