Surgical patterns in the endoscopic management of pediatric ureterocele: A systematic review and meta-analysis.

OBJECTIVE: To assess the results of endoscopic ureterocele treatments as well as the effects of ureterocele location (intravesical vs. ectopic) and anatomy (single vs. duplicated system) on treatment outcomes. MATERIAL AND METHODS: Following the Systematic Reviews and Meta-Analyses (PRISMA) standards, several medical databases as well as Google Scholar were searched comprehensively. Studies describing secondary operation outcomes for endoscopic transurethral incision and puncture were included. Studies were required to compare patients according to ureterocele location (intravesical or ectopic) and anatomy (single or duplex system) or preoperative reflux. Meta-analysis was conducted using Comprehensive Meta-analysis (CMA) software. RESULTS: A total of 83 studies entered this systematic review consisting of 3022 patients. According to the meta-analysis of 16 studies, the risk ratio (RR) of reoperation after ureterocele incision was significantly higher in patients with ectopic vs. intravesical ureteroceles (RR: 2.42; 95% CI: 1.89-3.11; P < 0.001; I2: 14.89%). Also, a higher reoperation rate was reported in patients with duplex system ureteroceles (DSU) vs. single system ureteroceles (SSU) with little heterogeneity based on 9 studies. (RR: 2.50; 95% CI: 1.60-3.91; P < 0.001; I2: 13.83%). CONCLUSION: Our results showed that ectopic ureteroceles and duplex systems are associated with higher reoperation rates after endoscopic procedures.

A study on comparative outcomes of percutaneous nephrolithotomy in prone, supine, and flank positions.

PURPOSE: To compare percutaneous nephrolithotomy (PCNL) safety and efficacy in prone, supine, and flank positions. METHODS: A total number of 150 candidates for PCNL were randomly assigned into prone, supine, and flank groups. Patients in groups 1 and 2 underwent fluoroscopy-guided PCNL in prone and supine positions, respectively, while patients in group 3 underwent ultrasonography-guided PCNL in lateral position. RESULTS: The success rates were 92, 86, and 88 % in prone, supine, and flank positions, respectively (P = 0.7). The mean access duration was 6.9 ± 4.2, 11.1 ± 5.8, and 10.8 ± 4.1 min (P = 0.08), and the mean operation time was 68.7 ± 37.4, 54.2 ± 25.1 and 74.4 ± 26.9 min (P = 0.04) in prone, supine, and flank groups, respectively. Pyelocaliceal perforation occurred in 2 (4 %), 2 (4 %), and 3 (6 %) patients in prone, supine, and flank positions, respectively (P = 1). CONCLUSION: We believe that PCNL in both supine and flank positions are as safe and relatively effective as prone position in experienced hands. Preference of the surgeon and proper case selection for each procedure is very important and necessary.

Ultrasonography-guided PNL in comparison with laparoscopic ureterolithotomy in the management of large proximal ureteral stone.

PURPOSE: The aim of study was to evaluate the clinical outcomes of PNL in comparison with laparoscopic ureterolithotomy (LUL) in proximal ureteral stones larger than 1 cm. MATERIALS AND METHODS: A total of 80 patients who were candidates for treatment of large ureteral stones in our urology center were enrolled in the study between September 2004 and September 2008. By using patient randomization, they were assigned into two forty-patient groups (PNL and LUL). After evaluating the patients with laboratory tests and IVP, PNL was performed under sonography guidance in the prone position or the patients were submitted to classic laparoscopic ureterolithotomy (LUL) transperitoneally. All patients underwent postoperative assessments including KUB and ultrasonography. RESULTS: A hundred-percent success was achieved in both groups. The mean age of the patients were 39.4 (16-63) and 35.2 (18-57) years old in PNL and LUL groups, respectively. The mean stone size in PNL group was 14.2 (10-25) mm and in LUL group was 13.5 (10-28) mm. The duration of the operations were 54.35 (50-82) minutes, and 82.15 (73-180) minutes (P < 0.0001); and the average hospital stay days were 2.6 (2-5) and 3.5 (3-8) days (p = 0.011) in groups PNL and LUL, accordingly. The mean Hb decrease in PNL group was 0.9mg/dL and in LUL group was 0.4mg/dL (p = 0.001). No statistically significant differences in terms of blood transfusion, fever, ICU admission, and prolonged urinary leakage were detected in both groups. CONCLUSION: According to our study, percutaneous nephrolithotomy under ultrasonography guidance is comparable with the laparoscopic ureterolithotomy for the treatment of proximal ureteral stones larger than 1 cm.

