Bladder calculi concomitant with benign prostatic enlargement: is prostate surgery mandatory in patients who have never received medical therapy?

The historical dogma that bladder calculi comprise the main indication for prostatic surgery has recently been questioned. In this study, we aimed to predict which patients should undergo simultaneous prostate and bladder calculi surgery or only bladder calculi removal by evaluating preoperative risk factors. One hundred and seventeen men with bladder stones and concomitant benign prostate enlargement (BPE) who had not received medical treatment before were included in the study. In the first step, only the bladder calculi of patients were removed and medical treatment was given for BPE. The patients who benefited from medical treatment during the follow-up were defined as Group 1 and the patients who required prostate surgery for any indication comprised Group 2. Risk factors for prostate surgery requirements were determined by comparing preoperative characteristics between the two groups with a cox regression model. In the follow-up of 117 patients with bladder stones removed and medical treatment initiated, 49 (41.9%) patients had prostate surgery indications. The indication for 33 (67.3%) of 49 patients was medical treatment failure. The presence of intravesical prostatic protrusion (IPP; hazard ratio: 2.071, 95% confidence interval [CI]: 1.05-4.05, P = 0.034), and high postvoiding residual urine volume (hazard ratio: 1.013, 95% CI: 1.007-1.019, P < 0.001) were found to be preoperative risk factors for needing future prostate surgery. In patients who have not received medical treatment for BPE before, bladder calculi developing secondary to BPE do not always constitute an indication for prostate surgery.

What is the best approach for pediatric kidney stones of moderate-sized between shock wave lithotripsy, ultramini percutaneous nephrolithotomy and retrograde intrarenal surgery?

PURPOSE: This study aimed to compare the results of ultramini percutaneous nephrolithotomy (UMP), shock wave lithotripsy (SWL) and retrograde intrarenal surgery (RIRS) in pediatric patients with kidney stones 10-20 mm size. METHODS: The files of 159 pediatric patients (36 RIRS, 39 SWL, 84 UMP) with kidney stones were reviewed retrospectively. Preoperative age, sex, stone size and location were evaluated. The three methods were compared in terms of operation and fluoroscopy duration, complications with the modified Clavien grading system, and stone-free rate (SFR) in the postoperative first month. RESULTS: The stone burdens of the groups were similar (P = 0.102). At the end of the first month, SFR was higher in the RIRS and UMP groups compared to the SWL group (88.9%, 92.9% and 69.2%, respectively, P = 0.002). UMP had higher SFR for lower pole stones than the other two methods (P = 0.042). There was no difference in complications between the three methods (P = 0.758). CONCLUSION: SFR was similar for all three methods in all localizations, apart from lower pole stones. UMP had higher SFR for lower pole stones than the other two methods. There was no difference in terms of complications between the three methods.

Comparison of Laparoscopic and Open Surgery in the Treatment of Renal Hydatid Cysts.

Background: To compare the efficacy, safety, and long-term results of laparoscopic and open approaches in patients undergoing surgery for renal hydatid cyst. Materials and Methods: The files of 36 patients who were surgically treated in our clinic and with diagnosis of renal cyst hydatid confirmed pathologically were reviewed. According to the surgical technique applied, the patients were divided into two groups as open (group 1) or laparoscopic (group 2) partial pericystectomy. Oral albendazole was given 10 mg/kg/day (in two divided doses) for 4 weeks preoperatively and for three cycles of 4 weeks at 1-week intervals after surgery in all patients. Demographic characteristics, laboratory and imaging findings, operation times, hospitalization times, complications, intraoperative bleeding amounts, and recurrence rates were statistically compared in both groups. Results: Open partial pericystectomy was performed in 21 patients in group 1, and laparoscopic transperitoneal partial pericystectomy was performed in 15 patients in group 2. Operation time and intraoperative bleeding amount in group 1 and group 2 were 119.6 ± 17.1/116.1 ± 17.6 minutes and 125.7 ± 27.8/113.9 ± 19.2 mL, respectively. There was no statistically significant difference between these values (P = .557, P = .167, respectively). Hospitalization duration of both groups was 5.9 ± 1.4/3.6 ± 0.7 days, respectively. Hospitalization duration in group 2 was statistically significantly shorter (P < .001). No recurrence occurred during postoperative follow-up in either group. Conclusions: In the treatment of renal hydatid cysts, laparoscopy, which is a minimally invasive approach, can be technically applied with the same principles as open surgery and has a similar efficacy and safety profile for short- and long-term results.

Effects of Infertility on Voice in male patients.

Purpose: In this study, we aimed to determine the differences in normospermic, oligospermic and azoospermic infertile men by performing voice analysis and to discuss this in the light of the literature. Methods: 71 male patients who applied to the urology clinic due to infertility and were then referred to us were included in the study. Hormone analysis and spermiogram were requested from the patients for routine infertility tests. Testosterone, Follicle stimulating hormone (FSH), Luteinizing hormone (LH), Prolactin levels of the patients were recorded. Age and spermiogram results were recorded. According to the spermiogram results, the patients were categorized as Group 1 (azoospermic), Group 2 (oligospermic), Group 3 (normospermic). Voice Handicap Index-10 Turkish version (VHI-10) was applied to the patients and the results were recorded. Results: The age of the infertile patients ranged from 20 to 37. The mean age was 28.23. The distribution of the patients was 21 patients in Group 1, 40 patients in Group 2, and 10 patients in Group 3. The mean Testosterone level of the patients was 2.78; mean FSH level 12.14; mean LH level 7.26; mean Prolactin level was 8.1. The mean VHI-10 scores of the patients were 10.52. The fundamental frequency F0 Hz (mean pitch) values of the patients were 176,468; jitter % (frequency perturbation jitter) values average 0.25; shimmer % (amplitude perturbation shimmer) values average 2,322; HNR dB values averaged 24,862. Conclusions: Testosterone is more effective on the voice, especially in male individuals.It would be more logical to think that many hormones, growth factors and local factors are effective instead of a single hormone.