Chronological perspective of substitute materials used for the surgical treatment of Peyronie's disease: A scoping review of literature.

This comprehensive scoping review aimed to identify all up-to-date original publications relating to substitute materials used for the surgical treatment of Peyronie's disease (PD), and characterize what material in which chronological trends were published in the current literature. Using the PCC framework (P: population, C: concept, and C: context), a search strategy was developed and used in four electronic databases, in addition to the Google scholar. All current published, in-press, and pre-print manuscripts with available English full-text were included. Eligible studies were required to be original research articles of any study design, reporting the usage of grafts on surgical treatment of PD. Included studies were reported in a narrative synthesis format. A total of 3379 articles were identified via an electronic search of databases and a total of 171 articles entered this scoping review. Most studies originated from Europe (n = 72) and North America (n = 66). Reports from the other continents increase in number in the 21st century. Highest number of the published papers was seen in 2001 to 2005 pentad. Autologous grafts (53.5%). Allografts (22.7%) and xenografts (15.7%) were the most frequently reported materials. Time flow of the used material and the alterations in trends for them is quite considerable. A global perspective of relevant publications on substitute materials in the surgical management of PD is presented in this review. The information in this summary may assist in establishing future research priorities in this area.

The optimum cut-off value of contralateral testis size in the prediction of monorchidism in children with nonpalpable testis: A systematic review.

BACKGROUND: Contralateral Testis Hypertrophy (CTH) is a clinical marker that could be used to guide the choice of the main surgical strategy. In patients with a Non-palpable Testis (NPT), the degree of CTH as measured by testicular length or volume has been shown to be able to predict whether the undescended testis will survive. OBJECTIVE: The purpose of this study was to establish the proper cut-off for identifying non-viable testes based on the current literature. DESIGN: We systematically searched several medical databases as well as Google Scholar search engines for references and citations. All the studies that reported CTH as a result of NPT in prepubertal boys were included. Data from the included articles was gathered by two independent reviewers. The checklist developed by the Joanna Briggs Institute (JBI) was used to evaluate the methodological quality of the studies that were included. Due to the incredibly high degree of heterogeneity among the studies, no meta-analysis was done. RESULTS: The current systematic review included 17 studies that assessed the cut-off point to detect non-viable testis. The size and length of the testes were taken into consideration based on our findings. We found that different studies reported various ideal cut-off values for predicting non-viable testes, which can be brought on by various measuring techniques, evaluation ages, and patient groupings. The difference in testis volume was greater than the difference in its length, which can be attributable to the fact that some studies used an orchidometer to measure the testis's length directly or indirectly. CONCLUSION: According to the results of our study, it seems that defining a cut point for diagnosis of CTH based on the size of the testis, cannot demonstrate the absence of a non-palpable testis.

Protective effect of Eprosartan against ischemic acute renal injury: Acting on NF-κB, caspase 3, and Sirtuin 1.

Kidney ischemia/reperfusion (I/R) injury is a leading cause of acute kidney injury (AKI) occurring frequently under major surgeries and sepsis. This study aimed to evaluate the effect of Eprosartan, an angiotensin II receptor type-1 (AT-1) antagonist, on the kidney I/R rat model. Male Wistar rats (n = 24) were allocated into (i) Sham, (ii) Eprosartan, (iii) I/R, and (iv) Eprosartan + I/R groups. Animals in the last group received a single dose of Eprosartan (60 mg/kg) 1 h before kidney I/R. Renal oxidant/antioxidant, inflammatory (NF-κB p65, COX-2, IL-6, TNF-α), and apoptotic (caspase-3, Bax, Bcl2) factors along with Sirtuin 1, Klotho, and mitochondrial biogenesis (PGC-1α, and Sirtuin 3) factors were evaluated by Western blotting. Significant recovery of kidney function and increased levels of antioxidant markers were observed in the Eprosartan + I/R group. The Eprosartan anti-inflammatory activity was demonstrated by significant downregulation of NF-κB and its downstream pro-inflammatory factors. Eprosartan pretreatment could also abolish I/R-induced alterations in the apoptotic parameters. Moreover, Eprosartan + I/R rats significantly presented higher levels of Sirtuin 1 content. In conclusion, Eprosartan exhibited nephroprotective effects against kidney damage induced by I/R in rats by decreasing oxidative stress, inflammatory, and apoptotic pathways along with increasing Sirtuin1 level.

Urodynamic findings in young men with chronic lower urinary tract symptoms.

AIM: To assess frequency of urodynamic abnormalities in young men with chronic lower urinary tract symptoms (LUTS). MATERIALS AND METHODS: We assessed 456 men (18-40 years old) with chronic LUTS. Those with the history of urogenital malignancies, neurological disease, urethral stricture or trauma, acute UTI, congenital urological disease, and diabetes mellitus were excluded. Patients were classified by special urodynamic diagnosis. RESULTS: Mean patient age was 25.8 ± 5.9 years old and the mean symptom duration was 12.3 ± 3.2 months. Urodynamic studies showed bladder neck dysfunction in 96 of cases (21%), dysfunctional voiding in 69 (15.1%), detrusor overactivity in 62 (13.6%), small cystometric capacity in 49 (10.7%), and acontractile detrusor in 48 (10.5%), underactive detrusor in 11 (2.4%), low compliance in 18 (3.9%), detrusor overactivity plus acontractile detrusor in 6 (1.3%), low compliance plus small cystometric capacity in 5 (1.0%), detrusor overactivity plus small cystometric capacity together with low compliance in 4 (0.8%), low compliance plus Underactive detrusor in 3 (0.6%) and normal urodynamics in 85 (18.6%). Mean Q(max) in patients with bladder neck dysfunction, dysfunctional voiding, underactive detrusor, acontractile detrusor, underactive detrusor plus low compliance, and acontractile detrusor plus detrusor overactivity were lower than those of the other groups. Mean postvoid residues in patients with underactive detrusor, and underactive detrusor plus low compliance, were higher than those in the remaining groups. Positive four-glass test in patient with normal urodynamic was greater than those in the remaining groups. CONCLUSION: A few clinical symptoms or noninvasive tests were useful in young men with chronic LUTS; hence, urodynamics are advised to make the correct diagnosis in this regard.

Impact of transcutaneous interferential electrical stimulation for management of primary bladder neck dysfunction in children.

INTRODUCTION: Several studies have revealed that electrical stimulation is an effective modality for treatment of lower urinary tract (LUT) dysfunction via raising the capacity or compliance of the bladder or maybe by pelvic floor relaxation and reducing detrusor pressure as well. OBJECTIVE: This study aimed to assess the efficacy of transcutaneous interferential (IF) electrical stimulation on LUT symptoms as well as urine flow parameters in children with primary bladder neck dysfunction (PBND). STUDY DESIGN: We reviewed the charts of all children with persistent LUT symptoms who underwent IF electrical stimulation between 2010 and 2017. Twenty-three neurologically and anatomically normal children (mean age: 7.7 years, range: 5-13) with LUT symptoms were included in this study. Children had different LUT symptoms such as hesitancy, straining, urinary incontinence and constipation with no sufficient response to medical treatment (α -blocker) for at least 6 months. IF electrical stimulation was performed for 15 sessions, two times per week. All children were symptomatic and had abnormal urine flow pattern with an electromyographic (EMG) lag time of more than 6 s on uroflowmetry with EMG. A voiding chart, uroflowmetry with EMG and kidney and bladder ultrasounds were performed before and after the treatment for all children. Maximum and average urine flow rates, EMG lag time and postvoid residual volume were analyzed. In addition, alpha blocker therapy was continued during IF therapy. RESULTS: Mean maximum and average urine flow rates improved from 14.1 to 7.6-19.7 ml/s and 9.5 ml/s, respectively, while mean EMG lag time decreased from 11.7 to 5.2 s after the treatment (all P < 0.05). Also postvoid residual volume decreased significantly from 35.6 to 7.6 ml at the end of treatment courses. DISCUSSION: Pelvic floor EMG lag time, a documented parameter on uroflowmetry with EMG, defined as the time from the start of pelvic floor relaxation during a volitional voiding effort (the first stage of normal voiding) to the start of urine flow. Results showed that IF therapy decreased pelvic floor EMG lag time in children with PBND. In addition, increase in mean maximum and average urine flow rates in our patients indicated that pelvic IF therapy and behavioral modification improved voiding dysfunction in most of the patients and probably decreased bladder neck activity during voiding. Future studies with larger sample size are needed to support this finding. CONCLUSION: IF therapy appears safe, effective and reproducible in improvement of PBND in children.