Small renal pelvis stones: Shock wave lithotripsy or flexible ureteroscopy? A match-pair analysis.

OBJECTIVE: Kidney stones in renal pelvis may be treated using various methods. For larger stones, percutaneous nephrolitotomy (PNL) is the first choice of option; where for smaller stones, shock wave lithotripsy (SWL) or flexible ureteroscopy (F-URS) could be more suitable options. In this article we aimed to compare the outcomes of F-URS and SWL on the treatment of renal pelvis stones <10 mm. MATERIAL AND METHODS: Files of patients treated with SWL and F-URS for renal pelvis stones <10 mm between March 2013 and May 2016 in our clinic were analyzed. For comparison, a match-pair analysis was designed. Complete stone removal was considered success. RESULTS: Forty patients were treated using F-URS (Group 1) and 40 patients underwent SWL (Group 2). Patients were assessed the day after the last session of the procedure. The early stone-free rates were 70% (28/40) in Group 1, and 15% in Group 2 (p<0.05). The same analysis was performed after three months. Stone-free rates were 100% and 92.5% in Groups 1 and 2, respectively (p=0.079). Three patients in Group 2 were not stone free after 3 sessions of SWL and considered unsuccessful. They were all successfully treated by F-URS. CONCLUSION: Even though there is no statistical difference among groups, our data may be interpreted as having better outcomes and tolerability with F-URS than SWL. We believe F-URS may have a great treatment prospect in this particular patient group.

Conservative/surgical treatment predictors of maternal hydronephrosis: results of a single-center retrospective non-randomized non-controlled observational study.

PURPOSE: To determine the parameters that may help the clinicians decide the best suitable treatment method for the pregnant women with symptomatic hydronephrosis which will be based on the easily accessible laboratory tests, monitoring methods and clinical symptoms. METHODS: Digital data and documents of 246 pregnant women with symptomatic hydronephrosis who were hospitalized in our clinic between the dates of January 2011 and January 2016 were retrospectively evaluated. All patients were statistically evaluated in terms of age, symptomatic maximal anterior-posterior diameter of the renal pelvis (MADP), parity, C-reactive protein (CRP) level, white blood cell count (WBC), presence of pyuria, growth of urine culture, fever, serum urine and creatinine levels, visual analog scale (VAS) score of pre- and post-therapy and threatened preterm labor. RESULTS: The study includes a total of 211 pregnant women with symptomatic hydronephrosis. In the second and third trimester groups, the surgical treatment group statistically provided higher levels of CRP, WBC and VAS. Mean MADP in the second trimester of the conservative and surgical groups where symptomatic hydronephrosis was on the right side was 16.67 ± 4.67 and 28.68 ± 7.70 mm, respectively. Mean MADP in the third trimester group of the conservative and surgical groups where symptomatic hydronephrosis was on the right side was 16.96 ± 5.96 and 28.85 ± 7.64 mm, respectively. CONCLUSIONS: In patients with symptomatic pregnancy hydronephrosis, the likelihood of surgical treatment for CRP levels, WBC counts and VAS is high.

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.

Papillary ureteral neoplasm of low malignant potential in the upper urinary tract: endoscopic treatment.

INTRODUCTION: Papillary ureteral neoplasm of low malignant potential (PUNLMP) is a rare diagnosis, and to our knowledge, has not yet been reported in the upper urinary tract. In this study, we aimed to present our experience in managing a very rare diagnosis, PUNLMP, in the upper urinary tract, with endoscopic treatment. MATERIALS AND METHODS: Files of patients who received surgery between January 2007 and January 2013 for upper urinary tract tumors were reviewed and patients treated for PUNLMP in the upper urinary tract in 4 urology clinics were reviewed. Patients included in the study had at most 2 tumors in the ureter and had a pathology of PUNLMP. RESULTS: The study included 11 patients with a mean age of 58.5 years. There were 9 men, and 2 women with a smoking rate of 81.8%. Nine patients (8 in the distal and 1 in the mid ureter) were managed using a semirigid ureteroscope. Two patients (1 with mid ureteral and 1 proximal) were treated using flexible ureteroscopy. The mean hospital stay was 1.56 days. Mean surgical time was 37.18 ± 7.14 minutes. The mean follow-up was 31.5 (range, 7-72) months. In the follow-ups, 3 patients had recurrences of 3, 2, and 4 mm in 9, 15, and 17 months, respectively. CONCLUSION: For tumors with a low risk of progression and relatively low risk of recurrence, organ-sparing treatments should be the choice of preference. To support our initial findings, randomized controlled studies on larger cohorts should be designed.