COVID-19 outbreak and the impact on renal disorders: A rapid review.

In this rapid review, we aimed to evaluate the effect of coronavirus disease 2019 (COVID-19) on renal functions and mortality of patients with kidney diseases. We searched MEDLINE, The Cochrane Library, Scopus, Embase, Web of Science, UpToDate, and TRIP databases using the following keywords: COVID-19, COVID19, 2019-nCoV, 2019-CoV, coronavirus, SARS-nCoV-2, urology, cancer, bladder, prostate, kidney, trauma, stone, neurogenic, and reconstructive. The initial search resulted in 495 records. After the primary screening of titles, abstracts, and full texts and removing duplicates, 10 articles were selected and included in this rapid review. Moreover, we performed meta-analysis of binary data for the outcomes with sufficient data. Owing to a high level of heterogeneity because of different study designs and contexts, we used a random model for the meta-analysis. Only 5 studies were eligible for the meta-analysis. In these studies, comprising 964 COVID-19 positive patients, the cumulative event rate of acute kidney injury (AKI) was 7.1% (95% confidence interval: 1.8%-24.5%, p<0.001, I2=92.4). Based on the qualitative synthesis of the 10 included studies, patients with COVID-19 and kidney diseases had higher risk of in-hospital mortality. If AKI occurs because of the novel coronavirus, the mortality rate will be very high. Therefore, we need further investigations and more studies to recognize the extent and the cause of renal involvement in COVID-19.

Characteristics of Traumatic Urogenital Injuries in Emergency Department; a 10-year Cross-sectional Study.

INTRODUCTION: Urogenital system injuries (UGIs) are seen in 10% of adult cases with multiple trauma. Although UGIs are rarely life threatening, they can cause major long-term morbidities. This study aimed to evaluate the characteristics of traumatic UGIs in patients who were referred to emergency department following multiple traumas. METHODS: This retrospective cross-sectional study was conducted on multiple trauma patients who were presented to emergency department during a 10-year period (2008-2017). All patients with kidney, ureter, bladder, urethra, or external genitalia injuries were studied. The patients' data were extracted from their clinical profiles. RESULTS: Out of the 13598 admitted patients in our trauma center, UGIs were seen in 267 (1.9%) cases. The mean age of patients with UGIs was 27.3 ± 6.1 years (74.15% male). The highest incidence of UGI was seen in those aged between 21 and 30 years (39.7%) and motorcycle accidents (49%) was the most frequent cause of trauma. 221 patients had an unstable situation and were emergently transferred to operation room (13.57% with traumatic kidney injury). The most common injured sites of urogenital system were kidney with 155 (58%) cases, followed by external genitalia with 91 (34.1%) cases. 77.5% of cases were managed conservatively and the rest (22.5%) underwent surgical procedures. CONCLUSION: UGIs comprise a low percentage (2%) of traumatic injuries, which are mostly caused by blunt trauma due to road traffic accidents. Kidney is the most common injured organ and UGIs mostly happen in young ages.

Multivalent calix[4]arene-based fluorescent sensor for detecting silver ions in aqueous media and physiological environment.

A new derivative of dipodal 1,3-calix[4]arene-based chemosensor (R), which was containing several binding sites have been synthesized and characterized by NMR, IR and LC-MS spectroscopic methods. The selectivity of Rhas been investigated in aqueous methanol, resulting in fluorescence shift and selective recognition of Ag+ among 20 various alkali, alkaline earth and transition metal ions. Microstructural features of R and its complex with Ag+have been investigated by Atomic Force Microscopy (AFM). AFM images can clearly differentiate R from its complex of Ag+. Moreover; the complicated binding mode of metal-ligand complex has been explored by UV-Vis, LC-MS, FIR, Fluorescence titration, Job's plot method and theoretical approaches. Density functional theory (DFT) method at B3LYP/LANL2DZ level of theory was employed for computational studies. Theoretical calculations revealed that selectivity and specificity of R toward Ag+ could be attributed to structural conformation of 1,3-alternate-calix[4]arene scaffold and molecular electrostatic potential of its surface. Furthermore; the competitive experiments were carried out to test sensor's ability for practical uses. Finally, the efficiency of R in matrix of physiological cations was examined and showed gradual emission enhancement which makes R an ideal candidate for monitoring of Ag+ in physiological environment.

New ZnO nanostructures as non-enzymatic glucose biosensors.

In a new approach, shape controlled synthesis of zinc oxide nanostructures were carried out using a solvothermal route assisted amino acids such as L-Lysine (lysine), L-Cysteine (cysteine) and L-Arginine (arginine) as bifunctional species with (or without) urea or oxalic acid as additives which affect the pH of the reaction. Rod, powder, particle, cube, rock candy-like, sheet, sphere, brain-like, groundnut-like and pussy willow-like morphologies were obtained through the synthetic route. Particle sizes varied from 25 nm to4 µm. To test the application, nine ZnO nanostructures, formulated by multi-walled carbon nanotube (MWCNT) on glassy carbon electrode (GCE) were applied as new nanobiosensors for detecting glucose in a simple and inexpensive way without using any glucose oxidase or nafion. Glucose sensing accomplished in a phosphate buffer solution (PBS, pH=7) for ZnO/MWCNT/GCE samples. Results showed that in this non-enzymatic biosensor system, spherical ZnO obtained from zinc acetate/cycteine/oxalic acid synthetic route has the highest sensitivity of 64.29 µA/cm(2) mM with repeatable results. For the mentioned sensor, no interference observed in the presence of dopamine, uric acid and fructose.

Diode laser ablation of prostate and channel transurethral resection of prostate in patients with prostate cancer and bladder outlet obstruction symptoms.

PURPOSE: To evaluate the efficacy of diode laser ablation of prostate for treating lower urinary tract symptoms (LUTS) in patients with locally advanced prostate cancer and comparing results with palli­ative transurethral resection of prostate (pTURP). MATERIALS AND METHODS: Thirty-six known cases of locally advanced prostate cancer with a maximum urinary flow rate (Qmax) of 12 mL per second or less and an International Prostate Symptom Score (IPSS) of 20 or more were included in this study. Patients were randomized into two groups. The first group underwent pTURP and for the second group diode laser ablation of prostate was done. In 6 months post-operative follow up, patients were evaluated for IPSS, post void residual (PVR) urine volume, Qmax and possible complications such as urethral stricture or urinary incontinence. RESULTS: Postoperatively, mean IPSS was 11.1 ± 4.1 in TURP group and 11.7 ± 3.6 in laser group (P = .64). Mean PVR was 18.4 ± 3.5 mL in TURP group and 17.7 ± 6.3 mL in laser group (P = .68). Mean Qmax in TURP and laser groups were measured 20.1 ± 4.5 mL/s and 19.4 ± 2.6 mL/s, respectively (P = .57). While there was a significant improvement in IPSS and Qmax and PVR in both groups, statisti­cal analysis did not show any significant difference postoperatively between pTURP and laser groups. CONCLUSION: Diode laser ablation of prostate and pTURP, both improved significantly IPSS, PVR and Qmax. But hospital stay and post-operative catheterization time was less in laser group.

Blind versus fluoroscopy-guided percutaneous nephrolithotomy: a randomized clinical trial.

PURPOSE: Due to the negative impact of radiation on the patient and the surgical team during percutaneous nephrolithotomy (PCNL), we aimed to evaluate success rate and complications of blind access for PCNL using lumbar notch landmark and compare with conventional fluoroscopy-guided access. MATERIALS AND METHODS: In a clinical trial, 100 patients who were candidate for PCNL, were randomly assigned into blind group (1) and fluoroscopy-guided group (2). In group 1 the lumbar notch was used to guide percutaneous access and in group 2 fluoroscopy performed after needle insertion, Amplatz placement and at the end of surgery. If the access failed, we would repeat puncturing up to 5 times. In group 2, access was achieved using full fluoroscopy guidance. All patients underwent postoperative assessment including kidney-ureter-bladder X-ray and ultrasonography. RESULTS: Both mean access time and mean operation time were statically similar in group 1 and group 2 (3.3 ± 0.5 vs. 3.6 ± 0.7 min and 35.2 ± 4.6 vs. 38.9 ± 4.1 min, respectively). A successful puncture was achieved in 86% and 94% of the patients in groups 1 and 2, respectively (P = .18). Total success rate of procedure was 80% and 88% of the patients in groups 1 and 2, respectively (P = .27). CONCLUSION: According to this study, it seems that blind access is a safe and effective PCNL method, and we recommend employment of this technique by skilled endourologist in urology centers especially for patient with large hydronephrotic kidney.

Effects of surgical position on patients' arterial blood gases during percutaneous nephrolithotomy.

PURPOSE: To compare arterial blood gas analysis of patients who underwent percutaneous nephrolithotomy (PCNL) in flank position under ultrasonography guidance with PCNL in prone and supine positions under fluoroscopic guidance. MATERIALS AND METHODS: In a clinical trial, a total of 90 patients with no upper urinary tract abnormalities were candidate for the PCNL. They were assigned into three groups using pseudorandomization method (30 patients in each group). Patients in group 1 underwent ultrasonography-guided PCNL in flank position. Patients in groups 2 and 3 underwent fluoroscopic-guided PCNL in prone and supine positions, respectively. Arterial blood gas was taken just before and 20 minutes after repositioning. RESULTS: The patients' mean age was 40.8 ± 6.9, 39.4 ± 10.6, and 37.2 ± 11.1 years in flank, prone, and supine positions, respectively (P = .69). The mean body mass index was 27.8 ± 3.4, 26.7 ± 4.7, and 28.1 ± 5.1 kg/m² in flank, prone, and supine positions, respectively (P = .21). Arterial oxygen pressure (PaO2) increased significantly in flank (111.7 ± 43.8 to 132.8 ± 58.1 mmHg; P = .01) and prone (118.6 ± 50.2 to 134.6 ± 58.5 mmHg; P < .001) positions and decreased nonsignificantly in supine group (121.7 ± 64.5 to 119.7 ± 60.9 mmHg; P = .23). With surgical positioning, there were no significant changes demonstrated in PaCO2 and serum concentration of HCO3 in the flank, prone, and supine groups. CONCLUSION: We could suggest that flank and prone positions could improve patients' oxygenation during PCNL procedure.

Is it necessary to place a Double J catheter after laparoscopic ureterolithotomy? A four-year experience.

PURPOSE: To assess the necessity of placing a ureteral stent after transperitoneal laparoscopic ureterolithotomy (TPLU). PATIENTS AND METHODS: In the period from May 2006 to November 2010, 46 patients underwent TPLU. There were 13 females and 33 males. All patients had an impacted stone larger than 1.5 cm in the upper and middle parts of the ureter. TPLU was performed as either a primary therapy or as a salvage therapy in patients in whom another treatment had failed. The exclusion criteria were pregnancy, a body mass index more than 35, and patients with abnormal results on coagulative tests. In all cases, after removing the stone, the ureter was sutured. In the first 23 patients, no ureteral catheter was placed, but in the second 23 patients, a Double J catheter was inserted through the ureter. RESULTS: In one case, the stone was pushed back. The stone-free rate was 97.8%. There were four cases of prolonged urinary leakage after the surgery. All of them were in the group in whose members the Double J catheter had not been placed. The problem was resolved in one patient spontaneously after 4 days, but for the other three patients, a Double J catheter was placed and the leakage was stopped in 24 hours. There was no case of urinary leakage in the second group of patients with a placed Double J catheter. CONCLUSION: Placing a Double J catheter during surgery does not increase the time of operation and may play a role in prevention of urinary extravasation after laparoscopic ureterolithotomy.

Ultrasonography-guided percutaneous nephrolithotomy in the flank position versus fluoroscopy-guided percutaneous nephrolithotomy in the prone position: a comparative study.

BACKGROUND AND PURPOSE: Gaining access to the pyelocaliceal system in percutaneous nephrolithotomy (PCNL) is routinely performed using fluoroscopic guidance with the patient in a prone position. We compared ultrasonography-guided access for PCNL with the patient in the flank position with conventional fluoroscopy-guided access. PATIENTS AND METHODS: A total of 60 patients were randomly separated into two 30-patient groups--namely, ultrasonography-guided access with the patient in the flank position as group 1, and fluoroscopy-guided access with the patient in the prone position as group 2. In group 1, the entire procedure was performed under ultrasonography guidance. RESULTS: Successful access was achieved 100% in both groups. The success rate was 86.7% in group 1 and 90% in group 2 (P = 0.45). The residual stone rate (stone >or=4 mm) was 13.3% in group 1 and 10% in group 2. The access duration was 14.5 +/- 2.6 minutes and 9.4 +/- 2.3 minutes in groups 1 and 2, respectively (P < 0.05). No significant differences for complications without any adjacent injuries were detected in both groups. Furthermore, the average hospital stay was 2.7 +/- 0.3 and 2.9 +/- 0.3 days accordingly for groups 1 and 2 (P = 0.89). CONCLUSION: Ultrasonography has a high ability to access calculi more easily through the pyelocaliceal system with the patient in the flank position. It is convenient for urologists, and the return to the supine position is possible easily when necessary. Besides, PCNL under ultrasonography guidance and with the patient in the flank position has high success rates and limited complications; hence, we recommend this technique as an alternative procedure for fluoroscopy-guided PCNL.

Desmopressin as an alternative solution for urinary leakage after ureterocaliceal surgeries.

INTRODUCTION: Persistent urine leakage is common following iatrogenic urinary collecting system injuries. Management of a urine leak usually includes manipulations such as catheter drainage, ureteral stenting, and percutaneous nephrostomy placement. The aim of this study was investigation the potential beneficial effect of desmopressin in reduction of urinary leakage duration. MATERIALS AND METHODS: Fifteen patients with incisional urinary leakage were enrolled in this study. They had undergone pyeloplasty (n = 9), pyelolithotomy (n = 4), and ureterocaliceal anastomosis (n = 1). All of them had ureteral stenting or nephrostomy catheters, and urinary leakage had lasted for at least 15 days. Seven patients received desmopressin spray, 1 puff, twice a day, from the 16th days of urinary leakage, and 8 patients (control group) did not receive any medical treatment. The duration of urinary leakage was compared between the two groups. RESULTS: The patients were 5 women and 10 men with the median age of 37 years (range, 26 to 58 years). None of the patients had urinary obstruction. There were no significant differences in age and sex distribution between the two groups. The mean urinary leakage duration was 28.7 +/- 7.2 days in the patients of desmopressin group and 47.7 +/- 8.8 days in those of the control group (P = .04). CONCLUSION: Our study showed that desmopressin can reduce the duration of incisional urinary leakage. We conclude that patients with prolonged urinary leakage after pyelocaliceal surgery who does not respond to surgical urinary drainage may benefit from desmopressin.

Ultrasonography-guided PNL in comparison with laparoscopic ureterolithotomy in the management of large proximal ureteral stone

Purpose: The aim of study was to evaluate the clinical outcomes of PNL in comparison with laparoscopic ureterolithotomy (LUL) in proximal ureteral stones larger than 1 cm. Materials and Methods: A total of 80 patients who were candidates for treatment of large ureteral stones in our urology center were enrolled in the study between September 2004 and September 2008. By using patient randomization, they were assigned into two forty-patient groups (PNL and LUL). After evaluating the patients with laboratory tests and IVP, PNL was performed under sonography guidance in the prone position or the patients were submitted to classic laparoscopic ureterolithotomy (LUL) transperitoneally. All patients underwent postoperative assessments including KUB and ultrasonography. Results: A hundred-percent success was achieved in both groups. The mean age of the patients were 39.4 (16-63) and 35.2 (18-57) years old in PNL and LUL groups, respectively. The mean stone size in PNL group was 14.2 (10-25) mm and in LUL group was 13.5 (10-28) mm. The duration of the operations were 54.35 (50-82) minutes, and 82.15 (73-180) minutes (P < 0.0001); and the average hospital stay days were 2.6 (2-5) and 3.5 (3-8) days (p = 0.011) in groups PNL and LUL, accordingly. The mean Hb decrease in PNL group was 0.9mg/dL and in LUL group was 0.4mg/dL (p = 0.001). No statistically significant differences in terms of blood transfusion, fever, ICU admission, and prolonged urinary leakage were detected in both groups. Conclusion: According to our study, percutaneous nephrolithotomy under ultrasonography guidance is comparable with the laparoscopic ureterolithotomy for the treatment of proximal ureteral stones larger than 1 cm. .